Anal use of the female condom: does uncertainty justify provider inaction?

Abstract

Despite limited safety data and the absence of efficacy data, several studies have reported that the female condom is being used for anal sex by men who have sex with men. We describe providers’ awareness of female condom use during anal sex among their clients and their experiences in counseling clients. We conducted semi-structured interviews with 78 health-care providers recruited from various health-care delivery systems in New York City: a family planning agency, a sexually transmitted infection agency, a hospital-based obstetrics and gynecology clinic, and two community-based AIDS service organizations. While two-thirds of providers reported that they were uncertain as to whether the female condom could or should be used for anal intercourse, nearly one-third believed that anything is better than nothing to prevent HIV/sexually transmitted infections during anal sex. Few providers had actually talked with clients about anal use of the female condom, and clients themselves had seldom mentioned nor asked for information about such use. Our findings highlight providers’ uncertainty about anal use of the female condom. Lacking guidelines regarding the safety and efficacy of female condom use during anal sex, health-care providers are left to make their own well-intentioned recommendations (or not) to potential users. The dearth of information on female condom use during anal sex could encourage individuals to use the female condom for anal sex, which may increase HIV transmission risk or represent a missed opportunity for protecting non-condom users. There is a need for a series of harm-reduction, acceptability, and efficacy studies and, in the interim, for the development of a carefully qualified safety set of guidelines regarding anal use of the female condom for health-care providers.

Keywords:

• anal intercourse
• female condom
• health care providers
• HIV/STI prevention

Acknowledgements

This study was supported by a Columbia-Rockefeller Center for AIDS Research (CFAR), National Institute for Allergy and Infectious Diseases grant (P30-A1428481 Principal Investigator: Scott Hammer, MD). This research was also supported by a center grant from the National Institute of Mental Health to the HIV Centre for Clinical and Behavioural Studies at the New York State Psychiatric Institute and Columbia University (P30-MH43520; Principle Investigator: Anke A. Ehrhardt, PhD). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH or NIAID.

The authors appreciate the assistance of our collaborators at the New York State Department of Health AIDS Institute, Ms Susan J. Klein, and at the Joseph Mailman School of Public Health at Columbia University, Dr David Hoos (formerly at the New York State Department of Health AIDS Institute and currently at the Joseph Mailman School of Public Health at Columbia University), in implementing this study and interpreting its findings; colleagues at the five participating institutions who supported and participated in this study; and Kristine L. Morrissey, Christina Pili, Sara Levine, Perry Brothers, and Jessica Y. Lee for help with data analysis. We also appreciate the critical comments from Marise E. Rodriguez, Manager of Data and Information Systems, AIDS Office, San Francisco Department of Public Health, as well as from Raymond Smith, PhD, Director of Communications, and Patricia Warne, PhD, Associate Director, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University.

Notes

1. We do not know if this information about anal use of the female condom was available on these websites at the time of our study, nor if the providers interviewed took the initiative to access any information regarding anal use of the female condom from these health department websites or any other sources.