The political dimension of sexual rights. : Commentary on the paper by Chandra-Mouli et al.: a never-before opportunity to strengthen investment and action on adolescent contraception, and what we must do to make full use of it.

BACKGROUND: The recent commentary article in this journal by Chandra-Mouli et al. speaks of a never-before opportunity to strengthen investment and action on adolescent contraception. We endorse the positive 'can-do' tone of the article, but noticed that at least four issues, which in our view are crucial, merit a comment. MAIN BODY: First of all, the article suggests that there is some sort of shared interest, based on a presumed global consensus around the use of contraceptives by adolescents - which is not the case: sexual rights are controversial. Secondly, for real progress in adolescent contraception to occur, we believe it is critical to thoroughly investigate and mention the factors, including political ones, that would need to be overcome. Thirdly, new avenues need to be explored that allow for accurate and positive teaching of adolescents about contraception in socio-cultural and political environments that are ambivalent about the issue. Fourthly, barriers at the global level that we already know of should not be silenced. There is sufficient evidence to call upon donors and international agencies to choose position and stop obstructing women's - including young women's - access to a broad range of contraceptives. The 'She Decides' movement is a heartening example. CONCLUSION: It is crucial to acknowledge the political dimension of sexual rights. It requires solutions not only at national levels, but also at the global level.

Acceptability of the female condom by sub-Saharan African women: a literature review.

Sub-Saharan African women are affected disproportionately highly by AIDS, while experiencing lack of choice for devices which protect them against sexual transmitted diseases, including HIV. One should expect that global policy makers react positive to the female condom, a contraceptive device which offers dual protection. However, those policy makers often argue that the female condom is not acceptable to its users. Our objective is to find out whether this general statement is based on existing empirical data. Through a literature review we analysed empirical studies done between 2003 and 2013 and compared the extent to which female condoms were acceptable among women in sub-Saharan Africa. We found that acceptability was defined in different ways, along the line of two types of studies: intervention and non-intervention studies. The intervention studies defined acceptability as women who agreed to use the female condom several times. The non-intervention studies which were not linked to specific interventions, operationalized acceptability in terms of women who liked the female condom, not necessarily based on practical experience or use. Intervention studies led to a high proportion of women using the technology, rating the experiences as satisfactory, although recommending technical improvements. In contrast, non-intervention studies showed low use due to non-acceptability mixed with reasons of unfamiliarity, unavailability or unaffordability. We concluded that women in sub-Saharan Africa accepted the use of the female condom when potential users were given access to the device, and exposed to interventions which supported the use of a female condom.

Silencing women's sexuality: global AIDS policies and the case of the female condom.

INTRODUCTION: The female condom is the only evidence-based AIDS prevention technology that has been designed for the female body; yet, most women do not have access to it. This is remarkable since women constitute the majority of all HIV-positive people living in sub-Saharan Africa, and gender inequality is seen as a driving force of the AIDS epidemic. In this study, we analyze how major actors in the AIDS prevention field frame the AIDS problem, in particular the female condom in comparison to other prevention technologies, in their discourse and policy formulations. Our aim is to gain insight into the discursive power mechanisms that underlie the thinking about AIDS prevention and women's sexual agency. METHODS: We analyze the AIDS policies of 16 agencies that constitute the most influential actors in the global response to AIDS. Our study unravels the discursive power of these global AIDS policy actors, when promoting and making choices between AIDS prevention technologies. We conducted both a quantitative and qualitative analysis of how the global AIDS epidemic is being addressed by them, in framing the AIDS problem, labelling of different categories of people for targeting AIDS prevention programmes and in gender marking of AIDS prevention technologies. RESULTS: We found that global AIDS policy actors frame the AIDS problem predominantly in the context of gender and reproductive health, rather than that of sexuality and sexual rights. Men's sexual agency is treated differently from women's sexual agency. An example of such differentiation and of gender marking is shown by contrasting the framing and labelling of male circumcision as an intervention aimed at the prevention of HIV with that of the female condom. CONCLUSIONS: The gender-stereotyped global AIDS policy discourse negates women's agency in sexuality and their sexual rights. This could be an important factor in limiting the scale-up of female condom programmes and hampering universal access to female condoms.

The female condom: the international denial of a strong potential.

The female condom has received surprisingly little serious attention since its introduction in 1984. Given the numbers of women with HIV globally, international support for women's reproductive and sexual health and rights and the empowerment of women, and, not least, due to the demand expressed by users, one would have expected the female condom to be widely accessible 16 years after it first appeared. This expectation has not materialised; instead, the female condom has been marginalised in the international response to HIV and AIDS. This paper asks why and analyses the views and actions of users, providers, national governments and international public policymakers, using an analytical framework specifically designed to evaluate access to new health technologies in poor countries. We argue that universal access to female condoms is not primarily hampered by obstacles on the users' side, as is often alleged, nor by unwilling governments in developing countries, but that acceptability of the female condom is problematic mainly at the international policy level. This view is based on an extensive review of the literature, interviews with representatives of UNAIDS, UNFPA and other organisations, and a series of observations made during the International AIDS Conference in Mexico in August 2008.

Where does public funding for HIV prevention go to? The case of condoms versus microbicides and vaccines.

This study analyses the priorities of public donors in funding HIV prevention by either integrated condom programming or HIV preventive microbicides and vaccines in the period between 2000 and 2008. It further compares the public funding investments of the USA government and European governments, including the EU, as we expect the two groups to invest differently in HIV prevention options, because their policies on sexual and reproductive health and rights are different. We use two existing officially UN endorsed databases to compare the public donor funding streams for HIV prevention of these two distinct contributors. In the period 2000-2008, the relative share of public funding for integrated condom programming dropped significantly, while that for research on vaccines and microbicides increased. The European public donors gave a larger share to condom programming than the United States, but exhibited a similar downward trend in favour of funding research on vaccines and microbicides. Both public donor parties invested progressively more in research on vaccines and microbicides rather than addressing the shortage of condoms and improving access to integrated condom programming in developing countries.