Full text of memo:
Date: March 17, 2015
TO: NASTAD, NCSD, and UCHAPS Members
FR: Julie Scofield, Bill Smith, and Sam Rivera
RE: Female Condom Information on Health Department Websites
- Review HIV and STD program websites’ prevention information sections and engage family planning/reproductive health sections to ensure consistent information about female condoms.
- Consider editing website content to reflect up-to-date information about female condoms. NASTAD, NCSD, UCHAPS, and the National Female Condom Coalition have compiled an example of recommended content below that health departments may use to update information provided on their HIV and STD websites.
NASTAD, NCSD, and UCHAPS recognize and champion the important work that our member health departments play in educating their communities about HIV and STD prevention, including ensuring dissemination of accurate information about all prevention modalities. In many jurisdictions,the public health sector has led in purchasing and distributing female condoms in the United States and collaborating with community partners to educate consumers about their proper use. Still, we know much work remains to maximize the impact that female condoms can have in promoting a higher standard of sexual health by preventing both disease and unintended pregnancy. This memo highlights recent findings that we hope you will find instructive about the kinds of information health departments currently offer about female condoms and how they can enhance communication around female condoms.
The female condom remains the only prevention option that offers receptive partner-initiated protection against HIV, STDs, and unintended pregnancy. While the safety and efficacy of female condoms for vaginal sex is well documented, such data regarding anal use is limited. The design of the female condom includes an inner ring that fits over the cervix to hold the condom in place during vaginal intercourse. Evidence-based instruction regarding anal insertion is unavailable due to the lack of research in this area. However, The Fenway Guide to Gay, Lesbian, Bisexual, and Transgender Health, published by the American College of Physicians, offers provisional instruction for use with or without the ring. The U.S. FDA has not approved any condom — male or female — for anal sex.
Many community-based and health department HIV and STD prevention programs promote the use of female condoms for anal sex as a risk reduction option for individuals who engage in receptive anal sex. However, the lack of evidence-based guidance regarding use of female condoms for anal sex has resulted in inconsistent public health messaging for the practice.
Assessment of Health Departments’ Female Condom Messaging
The journal of AIDS Behavior published “Inconsistencies on U.S.Departments of Health Websites Regarding Anal Use of the Female Condom” by Rodriguez, Kristina, et. al in late 2014. The article describes the results of a systematic review of female condom information provided directly by the department of health websites of 50 U.S. states and 29 U.S. cities. Researchers assessed both whether health department websites included any general female condom information and if there was any specific information regarding the use of female condoms for anal sex. In cases where departments of health included messaging regarding female condom use and anal sex, the language was categorized as supportive, neutral, or discouraging of its use in anal sex. Additionally, the instructions regarding method of use (insertion method, what to do with the inner ring) were described.
This assessment revealed that only about 60% of the health department websites included any information about female condoms. Of the websites that included female condom information, nearly half (46%) discussed female condoms for anal sex. The majority (nearly 96%) of these websites used supportive or neutral language when referencing female condoms for anal sex.
Specific instruction across the sites that mention using female condoms for anal sex varied widely, indicating a lack of clear guidance regarding female condoms for anal sex and the absence of safety and efficacy data. This critical gap creates multiple messages that are inconsistent across agencies, causing confusion for prevention programmers and community members.
Recommendations for Health Departments
As trusted sources of information, health departments are critical to ensuring that communities are aware of and understand their full range of STD/HIV prevention options, including female condoms. To that end, NASTAD, NCSD, and UCHAPS recommend that HIV and STD programs review their websites’ prevention information sections and in addition, engage family planning/reproductive health sections to ensure consistent information across the departments of health.
Information on the role of female condoms in reducing a person’s STD/ HIV risk should be included in all prevention information messaging.
Web content should include information about how and where individuals can access female condoms for personal use as well as instructions for how community-based organizations and clinics can access them for distribution.
Content should be up-to-date, accurate, instructional, and unbiased. NASTAD, NCSD, UCHAPS, and the National Female Condom Coalition recommend providing the following information:
- Female condoms are the only FDA approved woman-initiated technology currently available that offers safe and effective protection from unintended pregnancy and sexually transmitted diseases (STDs), including HIV, when used for vaginal sex.
- Currently the only female condom available in the U.S. is the FC2, which offers HIV, STD, and pregnancy protection comparable to male condoms when worn vaginally.
- Some people who engage in receptive anal sex use female condoms to reduce their risk of HIV and STDs. However, the FC2 is not FDA approved for anal use due to limited safety and efficacy data on female condoms and anal sex.
- The FC2 is made out of nitrile, the same non-allergenic material used for surgical gloves.
- How to use the FC2:
- For vaginal use, squeeze the inner ring of the FC2 between thumb and middle finger and insert into vagina. Use index finger to guide the ring behind the pubic bone. The ring will open up when released inside the vagina and will fit snugly against the cervix.
- For anal use, people report using one of two options for insertion. Neither option has been evaluated for safety or efficacy
- Option 1: Squeeze the inner ring of the FC2 between thumb and middle finger and insert into the anus. Guide the condom into the rectum, and leave about one inch of the condom outside of the body, covering the anal opening.
- Option 2: Remove inner ring and place condom over partner’s penis or toy. Add lubricant and enter slowly.
- Points to remember:
- The inner ring must be used for vaginal sex.
- Do not use a male and female condom at the same time.
- The FC2 can tolerate oil, water, and silicone-based lubricants.
- Use a new female condom with each sex act.
- The FC2 is latex free, making it suitable for those with a latex allergy
Available Resources and Support
The National Female Condom Coalition (NFCC) is a partnership of U.S.and U.S.-based advocates, researchers, health departments, community-based and national organizations (including NASTAD and NCSD) that advances a mission to increase awareness, acceptance, access, and use of female condoms. Female condom education, distribution, and advocacy programs that are also NFCC members can be found in Atlanta, Chicago, Houston, Los Angeles, New York City, San Francisco, and Washington, DC.
NCSD and the NFCC have created a fact sheet for health departments on success stories of female condom efforts. It highlights promising initiatives from Chicago, New York City, San Francisco, and Washington, DC. The fact sheet can be found here.
In late 2014, NCSD launched the Condoms (STILL) Work! campaign to focus our member’s condom promotion and availability efforts on the continued need to prioritize condoms of all types in preventing STDs, including HIV.
The NFCC offers a range of community mobilization and capacity building tools and technical assistance for both health departments and community-based organizations. Visit www.nationalFCcoalition.org for more information or contact Jessica Terlikowski at firstname.lastname@example.org to learn more about the resources and support available and how to join.
NCSD, NASTAD, and UCHAPS offer additional tailored technical assistance to our member health departments, including information on female condoms. For assistance in this area, please contact LaTwyla Mathias at email@example.com, Erin Bascom at ebascom@NASTAD.org or Dea Varsovczky at firstname.lastname@example.org with questions or requests for technical assistance.
NASTAD, NCSD, UCHAPS, and the NFCC will be reaching out to health departments to learn more about their experiences with female condom education, programming, and distribution. Health departments interested in sharing their perspectives and experiences are also encouraged to contact NASTAD, NCSD, UCHAPS, and NFCC directly.