When people think of global health, they might picture heroic doctors or selfless nurses. But many others work behind the scenes in global health, doing work that’s much less sexy, but equally essential. Some of those people work here in the Triangle in a lab that tests life-preserving and life-saving products shipped around the world. Central to their work is testing condoms for safety and effectiveness. In the next installment of our series, North Carolina Voices, Global Health Comes Home, Rose Hoban takes a visit to FHI’s product testing lab.
Even with the prospect of AIDS people keep having unprotected sex. So, since the start of the AIDS epidemic, condoms have been a central part of HIV prevention campaigns all over the world. That’s because condoms are the best – some would say only – way to prevent the transmission of HIV during sex.
"Back in 1987, US AID realized that they were the primary distributor of condoms for family planning, but they also needed condoms for HIV prevention," says Eli Carter, one of the world’s foremost experts on condoms. He works in Durham for the non-governmental organization, FHI.
FHI was an early contractor with US AID – the Agency for International Development. That’s the government agency providing assistance to poor countries. AID was buying condoms from one main supplier, and they were getting a lot of complaints from the field.
"Some breakage, some storage conditions that were poor... condoms didn't smell good... so they… not only did we want to provide good quality condoms, but they wanted condoms to be pleasant to use, that smells good and were attractive... so they wanted to promote condom use," Carter says.
Carter is an industrial chemist who had done quality assurance work. He was asked to start an independent quality control lab to test condoms and other health related goods distributed through AID’s programs. Carter recently gave me a tour.
"We are in the back entrance of the laboratory where samples are received. And we get samples from all over the world, primarily from China, Korea, Malaysia, India... and some US manufacturers," he says.
Enormous boxes of condoms are arranged on shelves near four people sitting around a table. They tear open condom packages and unroll out them onto trays. They go through thousands a day, enough so the wrappers fill a big plastic garbage can.
In just the four years between 2004 and 2008, the U S government provided more than 2.2 billion condoms to health programs around the world. The Durham FHI lab does random sampling of up to 2000 condoms from much bigger batches made by single manufacturers.
"We want to make sure that they are safe for use," Carter says. "So, condoms must be of a certain size, they must be without holes, they must be strong enough, they must have lubricant on them in the certain amount, and they must be packaged properly."
Visiting the lab can lead one to marvel at the resilience of latex. Lab workers measure them, they stretch them, Bring up and run water running sound underneath. And they fill them with water to detect holes.
"Now that's a pretty big hole," Carter says, testing one out. "Normally we don't get holes quite that large...I think in 315 there only allowed two condoms with holes. If you find three the lot is rejected... we don't reject many lots."
And then there’s the airburst test. I have to confess, I looked forward to seeing the condoms get blown up like balloons. Carter says the condoms should be able to take between 35 and 40 liters of air before they burst. This thing blows up to be a balloon that's about the size of what?
"That condom will probably be about 3 1/2 feet tall by the time it bursts and may be 12 inches in diameter," Carter tells em.
The size of a very large watermelon, a prize-winning watermelon at the State Fair
Popping condoms aside, the work done at FHI’s quality and compliance lab is deadly serious. A faulty condom can contribute to the transmission of HIV or other sexually transmitted diseases. And to the 36 million people a year who receive services from US AID – that’s no laughing matter.