Taking stock of condom stock-outs
Some people argue that no one really uses them ‘in the heat of the moment’. Others say they just don’t like the artificialness that they bring to what should be a ‘natural’ experience – sex. “It’s like eating a sweet with its wrapper still on, or an unpeeled banana,” so they say.
But like them or hate them, use them or avoid them, the possibility of not having condoms at all as an HIV prevention option is a very serious issue with very real implications for those who do choose to make use of them.
And if recent reports from South Africa of condom stock-outs in the Free State province’s public hospitals are anything to go by, the likelihood of such an occurrence is more real than one might want to imagine.
In an article carried by the PlusNews HIV analysis service, it was revealed that some South African clinics are reporting complete condom stock-outs owing to what a Treatment Action Campaign (TAC) representative described as a severe shortage of human resources, as well as weak distribution networks and budget shortages.
These stock-outs obviously violate a basic human right – the right to health, and its various options. For, much as their use and comfort may be debated, condoms constitute an impotent component towards realising the sexual and reproductive health rights of all people. Not having access to them limits one’s health options in a similar way that not having access to ARVs (if one is HIV positive and in need of them) does.
Yet with condoms costing much less to produce than ARVs, it is simply much more affordable – for governments, donors, non-profit and commercial sectors – to prevent, rather than treat HIV.
For this reason, and the ones to follow, stock-outs are completely unacceptable.
The next reason to bear in mind is that condoms play a dual prevention role in that they can be used to both prevent pregnancies, as well as to prevent transmission of HIV and STIs. According to the United Nations Population Fund (UNFPA), of an estimated 10.4 billion male condoms used worldwide in 2005, around 4.4 billion were used for family planning and 6 billion for HIV prevention.
But their efficacy is premised upon correct and CONSISTENT use, which is why stock-outs in the public health care sector present such a major challenge to sexual and reproductive health efforts. It is indeed a tragedy that many of the countries with the highest global HIV prevalence rates harbour some of the world’s poorest communities who cannot afford to purchase condoms and therefore rely solely on those that are freely provided, or sold to them at subsidised prices. For these people, stock-outs spell danger because while condoms may still be available to them via the private sector (such as supermarkets and pharmacies), the commercial brands sold there would be far too expensive, and therefore beyond their financial reach.
What stock-outs essentially mean is that people could become infected not through a lack of knowledge, but perhaps largely through a lack of financial resources to purchase prevention tools.
Nobody equipped with information about HIV and AIDS today should become infected, or re-infected. Nobody should have to seek out means of prevention and fail to find them, especially at a time when the theme around prevention is becoming evermore-dominant in global discourse around the HIV pandemic.
Stock-outs of condoms should never happen. It is too blatant a theft of one’s rights to sexual and reproductive autonomy.
Effective planning and budgetary allocation of funds towards procurement of sufficient quantities of condoms should be carried out by all governments and key stakeholders to prevent any shortfalls in supply. This should be bolstered by regular monitoring and evaluation of trends in sexual behaviour and activity of populations. This is crucial for as people begin to engage in sexual activity at an ever-earlier age, as well as learn about the dual efficacy of condoms (as discussed earlier), and also disregard previously held misconceptions about them, it follows that demand for condoms will rise. Supplies based on the sexual habits of a population five or ten years ago will not suffice.
And nor will moralistic debates pitting abstinence as ‘good’ against pre-marital sex as its ‘evil’ opponent.
Governments must also put in place policing measures to ensure against corruption in the supply and distribution chain of condoms to public health facilities. While it is well acknowledged that theft and other forms of corruption take place in the supply and distribution of the more lucrative essential medicines (such as ARVs and painkillers), it is important to investigate if the same underhand dealings are also taking place with condoms.
Ultimately, the argument presented here is not about what people do – or should do – with condoms. It is simply about equipping them with the option to choose.