Kampala — THE Ministry of Health has re-introduced female condoms in the country 10 years after halting their distribution due to low demand. This time the female condom has been added as a strategy in the fight against HIV despite donors' reluctance to fund the initiative.

Dr Zainab Akol, the director National AIDS Control Programme at the health ministry, says they will "use small efforts already in the country" to the integrate female condom into HIV prevention approaches.

However, an article 'Battle in Uganda Over Female Condoms' published in foreign media-The Times, says major funders of anti-HIV/AIDS programmes in Uganda are not enthusiastic about the proposal with many deciding not to back the plan.

"They fear that by offering yet another choice, the Government's move may only distract from other drug and condom programmes," the news outlet says.

The US President's Emergency Plan For AIDSâ-àRelief, PEPFAR, is the biggest funder of HIV programmes in Uganda. The programme is hesitant to fund this strategy without evidence of its impact. This raises fears on whether the Government can sustain the initiative.

Reacting to the article Akol echoes many advocates' concerns that the HIV/AIDS epidemic needs multi-faceted approaches.

"That is why we are going back to culture, religion, anything that can help," Akol says adding: "Women bear the brunt of HIV/AIDS and anything that can help protect them is welcome.

We are going to advocate female condoms and women should be able to choose."

HIV/AIDS activists say millions of women might be spared HIV/AIDS and unwanted pregnancies if they access this method.

The female condom, which is about 16cm long, is a polyurethane sheath that covers the vagina, cervix and external genitalia. It has two rings; one at the bottom to hold it in place and another at the opening and can be inserted just before intercourse.

In Uganda, the Government imported 1.5m female condoms in 1999 but halted their distribution due low demand with women complaining that it was expensive (sh3,000).

One critique from the ministry says: "If they can heavily fund bird flu which has not even plagued us yet, why can't they help us with a lifelong epidemic.

If new interventions would distract us from distribution of the male condom and drugs, then we should not even be conducting research into effectiveness of microbicides or male circumcision in preventing HIV/AIDS infections."

Dr Saul Onyango of the Uganda AIDS Commission, says: "We are not going to rid ourselves of this epidemic and its effects now.

That is why we should not look at one intervention against another." He explains that PEPFAR has its policies but they do not bar other donors from supporting the programme.

"Let us help women who are the most afflicted. The prostitute who is faced with a drunken client who will not wear a condom, should she trade her life," he argues.

He says the first attempt at introducing female condoms may have failed but the lessons learnt can help to successfully roll out the new programme.

"There was poor sensitisation of the public. People confessed that on first time use, the condom was not pleasant but after some time, it was okay.

Couples have to agree to use the condoms correctly and consistently especially in our environment where HIV/AIDS is thriving in long-term relationships," Onyango says.

HIV infections dropped from 20% in the late 1980s and early 1990s to 6% but research shows it is on the rise.

Women account for nearly half of HIV infections worldwide. In sub-Saharan Africa, 75% of those infected are women and the picture is not any different in Uganda.

Zestha Kibirigye, from the focal person condom distribution unit at the health ministry says research reveals that women want a method that will give them control in protecting themselves from sexually transmitted infections and unwanted pregnancy.

"The ministry will distribute 100,000 condoms, especially in the eastern and central parts of Uganda. They will be at government health centres," Kibirigye says.

Kibirigye says the female condom just needs time to gain acceptance. "Complaints about female condoms are not so different from those about the male condom.

People need to accept and believe in them, just like they did with the male condoms," she says. There is also stigma associated with buying condoms.

According to Akol the advocacy forums are not yet strong. "You cannot go to women and just tell them to buy female condoms. It is not a priority. It needs to go as a package.

Women are in antenatal clinics, immunisation centres. Let them be familiar with the condom. For now we want HIV positive women and commercial sex workers who need them to use them," she says.

"Even this noise thing, do you know how far the evolution of the male condom has taken. The process can be the same with the female condom. We cannot improve the female condom if they are not utilised," she adds.

She says donors like PEPFAR will come on board once the demand for the female condom picks up.

The problem is that female condoms are a new concept and people fear to invest in the venture. "We have United Nations Population Fund and United States Agency for International Development helping us and we are shall continue to attempt," she says.