The Monitor (Kampala)

Uganda: Engabu's Second Coming

In 2004, Engabu condoms were withdrawn from the market due to public outcry over their poor quality. Some changes have been made and hopefully, they will meet the consumers' expectations this time

Uganda has over the years been exemplary in scaling down the spread of the Aids scourge among her people not only in the Sub-Saharan Africa region, which is facing a severe Aids crisis but also the world over. UNAIDS estimates that the sero-prevalence rate in Uganda has fallen from around 15 percent in the early 1990s to 5 percent in 2001 and the 2006/7 national budget put it at slightly over 7 percent.

This has not come about in a miraculous fashion. Uganda adopted the ABC strategy which stands for abstinence, be careful and condom use to combat the pandemic in 1986 with the setting up of the Aids Control Programme.

Because condom use is one of the means of abating HIV/Aids, the Ministry of Health in conjunction with various private firms has over the years been distributing the Engabu condom, which by design is brown in colour, countrywide. Engabu is a Luganda word loosely meaning shield for protection. It was produced as a result of findings of a market baseline conducted by Population Services International(PSI) in 1991 in Kabarole District.

The condoms are distributed free through health units, bars and restaurants and academic/tertiary institutions like Makerere and Kyambogo Universities. At the recent close of Makerere's second semester, a good number of Engabu condoms were distributed to all student halls of residence and nearby hostels, as has always been the case. However that wasn't the case about two years ago. In early 2004, the public lost confidence in the use of Engabu citing defects like the foul smell they were giving off and more so the negative publicity from some sections of the public that the condoms were faulty and substandard.

This somehow coincided with the reduction in stock of the common condom brands like Life Guard and Protector, leaving the people with no option but to use Engabu. Some people were left with fears that they had contracted HIV.

In September 2004, Ms A.B Valendor of Sweden tested a batch of Engabu condoms that had been procured by a German company, Stephan Buchmann and advised that the condoms failed both the freedom-from-holes and smell tests.

A medical journal, the Lancet that was published on March 26, 2005, said that quality tests were repeated by an Australian laboratory that had done the pre-shipment tests and certified the condoms' quality but found that the condoms' only problem was that they had a bad smell- contesting the Swedish firm's earlier tests.

During that time, the health ministry had made a recommendation to re-brand the condoms so as to recuperate the public's confidence. The public had argued that the brand name was reflective of poor quality.

Condom shortage

Health officials both in Uganda and overseas later in the year put the blame of condom shortage on the $500m US President's Emergency Plan For Aids Relief (PEPFAR) that at the time channeled its resources through pro-abstinence and anti-condom organisations, which could in no way support the purchase of more condoms.

Stephen Lewis, the UN Special Envoy for HIV/Aids in Africa at the time said, "there is no question that the condom crisis in Uganda is being driven and exacerbated by PEPFAR and by the extreme policies that the administration in the United States is now pursuing."

During that spell, the condom retail price shot up from Shs100 to Shs1,000 and many people failed to make enough purchases, which increased their risk of engaging in unprotected sex. There is also a popular belief that the condom price increased because all consignments of other brands had to undergo a rigorous testing exercise before distribution yet there was limited capacity to effect a fast testing exercise.

Due to a lot of public outcry over the poor quality of Engabu, the government instructed that all condoms distributed freely should be withdrawn. Soon, National Environmental Management Authority officials destroyed about 20 million sheaths of condoms in an unknown location in Nakasongola. After a year in the 'wilderness', with assistance from the World Bank, the Engabu condoms have started sharing space on the shelves with other items in drug stores and shops countrywide.

According to the director general at the Ministry of Health Dr. Sam Zaramba, these condoms are supposed to be a preserve of the low earning and vulnerable populations of this country.

Safety measures

A statement issued by the Ministry of Health at the start of June pointed out that the Engabu condoms were tested using different international testing laboratories in Australia and the United States to ensure they meet quality standards.

In addition to the pre-tests, National Drug Authority (NDA) subjected the consignments from China's Guangzhou Rubber Factory, which manufactured Engabu to post-shipment tests. The new condoms have a sticker with words "Tested for Quality" inscribed on each of the packets.

According to various health websites, when they are testing condoms to ensure that they can be functional, elasticity (stretch up to seven times their normal length), strength (expand to hold 18 litres), durability (have a shelf life of at least three years) and porosity are strongly emphasised.

Vasta Kibirige, the person-in-charge of condoms at the Ministry of Health, says that the Engabu condoms' only negative aspect was that they had a foul smell but nothing related to whether they were weak or porous. She says, "The Engabu condoms that were withdrawn only had a foul smell and this was a certain batch but the moment we realised that, we had to stop distribution of other batches".

Because these condoms are placed in toilets of public places, some people have concerns over their safety. Mr Peter Mutabaazi, a patron of a certain pub on the outskirts of Kampala says that he can't use those condoms because he fears that they could have been tampered with by unscrupulous people.

However, Kibirige dispels this as an unfounded rumour. "I don't think people tamper with these condoms because we haven't received any reports to that effect," she explains.

Negative perception

According to statistics from PSI, Ugandans consume about 5 million condoms per month.

Kibirige says that the Engabu condoms were specifically manufactured for low-income people who requested the ministry to avail them with free condoms but adds that even well-to-do people can always use them because they have no harm. However, some people still don't have faith in the new Engabu despite all that has been said of them in the media and by health practitioners.

The word 'Engabu condoms' has become some sort of taboo among not only the affluent but also the low-income groups because they associate them with low quality. Fred Muzaale, 42, a blacksmith along Gayaza Road says that he stopped using them way back after word went around that the condoms were unreliable. Asked whether he would resort to them, he said, "Kati nagumila ku Life Guard ezo sikyazesika," literally meaning, "I got comfort in Life Guard and there is no way I can trust the Engabu."

For Patrick Okot, a third year student at Makerere University, Engabu condoms are really a 'shoulder to lean on'.

In a soft voice he says, "Since the university administration serves us these condoms freely, I don't see any need of buying other brands and in any case, they are readily available when need arises." Flora, 24 says that she can't stand a man who uses Engabu condoms and adds that they are a turn off. "The moment I see my man getting out an Engabu condom, I will immediately dress up and run for my dear life," she says.

Cost

According to the Health Ministry officials, Engabu condoms are essentially not meant for sale but to be distributed free. The condoms have been made free of charge by the government because of funding from the World Bank.

However, rounds in numerous pharmacies and shops around Kampala, revealed that a great number of them were on display and designated for sale. Most retail shops were selling them at Shs300, Shs200 lower than the other common brands like Life Guard and Protector.

When Moses Kulubya, a middle aged man who operates a retail shop in Wandegeya was asked how the Engabu condoms were performing in terms of sales, he said that it's mainly low income people who purchase them and that on average, he sells about three to five packets (a single packet has three condoms) a day. "Engabu sales here are very low and business in that aspect is not moving on smoothly," said Kulubya.

With Engabu now trying to make a come back, many people are keeping their fingers crossed because of their earlier failure to meet their expectations. The government and other stakeholders have to work towards restoring public faith in these condoms.

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