This article, written by Lillian Roberts, is part of an African Alliance series celebrating 25 years of the inner condom in South Africa and the people who helped to establish the world’s biggest state-funded inner condom project.  

Activist Yvette Raphael first heard about the inner condom in the early 2000s. It was shortly after she was diagnosed with HIV, when she became a human rights activist who fights for young women and lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) communities.

Back then, hundreds of thousands of South Africans were dying of AIDS each year. Raphael and her fellow activists were tasked with raising awareness about the inner condom, which held the promise of choice for women whose partners weren’t keen on using protection.  

Two decades later, Raphael is the co-founder and co-director of Advocacy for Prevention of HIV and AIDS (APHA) in South Africa, she speaks to African Alliance about those early days of activism with the spirit and verve for which she’s become known.

South Africa now has the biggest government-funded inner condom programme in the world. Two decades ago though, Raphael and her fellow activists were fighting waves of misinformation about these condoms. She thinks disinformation about the inner condoms was probably just as well established as the myths about antiretroviral medicines. 

There was the drama and negative sensationalism  that inner condoms were too big, for instance.    

“I remember going into a training session and this facilitator was just explaining how big it is, and how it’s going to cover over the front part of the vagina, and how you have to make a perfect eight [with insertion, for it to work]. All of those things just turned women off of it.”

The inner condom does not have to be made into a complicated eight shape to work. In reality, it’s similar to using a tampon, except you squeeze the closed end with fingers to insert, then use a finger to push it as far as it will go, up to the cervix. As long as you make sure the outer, open ring is still on the outside, you are good to go.

Raphael says other challenges were the availability of the inner condom, the costly price to manufacture it, and the fact that people get 10 male condoms in a strip, but would only be handed one or two female condoms per person. 

Getting in the driver’s seat of your sexual health

 “First of all, the inner condom is important because it’s one of the early female controlled interventions. I think we did not emphasise the fact that this is agency, this is female control.”

She adds that as one of the HIV prevention methods, it’s important for everyone to remember it’s another option in the basket for people with vaginas – and we shouldn’t throw it out.

“Women are not homogeneous. Every single woman has different needs and there are women who would prefer to have sex with an inner condom – they need to have it accessible.”

She points out that people may go through phases; today they may prefer to use an inner condom, tomorrow they might reach for an  HIV prevention medicine such as PrEP (although using PrEP without a condom won’t stop people from getting other sexually transmitted infections). 

But it’s women’s right to choose, she says.

“We should not get tired [of emphasising the fact] that it is a choice. We want women to have options available so that women can make choices.”

On September 8, 2023, The African Women’s HIV Prevention Community Accountability Board launched its HIV Prevention Choice Manifesto in Kampala, Uganda. The Choice Manifesto calls for continued political and financial support for more choice in HIV prevention to meet the needs of girls and women in Africa, and allow them to shape their own futures, with a seat at the table.

Keep calm and condom on

What does she want for the future of the inner condom?

“Wherever there are male condoms, there should be the same number of inner condoms.

 “People need education around the inner condom and how to use it,” Raphael adds. 

She believes that a transfer of knowledge has to happen; from the seasoned advocates to the younger generation – a passing on of the baton, to take the fight forward.

It’s silly, Raphael says, that everybody gets taught how to use a male condom in school, when not everybody has a penis.

The government’s sex education curriculum does include lessons on both types of condoms, but it’s unclear to what extent teachers are following these plans. The plans caused a huge outcry from parents and teachers unions when they launched in 2019. 

Raphael says information about inner condoms should be unavoidable. Instructional pictures should be everywhere; on clinic walls, at informal gatherings, and in community meetings. 

Passing the baton 

Raphael has worked on award winning programmes, including Brothers for Life, Scrutinize, Four Play, Intersexions and ZAZI.

In the ZAZI training programme she worked to include information about new prevention technologies and to mentor young prevention advocates. The ZAZI toolkit is being revived, she says, and they are using the HIV prevention methods so young people can be informed.

“If you go into these meetings and watch, you realise that there’s truly a gap of information for young people who are in this space. Then you ask yourself, how many of these young people are able to do a session and transfer knowledge and also be champions for HIV prevention? So, for me that is a big gap is that we do not have enough HIV prevention champions walking around the country.”

Stigma around HIV and STIs remains an ever-present issue, with people not wanting to get tested. Raphael explains that while funding for HIV may be being cut down, there’s certain programmes we know work and should be kept – things like peer educators and making the full kit of HIV prevention available for the public. 

Raphael says she’ll continue to advocate for the full package of HIV prevention and treatment, including inner condoms, but she thinks it’s time for a new generation to speak up as well. 

“It’s high time younger people with the same amount of grit picked up the baton, to help carry the load.”