International Condom Day – 2021
Theme: ‘SAFER IS SEXY’
Dr. Leon Ogoti
Public Health Committee
When King Minos of Crete devised a sheath fashioned from sheeps’ bladder in 3000 B.C. and used it to protect his wife from his semen – which he believed to contain scorpions and spiders – he had no idea that 5,000 years later this revolutionary act would be celebrated globally on the 13th of February and would play its part in preventing 50 million HIV infections and many more cases of Syphilis and Gonorrhea and countless unplanned pregnancies.
History
Condoms have come a long way through the ages, with initial Condoms designed to cover just the glans. Initial fabrications ranged from goats’ bladder, to lamb intestine, to oiled silk paper. In Asia there was a preference for more rigid options with animal horns and tortoise shells making appearances and in Rome, in an ultimate show of spite, Roman gladiators adapted the bulging muscles of their slain opponents as protective sheaths.
In many societies Condoms were a preserve of the rich. For years they were only used for family planning with varied levels of acceptance as family planning was largely frowned upon in religious circles and by segments of the medical fraternity. Additionally, the aspects of unavailability and expense played a role in their ‘prohibition’.
Things began to change in the late 19th century when Charles Goodyear of the Goodyear tire brand discovered vulcanization of rubber and the production of rubber Condoms began. Despite this progress, the process of acquiring a Condom remained relatively cumbersome because though they were designed to be reusable, to get one a man had to walk to the Doctor’s office for fitting before the Condom could be ordered.
Then the 20th century rolled in and two separate disease outbreaks resulted in the unprecedented levels of Condom use seen to this day.
The first was during the 1st and 2nd World War: due to poor prevailing knowledge on sexually transmitted diseases, sexual hygiene, and the mental depravity caused by the conditions of war, the number of sexually transmitted infections shot up with Syphilis and Gonorrhea causing the death of as many as 18,000 soldiers a day. Syphilis was the cause of one in every eight hospital admissions and at the peak of its’ powers is known to have resulted in more deaths than HIV/AIDS has this far.
The introduction of penicillin in the 1940s provided some respite, shortening the duration of treatment and saving many lives, but the destruction caused by Syphilis and Gonorrhea was so significant that the USA and the UK had to dedicate a significant part of the War budget to avail Condoms as a part of their war effort just as other European countries had done.
In an effort to meet this skyrocketing demand, the greatest development in Condom manufacturing resulted and brought forth the now widely used and celebrated ‘lubricated latex Condom’. The result? 40-50% of sexually active persons at that time were using Condoms. Due to ease of manufacture of latex condoms - availability and affordability ceased to be an issue. Before this a single Condom would cost a commercial sex worker several months of pay.
The second was in the early 80s when the HIV pandemic came about and this singular event resulted in the greatest increase in demand for Condom use and this continues to be the case four decades on. Improvement to the rubbers continues to happen with manufacturers attempting to make their use as pleasurable an experience as possible and reduce the barriers to use with more recent innovations such as invisible Condoms.
Future of Condoms
Now a billion dollar industry, Condom use remains the single most efficient and available technology to reduce transmission of HIV and other STIs given the transmission of HIV still largely occurs by sexual transmission (over 80% of cases).
3 out of every 4 Kenyans, aged 15-64 know enough about Condoms, how to use them, and what diseases they prevent. However, studies on the rates of use at last intercourse were persistently below 50% for men and 40% for women, meaning there is continued need for increased knowledge on the role of Condoms but just as important is the need to interrogate the barriers to efficient and effective Condom use and identify strategies to address them.
Unrestrained access to quality and affordable Condoms has been hampered in recent times by:
- Progressive funding cuts to organizations involved in the provision of Global Family planning services and commodities due to the infamous and now repealed Global Gag rule.
- Failure to assess imported Condoms for the required standards of quality by KEBS leading to a sense of mistrust by Kenyans
- Pandemic occasioned lockdowns which have continued into 2021 - as new strains of the Covid-19 virus continue to emerge in the major Condom manufacturing countries such as Singapore and Malaysia - will also result in shortages for as long as the COVID-19 pandemic lingers.
These obstacles provide a grand opportunity for increased government funding and support towards local manufacturing of condoms and reducing industry bottlenecks, with an aim of feeding the huge unmet need for these products with the government only able to supply 160 of the 350million Condoms required annually in Kenya.
The drive to increase Condom use among sexually active persons must be complemented by more attention and stronger bolder conversations around combination prevention methods such as Pre exposure prophylaxis, post exposure prophylaxis and voluntary male medical circumcision as well as increasing support towards gender equality which gives women more decision making autonomy in their sexual relationships.
This will inevitably aid in addressing the HIV burden locally, the quietly rising STI burden and going some way towards attempting to meet the commitment on ‘Zero unmet need for Family Planning information and services and universal availability of quality, accessible, affordable and safe contraceptives’ made at the 25th International Conference on Population and Development (ICPD) summit, held in Nairobi in November 2019.
