May 30, 2010
"Miss Thing." "Girl." "My ass." "Have you ever?" They're all typical starters to midweek discussion groups made up of the mostly African American and Latino gay and bisexual men served by New York City's Ali Forney Center, which provides services for homeless LGBT youth, and Steven Gordon, the agency's supportive-services director. The participants are perhaps not new to sex; however, many are inexperienced in articulating their feelings about it. Gordon encourages them to speak candidly about their practices, which for many include anal sex.
Recently Gordon decided to conduct an informal experiment. Actually, more of an "I wonder what would happen if I placed a bin of female condoms next to the popular male-condom-bucket" experiment. He was surprised. "No one took them," he says.
Gordon began to wonder why male-condom use was steadfast, yet mystery surrounded the female prophylactic. He asked his group.
"Their minds didn't even go toward using the female condom because it's called the female condom, and it's not widely known that it can be used for anal," Gordon discovered of his group participants, who are disproportionately at risk for HIV. New infections among young Black men who have sex with men (MSM) are roughly twice that of their White and Hispanic counterparts, according to CDC statistics. The risk is even higher for runaway and homeless youths who engage in sex work and drug use.
One of the benefits of female-condom use -- besides its protection against STDs, including HIV, during anal and vaginal sex -- is that it empowers receptive sexual partners to protect themselves whether or not their partner wants to use a traditional condom.
Young people are told, "Here's a male condom, put it on," Gordon explains. "That is their only protection." Many of the members of the group had heard of the female condom but didn't know what one looked like, what its capacities were, or that it could be used in the anus.
The female condom works by collecting semen, just like a traditional condom; but instead of covering the penis, it's inserted into the vagina or anus. For more comfort during anal intercourse, the small inner ring is removed. This also reduces the risk of rectal trauma and bleeding. The outer ring rests outside the anus, providing an additional barrier against STDs transmitted through skin-to-skin contact.
The female condom, while in its infancy compared with the 400-year-old male version, has existed for almost 20 years. New York, one of a handful of major cities that distribute female condoms, has been handing them out since 1997. Today its health department issues nearly a million annually.
Yet it's no accident that there still isn't widespread knowledge of the female condom's effectiveness during anal sex. Female condoms aren't marketed to either women or men for use in anal sex because it's illegal to do so; yet research shows that unprotected anal sex with an HIV-positive partner carries an even higher risk of transmission than does unprotected vaginal sex.
The New York City Department of Health and Mental Hygiene "cannot specifically say" that it is "targeting the female condom to males because the Food and Drug Administration has not explicitly approved it for anal sex," says Monica Sweeney, M.D., New York's assistant commissioner of HIV/AIDS prevention. Yet the health department's counselors and spokespeople do not shy away from talking about them. "We say that female condoms are good for anal sex" and "promote their use widely," but the department doesn't put it in writing, Dr. Sweeney says. "It's a way to get the message out there without breaking the law."
Although many believe the FDA, which approves specific condom uses, tests for efficacy and safety, in reality the agency is merely an oversight committee that depends on manufacturers, research institutions and health organizations to submit empirical data supporting a product's use. From there, the agency begins its approval process.
That's where Norman Candelario, a research coordinator for community health at the Gay Men's Health Crisis (GMHC), comes in. Candelario facilitated data collection for a soon-to-be-released study on the female condom and anal sex.
"We learned that the female condom should be part of MSM's safer-sex menu. We hope to create protocols on how female condoms can be incorporated into the HIV-prevention arena," Candelario says. The researchers also hope that GMHC's analysis will lead to larger studies that pique the FDA's interest.
But risks exist. The FDA and other health officials are concerned that the female condom can slip or be pushed into the anus if not positioned properly, and penises larger than 6.5 inches -- the condom's length -- can dislodge it during intercourse, particularly if sex is vigorous. In vaginal intercourse, the inner ring (removed for anal sex) rests the condom against the pelvic bone. Without the ring, the risk of exposure increases because the condom can more easily get pushed into the anus and leak fluid. So men and women need training on how to use the female condom for anal sex, including, for example, the need to ensure that the penetrating partner doesn't miss the condom, inserting his penis straight into the anus.
Before people can be properly trained, however, we have to start talking about anal sex in general. Candelario warns that a phobia exists where "people don't want to talk about anal" sex.
Mention it and the FDA shies away, quoting former Surgeon General C. Everett Koop in its Condoms and Sexually Transmitted Diseases Brochure: , "Condoms provide some protection, but anal intercourse is simply too dangerous to practice."
Too dangerous perhaps, but too common to ignore.
In the meantime, Candelario assures that "outreach efforts are happening" and many agencies are disseminating information about how risky it is to have unprotected anal sex.
"We want people to have sex," Dr. Sweeney says. "We just want them to practice safe sex."
New York City resident Ramon Johnson is the gay-life guide at about.com, part of The New York Times Company.