*Damning statistics: 500 milion sexually transmitted infections, 2.1 million new AIDS’ cases, 80 million unwanted pregnancies
Most people know about condoms but few acknowlege their relevance. They top family planning items across the world. Meanwhile, whereas condoms are a household name in Nigeria, many people don’t use them. Reports show that about 1.8 billion sexual activities occur in Nigeria yearly, 80 percent of which are unprotected, a development that may be contributing to the burden of infectious diseases as HIV, syphilis, gonorrhoea and other sexually transmitted infections, STIs. Chioma Obinna examines the position of condoms in family planning issues and in driving the control and prevention response to STIs.
When 28-year-old Imeh Umoh decided to hang out with an old school friend for the weekend, he got what he did not bargain for. He and his old flame, Franka, were meeting again. Memories of the past returned. Imoh and Franka resumed their love story. But the reunion left Imoh heartbroken. Few days after the eventful weekend, he began to feel pain and burning sensation during urination. The tip of his male sex organ became reddish and swollen.
Series of lab tests revealed Imeh had contracted chlamydia, one of the three most common sexually transmitted infections rated by the World Health Organization, WHO.
“It left me with pains and regrets. I was carried away. There was no condom with me then. I trusted her.” Sadly, neither Imoh nor Franka could use protection.
Unfortunately, Imoh is not alone. There are thousands of people who are yet to understand the consequences of unprotected sex.
For 19- year-old Kenneth Eze, condom sounds like a taboo to his ears. “I felt I didn’t need condom because I did not feel comfortable wearing it”. Like some men who patronise commercial sex workers, Kenneth was ready to pay any amount to have sex with them. Just like many adults and adolescents, Kenneth believed that nothing was going to happen to him. But he got a shock of his life when he tested positive to gonorrhea. He shouted how?
He was devastated. He developed the infection after having unprotected sex with a sex worker in Lagos.
“She had warned me. She even insisted that we use condom but I was able to convince her when I offered to double her money. She gave in and we had pleasurable sex.”
Although the condition is treatable, getting it cured is more difficult now that antibiotic resistance is everywhere.
Biodun Salako was not spared despite her alleged consistent use of the female condom. Why? While we hope that everyone knows how to put on a condom, the question is whether they are using them correctly? Some people use condoms at the beginning of relationships but they stop using them after a while. That was the case with Biodun.
Although Biodun claimed to be using condom, she and her partner never used it correctly. “If I had used it correctly, things would have been different for me now.”
Biodun is among Nigerians who claimed they do not have sexual satisfaction with condom. “I usually put them on but I take them off too early. Sometimes, I do not use the condom from start to finish.”
Experts say Biodun’s style makes condom less effective and leaves room for error. When used correctly, a condom should save your life.
But unlike Imoh, Kenneth and Biodun, Aisha Abdullahi had been using female condom since she became sexually active. Few days back, her finance just discovered that he was positive to HIV.
“I thank God I was aware of condom. I kept using condoms for a long time with my partner. My fiancée just tested HIV positive.”
For Aisha, every sexually active person should be mature enough to fully comprehend the risk factors associated with sex, and, therefore, remain adamant about condom use.
While HIV is no longer a death sentence, it is life-altering. Aisha’s diligent use of condom may have protected her from infection.
Her determination to remain adamant about condom use occurred after her friend was admitted to hospital for severe abdominal pain. The friend was later diagnosed with pelvic inflammatory disease (PID), which developed due to an untreated chlamydia infection, (a severe case of PID can result in infertility). She (friend) had frequently engaged in unprotected sex with her boyfriend, as a result she spent about three weeks in the hospital being treated for PID.
“A few years after, my friend got married, but she could not conceive due to the infection she had years back.”
See lasts only a few minutes of enjoyment, but the enjoyment from unprotected sex has led thousands of people to their early graves while some have been maimed for life. Experts say, the small rubber-like product, remained a way to stay out of trouble.
According to WHO, condom is a sheath that is worn either over the penis (male condom) or inside the vagina (female condom) during sexual intercourse, for the purpose of preventing pregnancy or protecting against sexually transmitted infection.
WHO and other United Nations organisations, in their 2015 position report on condom, adjudged it as a critical component in a comprehensive and sustainable approach to the prevention of HIV and other STIs and is effective for preventing unintended pregnancies.
In the report, the bodies claimed that in 2013, an estimated 2.1 million people became newly infected with HIV and an estimated 500 million people acquired chlamydia, gonorrhoea, syphilis or trichomoniasis. In addition, every year, more than 200 million women have unmet needs for contraception, leading to approximately 80 million unintended pregnancies.
These public health priorities, they posited, require a decisive response using all available tools, with condom playing a central role.
Just a few days, ago, WHO, in its just –released new guidelines on three most common STIs, gonorrhea, chlamydia and syphilis, raised the alarm that the trio affected 214.6 million people each year coupled with the fact that these diseases are now showing resistance to antibiotics.
According to the world health body, male and female condoms are the only devices that both reduce the transmission of HIV and other STIs and prevent unintended pregnancy. Laboratory studies show that condoms provide an impermeable barrier to particles the size of sperm and STI pathogens, including HIV.
Also, research among sero-discordant couples (where one partner is living with HIV and the other is not) shows that consistent condom use significantly reduces the risk of HIV transmission both from men to women and women to men. And consistent and correct use of condoms also reduces the risk of acquiring other STIs and associated conditions, including genital warts and cervical cancer.
Unfortunately, despite these facts, many Nigerians have continued to be indifferent to the use of condom. Those who tried to use it are not using it correctly. These situations have continued to fuel increasing numbers of unwanted pregnancy, abortions, HIV and STIs, among others.
In a report, the Managing Director of Society for Family Health, SFH, an organisation distributing condoms in the country, Mr. Bright Ekweremadu, said if Nigerian men were to use condoms, no supplier in the world would be able to meet the quantity of condoms Nigerian men would need.
Ekweremadu stated that research showed that young Nigerians, between 18 and 34 years in the cities of Lagos & Abuja, make the highest use of condoms. Despite the research report, the number of HIV and other STIs have continued to rise.
However, a recent global modelling analysis estimated that condoms have averted around 50 million new HIV infections since the onset of the HIV epidemic. In 2015, 27 billion condoms made available globally through the private and public sector was expected to provide up to an estimated 225 million couple years protection from unintended pregnancies.
According to a report by the US Centres for Disease Control, CDC, young people, aged 15–24 years, acquire half of all new STDs and one in four sexually active adolescent females have an STD. Besides chlamydia, herpes, PID, and HIV, there are more than 20 different types of STDs, including gonorrhea and syphillis, with HPV being the most common.
Influence of religion
For many Nigerian Christians, God is the best preventive health care and many churches have condemned the use of condoms, as a result at which condom usage has become a sensitive topic in many communities in Nigeria.
Today, Nigeria is one country where the female condom is yet to be embraced. Reports have shown that many factors have continued to work against the acceptance of the condom. Reports show that less than two per cent of women in Nigeria use condoms.
Some stakeholders have blamed the poor acceptance on ignorance and low awareness.
Speaking to Sunday Vanguard, a condom advocate, Mr Johnson Babatunde, narrated how he handles his four female children, describing condom as an important tool in sexual activity.
Babatunde, who noted that parents should look into the sexual activities of their children, said: “I have four grown up girls and what I did was to buy packs of condoms and leave them on the dining table. Within weeks, I noticed that the condoms were disappearing one after the other. When I discovered this, I continued to buy more. That tells you that we need not pretend about these things. Our children are doing this and we need to protect them.
“I have never discussed condoms with them. There is no need telling our daughters, to practice safe sex. Telling people to abstain does not guarantee 100 percent.”
Investigations by Sunday Vanguard showed that there are misconceptions about condom which made many people claim that the use reduces sexual pleasure.
According to the Chief Medical Officer at Planned Parenthood, Maryland, Dr. Raegan McDonald-Mosle, said: “Condom can enhance your sex life. People who use condoms rate their sexual experiences as just as pleasurable as people who don’t.”
Dismissing the myth that condom reduces sex pleasure, he said what’s not comfortable is when you obsess over whether or not you have contracted an STD or are accidentally pregnant after a sexual encounter.
On two condoms are better than one, McDonald-Mosley explained that using one condom consistently and correctly is the best way to reduce your risk of pregnancy and STDs.
“In fact, putting on more than one condom”, at once may make them less effective. This is because the friction from doubling up can cause either one to tear. Two condoms at once is also a total waste of money”, he said.
If condoms are unreliable, why are doctors always recommending them? Condoms are a totally safe form of protection, but you have to use them correctly. Factors that will make condom more likely to break include prolonged exposure to light, heat, and air, but McDonald-Mosley says that as long as you check expiration date printed on each individually wrapped condom, and make sure to use water or silicone based lube, you should generally be fine.
On if condoms are the man’s responsibility, McDonald-Mosley advised : “Your health will always be your responsibility, and there should never be any shame in making sure you stay healthy. Everyone deserves a sex life that is pleasurable as well as safe.
Tips on usage
Use a new condom for each act of sexual intercourse and make sure there is adequate lubrication (use water-based).
The condom should be rolled down to the base of the penis. This helps prevent slippage and covers more surface area.
Hold of the base of the condom while withdrawing after ejaculation while the penis is still erect. Again, this helps prevent the condom from slipping off.
Be aware of direct or indirect contact of your partner’s semen, vaginal secretions or faeces with your mouth, vagina, anus or penis.
Despite the low cost of condom, demand for it in Nigeria has remained low. Collective actions are needed to increase the demand and acceptability. To ensure safety, efficacy and effective use, condom must be manufactured according to international standards, specifications and quality assurance procedures established by WHO, UNFPA. Condom programmes should ensure that condoms and lubricants are widely available and that young people and key populations have the knowledge, skills and empowerment to use them correctly and consistently