At the Ivan Toms Centre for Men’s Health – adjoining to the Somerset Hospital in Green Point, Cape Town – free water-based lubricant is obtainable in 5ml foil sachets.
Inside the centre’s ready room, the lubricant is stored in a big plastic bowl alongside free condoms. Speaking from behind a masks, a receptionist motions to take as many sachets as is required.
Each sachet is branded “Max” and bears the stamp of South Africa’s Department of Health, the phrases “not on the market”, and an expiry date.
Opened in 2009 – a partnership between the Western Cape Department of Health and non-government organisation Anova Health – the Ivan Toms Centre for Men’s Health was the primary state clinic centered on MSM (males who’ve intercourse with males) in Africa, providing free healthcare to this usually stigmatised group.
South Africa’s Department of Health has mandated that lubricant ought to be freely obtainable alongside condoms at clinics across the nation.
But a report by community-led monitoring group Ritshidze launched earlier this yr discovered that of 131 South African clinics that declare to supply MSM well being companies, 43 didn’t have lubricant obtainable. The report discovered that solely 26% of MSM respondents managed to entry free lubricant at their native well being facility.
“Lubricants usually are not simply accessed in South African clinics,” says Luckyboy Mkhondwane, of the Treatment Action Campaign (TAC). “Mostly folks can get them if there’s a undertaking working with MSM in that clinic, for instance, Anova Health or Engage Health. Other than that, folks purchase their very own lubricant or find yourself utilizing oil-based substances.”
Why is lubricant necessary?
The use of lubricant reduces the danger of HIV transmission when males have intercourse with males. The World Health Organization states that water or silicone-based lubricants are central to right condom use throughout anal intercourse.
“Lubricant is a liquid or a gel that forestalls extreme friction throughout sexual activity,” explains Mkhondwane, who has lived overtly with HIV since being identified in June 2002. An impassioned remedy activist, Mkhondwane joined the TAC the next month in July 2002. “Friction could cause condom breakage which might improve the danger of HIV an infection,” he explains.
There are three varieties of sexual lubricant generally obtainable: water-based, silicone-based, and oil-based.
Simon Collins, of UK-based remedy activist group HIV I-base, stresses the significance of not utilizing oil-based lubricants with condoms. “If you might be utilizing condoms, you should use a water-based or silicone-based lubricant,” says Collins. “Oil-based lubricants are positively out as a result of they break down the rubber or latex. Oil-based lubricants weaken condoms so HIV can cross by. An oil-covered condom might break up throughout intercourse, which the person might solely realise after the occasion.”
Mkhondwane provides that silicone-based lubricants are pricier than water-based lubricants. For instance, at Clicks the most cost effective model of water-based lubricant is R62, whereas the most cost effective Silicone-based lubricant is R126.
“Water-based lubes are all-purpose and can be utilized with condoms and intercourse toys,” he says. “The formulation makes them good for delicate pores and skin and stopping irritation. The water-based system additionally makes it a lot simpler to clean off your pores and skin and off any material it might get on. This additionally signifies that it will not go away stains. The draw back to water-based lube is that it tends to get sticky, and it might require extra frequent reapplication.
“Silicone-based lubes are slippery and longer lasting than water-based lubes. Unlike oil-based lubes, silicone is protected to make use of with latex. You additionally needn’t use as a lot silicone lube to get the identical impact and silicone lubes require much less reapplication. But these lubricants are additionally far more troublesome to clean off, and most formulations can simply go away stains [on] sheets. And they can not be used with intercourse toys as intercourse toys are normally made out of silicone.”
In its National Condom Training Curriculum the nationwide well being division stipulates: “Do not use oil-based lubricants, comparable to Vaseline, child oil, or cooking oil as it might harm the integrity of the condom.” The doc additional states: “NDoH [the National Department of Health] presently procures condom-compatible water-based lubricant sachets of 5ml, for distribution with the condoms.”
Responding to Spotlight, Department of Health spokesperson Foster Mohale reiterates that “all clinics ought to have lubricant”. He provides that the division goals to distribute 20 million lubricant sachets at provincial main and secondary distribution websites a yr. Asked why lubricant is just not obtainable at many of those websites, he says, “Each province has a goal primarily based on inhabitants. The lack thereof might be forecasting and administration challenges… Provinces must forecast higher and procure on time.”
Mkhondwane, nonetheless, says, “My tackle that is that the power managers do not contemplate lubricants to be a precedence. If they have been thought of as such, they might be ordered along with different prevention commodities like condoms. It actually does not make sense that individuals can entry condoms as HIV prevention instruments but not lubricants, which really ought to be a part of the package deal. Forecasting and procurement ought to be executed based on the variety of condoms that every facility distributes at a given time. The facility managers play the larger position but if procurement is just not executed district, provincial and nationwide well being [health] ought to be enquiring on this and developing with a attainable treatment.”
Note: A consultant of the TAC is quoted on this article. Spotlight is revealed by SECTION27 and the TAC but is editorially impartial – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.