20 September 2009

Uganda: HIV/Aids And Condoms - the 'Hole' Truth

Kampala — Couples are encouraged to use condoms because they prevent sexually transmitted diseases and pregnancy

CONDOMS mean safe sex and good health when used correctly because they are the only proven available preventive method in HIV/AIDS transmission and sexually transmitted diseases, but when of good quality.

However, when their safety is jeopardised the line between health and disease becomes a matter of concern for millions of users.

This is what happened last week in Kenya when one of the commercial condom brands, Contempo Hot, was found wanting on leakage grounds.

Hot was banned in Kenya and Zambia.

In Uganda where the brand is also available, authorities say the batches received are safe.

"Ugandans need not worry because since 2006, we have imported 550,000 pieces of Contempo Hot condoms and all have been safe," says Peter Ssali, the quality manager National Drug Authority (NDA), which tests and monitors condoms.

The controversial condoms are manufactured by Ansell Ltd, a UK-based company. "We repeated our tests after the Kenyan safety concerns were reported, but ours are safe," Ssali says.

But how can the same brand of condoms be faulty in one country but be fine in another? "Because they are not the same batch," says Vastha Kibirige, the focal person in the health ministry's condom unit.

"It's like bread. You can mix dough to make 15 loaves at a time using the same ingredients, but the process may differ during the different baking rounds making the bread test differently.

"Condoms come in different batches of 270,000 to 300,000 pieces labelled according to the lot of manufacturing under the same conditions and assembly line. The Kenyan ones were a different batch," she says.

Kibirige says NDA is to check border points for any other batches of Hot condoms that could have come into Uganda from Kenya.

"Normally these are small numbers brought in by travellers like long distance drivers, tourists and individuals on business," she explains.

What they test for

Ssali says there are seven internationally set guidelines by the International Organisation for Standards to which NDA adheres. "we test for condom strength. We blow air into them and test the level of pressure at which it bursts," he says.

"We also test for small holes and visual defects because leaking can cause infections.

The amount of lubrication is another factor. Condoms are made from rubber. Without lubrication, they may easily burst," he says.

Ssali says they also test for packaging to see if a condom can last and survive shipping, storage besides distribution.

"The seal must also be intact according to specifications to allow lubrication to last and avoid air entry which can make it rot.

Air entry makes the rubber deteriorate and the condom ages fast," he explains adding that they test their width too because if the condoms are too wide, they can easily slip off and should they be too small, they are uncomfortable, or could even hurt.

"Then thickness. Very thick condoms reduce sensitivity. But it's expensive to emphasise thinness, yet ensure strength and minimise leakages. That is why normally very thin commercial condoms like Durex are expensive," Ssali argues.

The length of the condoms also matters. "They have to be the right length lest they slip off or leave one at risk because of exposure to fluids," he says.

However, given the demand of condoms, commercial companies have stretched their creativity in variety to include flavours, studs for extra sensation, heat (like the case of Hot condoms) to add warmth

What happens to the faulty ones?

"When we test batches and one is found faulty, the whole lot has to be eliminated. It's only after the condoms have passed that we pay the manufacturers," Ssali says, "All batches of condoms that fail the test are burnt in an incinerator.

There is no need for alarm because we always get them at the point of entry. We do not allow imported consignments, even donations, to be cleared at the port of entry like it is done in other countries like Kenya," he says.

Ssali says in 2005, they got 25 faulty batches of condoms. "In 2006 we got seven, in 2007 one, 2008 six and 2009 two. All have been replaced," he says.

Unfortunately, efforts to see the condom testing machine were futile because the German specialist, who services the machine annually, is in the country to work on it.

Ssali says the importation of 'our own condom machine' has tremendously improved safety. "We were relying much on their pre-shipping tests, but with the current strict regulations, manufacturers are now doing their best," he says.

Kibirige substantiates that the common problems were to do with aging. "Now we do an age conform test also," Kibirige discloses.

"We put the condom in an oven at a particular temperature and regulate for seven days then repeat the tests to see how they will be after three years.

If it bursts too early, smells, develops holes, we know that the batch cannot last on our shelves, so we send it back," she explains.

"What is important is to check how the condoms are stored because concerns of leakages like it is been observed in Kenya is something that you cannot ignore.

"It can be a big blow to the HIV/AIDS prevention strategy because the people can be infected through leaking seamen from the condom or vaginal fluids through the condom to the user," she says.

Uganda's prevention strategy is Abstinence, Be faithful or use Condoms - ABC as it is popularly known.

While there are no official figures on how many people use condoms, it is the most popular strategy because of its additional benefits for prevention of unwanted pregnancies with at least 160 million distributed in the country annually by the Government.

"That is why we cannot compromise on the safety of our condoms. They are very safe.

You have not had of any faulty scandals because we find them and discard them before they can get to the public," she says.

How many types of condoms do we have?

Vastha Kibirige, the focal person in the health ministry's condom unit says there are over 31 condom brands in the country; those provided free at HIV/AIDS testing centres, those sold through social marketing at subsidised costs and commercial condoms like Hot, which are relatively expensive.

"We care for all socio-economic classes - people who can't afford, the average ones who can part with some little money and the ones who fancy style and can access the commercial condoms in supermarkets or pharmacies.

But all condoms are safe. The price is simply a reflection of taste and affordability," Kibirige explains.

She says it takes a lot of consideration to develop a brand. This includes brands normally called 'government condoms', which are provided through social marking like Trust, LifeGuard, Protector, 'O', and the soon-to-be launched Life Defender.

"We look at colours, names, flavours, sensation, length, amount of lubrication, thickness, and packaging. We normally engage the public first. It's from them that we learn what they want," she says.

"We design the brand, shop for a manufacturer and provide the samples, while they produce and package the condoms for us.

"We give them everything, including the design works and packaging material specifications.

They do the pre test and bring for us samples with the test results. They ship the condoms and we also do random tests. If they pass, we pay but if they fail, we send back the batch.

It's the strict conditions that force the manufacturers to be very careful."

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