In a paper published in the November/December issue of Culture, Health & Sexuality, Kaler presents findings that show female condoms are being dismissed as a viable method of protection for a number of reasons, including cost and availability in developing nations, and, in North America, for esthetic reasons.
These attitudes have serious implications for developing the next generation of barrier methods, such as revamped diaphragms and cervical caps to reduce transmission of AIDS.
"Female condoms, and female barrier methods in general, are a very important avenue of exploration for HIV protection that has been prematurely closed off," Kaler said.
In her paper, which examines the past eight years of female condom promotion in Africa, Kaler interviewed 34 health care workers from the United States and South Africa.
She discovered that "female condoms, like other reproductive technologies, are judged against the 'gold standard' of the birth control pill: a discreet, convenient 100 per cent effective method for achieving a reproductive health goal. Other technologies that fall short of this ideal are dismissed as unworkable or inadequate," she said.
Condoms are traditionally seen by reproductive health care workers as second-rate methods of barrier control against pregnancy, and so are not as strongly promoted as they should be for protection against HIV/AIDS, Kaler said.
The female condom is currently approved for one-time use only and at an average price of 56 cents each, they are proving too expensive for women in developing nations to purchase--especially for women who have intercourse frequently, Kaler said. In addition, supplies of the condoms are not steady, making them inaccessible as well as unaffordable, she added.
For their female counterparts in North America, the female condom is almost an object of ridicule, and an uncomfortable reminder that disease lurks, Kaler said.
The focus for researchers is on developing microbicides--gels--that could be applied to deter the spread of the virus, rather than advocating for female-controlled preventive methods like the condom and diaphragm, which already exist, she added.
The condom, which attaches to the cervix, also takes some initial training in learning to use, further hampering widespread acceptance, Kaler said.
In North America, the device needs to be marketed in such a way that women will see it as an empowering, even fashionable way to approach the issue of their own reproductive health. "Products need to be re-positioned by association with glamour and sexiness, rather than safety and protection," Kaler said.
In developing countries, advocates for the female condom need to have a stronger voice, and large-scale trials of the device need to proceed as quickly as possible, moving beyond pilot and acceptability studies. As well, it is important to take a longer view of the female condom's benefit to society, Kaler said, noting that it took decades for positive changes to show up with such devices as tampons and male condoms.
"We should look at the number of potential infections averted."
The Social Sciences and Humanities Research Council of Canada funded Kaler's study.