Love in times of scarcity

Unavailability of contraceptives is at 90%, according to the Venezuelan Pharmacists Federation (Fefarven).Condoms can be found with less difficulty but prices range from VEB 650 to VEB 1,900

The pill is the most popular contraception method among Venezuelan women, but it is also the most unavailable (Félix Gerardi / File photo)
The pill is the most popular contraception method among Venezuelan women, but it is also the most unavailable (Félix Gerardi / File photo)

Over the last two years Venezuelans have become acquainted with the concept of “scarcity.” The impact of reduced access to contraceptives is major on both the government and citizens. In a country where reagents needed for diagnostic testing are hard to find, there is now an increased risks of unintended pregnancies or of contracting sexually transmitted infections (STI).

Condoms and other contraceptives disappeared from many Venezuelan pharmacies and clinics starting in 2014.  These products are not manufactured in the country, and the government has tightened dollar disbursements to importers amid sliding oil revenue.

The condom shortage was first reported in December 2014 in some regions of the country, but by January 2015 shortage had spread across 11 states, as reported in February 2015 by local NGO StopVIH.

Unlike birth control pills, male condoms eventually reappeared and can be purchased today, although not without some difficulty, at some retail pharmacies, even if traditional brands like Durex or Sanamed Duo are not available. Condoms for those who are allergic to latex and female condoms are simply not there.

On a tour of several pharmacies in the Greater Caracas area, we found availability of the Recare, SexStyles, SexUsa and Playboy brands; all are imported, mostly from China or Taiwan.

Prices range from VEB 650 to VEB 1.900, depending on the brand and on whether condoms come in 3-packs or 6-packs.On average a pack of condoms sells for the equivalent of one tenth (10%) the country’s minimum monthly wage of VEB 11,578.

Condom use is a serious public health issue. Venezuelans need at least USD 65 (at the official exchange rate of VEB 10 to the dollar) to buy a pack of condoms.

Three matters of concern

Jonathan Rodríguez, President and Founder of StopVIH, finds the condom shortage extremely worrying, especially if you take into consideration that an important component of the country’s population is young and therefore sexually active. According to 2015 estimates by the National Statistics Institute (INE), Venezuela had a youth population (persons aged 12-29) of approximately 4,724,000.

“If condoms are not available, the consequences are likely to be negative, because young people won’t stop having sex, especially teenagers, who have raging hormones and do not weigh the consequences of their sexual behavior,” says Rodríguez.

A second matter of concern is the price of condoms, since due to the economic crisis most Venezuelans and especially the young cannot afford condoms at the current prices. “The government has to understand that the country has a large sexually active population, and access to condoms must be guaranteed for young people. If condoms are very expensive, the youth won’t be able to afford them, but they will continue having sex, wearing a condom or not,” says Rodríguez.

Rodriguez describes the situation as being “serious.” He notes that the current condom shortage and soaring prices are generating consequences not yet clearly recognized. “We are distracted with the economic problems, but certainly the indicators are there and they are moving negatively. When we’ll check them we’ll surely find an increase in the rates of sexually transmitted infections and in mortality from HIV/AIDS.”

According to estimates by the Ministry of Health, there are between 160,000 and 220,000 people currently living with HIV in Venezuela, of which 61,000 are receiving free treatment. Every year at least 11,669 people are newly infected, some 600 infants are born with HIV/AIDS, and approximately 2,161 people die of AIDS-related causes.

In this connection a third concern is added: the lack of comprehensive sexual and reproductive health programs inculcating into the minds of youth the need to protect themselves against unplanned pregnancy and sexually transmitted infections, such as HIV, human papilloma virus (HPV), syphilis, gonorrhea, chancroid, hepatitis B and C, among others.

Better to prevent than to treat

Freddy Reyna, President of Acción Solidaria (Acsol),a non-profit agency that raises funds to pay for HIV/AIDS treatments, stresses the need to strengthen government STI prevention programs. He notes that prevention is not limited merely to wearing a condom, but also includes the possibility of getting tested for STIs. According to Reyna, there are some 140,000 people in Venezuela with HIV who don’t know they have it.

Reyna further notes that at the present time there is a difficulty getting tested for HIV and VDRL. There are also problems with VDRL treatment and lack of reagents for viral load tests, or for counting CD4 cells, a key measure of the health of the immune system.”If you don’t have tests to detect an infection and also you don’t have condoms, you’re not giving people the tools for prevention, either clinically or relating to prophylaxis (…).The situation is terrible, we are at a time of incredible anxiety,” he says.

Jonathan Rodríguez advocates initiatives like condoms donation and installing free condom dispensers in bars, clubs and places where casual sexual encounters occur.” The Venezuelan Constitution and international treaties guarantee free and universal access to health services; hence donations made by the government should be more consistent and in larger amounts, as preventative sexual health care constitutes a very serious public health issue.”

Similar policies are now being applied in other countries in the region. The Brazilian government handed out some 70 million condoms during Carnival last year as part of its HIV prevention campaign.

The Venezuelan government donates from time to time a certain amount of condoms to some NGOs working on HIV Prevention. StopVIH and Acción Solidaria have benefited from such donations; however, the directors of both organizations complain about the infrequency of such donations and the limited amount they receive. “In November last year the government donated us seven boxes of condoms, each containing 7,200 condoms. But that supply was gone in one or two days. That’s a ridiculously small amount,” says Rodriguez.

Maduro promised on June 5 2013 to build a network of condom factories “to protect Venezuela from early pregnancies.” None of the factories have been completed.

More preventive campaigns

Both Reyna and Rodríguez point out the lack of STI prevention campaigns. “The only campaign by the Ministry of Health was launched in 2008 and lasted only three months,” says Reyna. He stressed the importance of ensuring that the national authorities support sustained campaigns to promote condom use.

A study conducted between 2007 and 2008 by Acción Solidaria and the United Nations Population Fund (UNFPA) shows that 93.1% of youth knew about condoms and what they are used for, but 72.6 % had ever used one, and only 30% had used one in their first sexual intercourse.

Similar data were reported in the 2013 National Youth Survey (Enjuve 2013) conducted by the Institute of Economic and Social Research at the Catholic University Andrés Bello (IIES-UCAB).According to this survey “more than 2 of every 5 men and women aged 15-29 who already had sexual relations reported having unprotected sex in their first encounters.”

The figures show that “a significant proportion of the Venezuelan youth are most vulnerable to STIs and may be likely to become early parents because of their early initiation into sexual activity without using a condom or other protection.”

The study also notes that many of the youth who use condoms during intercourse do so to prevent pregnancy but not to protect themselves against STIs. Therefore, in occasions when condoms are not available, they may engage in nonvaginal forms of sexual activity or in coitus interruptus.

No contraceptives, no planning

The President of the Venezuelan Pharmacists Federation (Fefarven) Freddy Ceballos said that the shortage of contraceptives ranges from 85% to 90%, exceeding the overall rate of shortages of medicines, which he puts at 80%.

But the lack of contraceptives goes back to the first half of 2014, when agencies like the Family Planning Civil Association (Plafam) denounced that the shortage of contraceptives threatened family planning and violated women’s right to choose whether or not to get pregnant. Before that about 80 different brands of women’s contraceptive drugs and devices were available in Venezuela, including daily pills, emergency pills, contraceptive patches, blister strips, ovules and subcutaneous implants.

In 2015 the shortage of contraceptives stood at 45.2%, i.e. half the percentage calculated for the first two months of 2016, which shows that as time passes the situation worsens. In 2013 the demand for the top 20 brands of female sex hormones was 24,961,506 units, while in 2014 the turnover reached 22,575,487 units, but in 2015 it dropped to 11,973,571, according to unofficial sources.

To check how many oral contraceptives are available to the public, El Universal toured at least 10 small pharmacies in the Greater Caracas area between 1 and 3 March 2016. Seven of them had no oral contraceptives in stock; the other three had only one brand.

Using the online product search services of the two large pharmaceutical chains that exist in Venezuela, we found that between 1 and 4 March 2016 only one of the more than 20 brands of birth control pills sold in the country was in stock in one of the pharmaceutical chains, but its sale was limited to one box per person, as it was confirmed by telephone. The other pharmaceutical chain had more brands in stock, but only in some of its stores.

The pill is the most popular contraception method among women aged 15-29 years, according to the 2013 National Youth Survey. No prescription is required to purchase them and they are cheaper than other contraceptives. Prices range from VEB 5.80 to 405, depending on the laboratory and whether they come in packets of 21 or 28 tablets.

For Valeria Diaz, director of communications at the Family Planning Civil Association (Plafam), there is no doubt in her mind that the shortage of birth control pills will significantly influence the increase in the number of unwanted pregnancies. Already, as underscored in the UNFPA 2015 State of World Population report, Venezuela tops teen pregnancy rate in Latin America and the Caribbean with a rate of 101 pregnancies per thousand.

Owing to the pills shortage, Plafam is offering other contraception alternatives at very affordable costs, such as blister strips or intrauterine devices (IUDs), which are long-lasting methods. They also have emergency pills in stock and even have condoms, provided by the International Planned Parenthood Federation (IPPF).

Source: ElUniversal