Expanding Safer Sex: Introducing Female Condom - Historical Perspective & Insights, Slides of Public Health

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Expanding Safer Sex Options:

Introducing the Female Condom

What was said in 1997

“The public health rationale for introducing amethod that provides protection againstpregnancy and STI/HIV is clear. Globally, healthand human rights advocates have beendemanding that scientists develop fertilityregulation methods that are safe and reversible,under the control of the user, not systemic inaction, which protect the user against STIs andHIV, and do not need to be provided by a healthservice. The female condom comes closer tothese requirements than any other familyplanning method.”

WHO/UNAIDS Information Pack, 1997

Experiences to date

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Enormous interest in the female condomhas been generated at policy making,programming and user levels…

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…but it has not always been clear how toturn this interest into protected sex.

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Clearly, it’s not just a product…

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…and the programme cannot just be aprocurement exercise

Experiences to date

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Over 70 countries in Africa, Asia, EasternEurope and Latin America since theUNAIDS/FHC Partnership began in 1996

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Of these, over 30 are new in the last year

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Initial sales tend to be for pilot projects…

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…which can evolve into substantial, annualprogrammes IF strategic planning andadvocacy take place (i.e. Brazil, Ghana,Namibia, South Africa, Zimbabwe)

The Zimbabwe Experience

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First large scale FC intervention

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Superb case study of advocacy – the WASNpetition drive

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Introduction through both social marketing(as

Care Contraceptive Sheath) and the

public sector (as

The Female Condom)

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Sustained, substantial increase in femalecondom availability from 1997 to thepresent

Key Issues in Zimbabwe

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Contraception vs. disease prevention position

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Increased protection – 27% of marriedwomen never used a MC before using a FC,and 20% of consistent FC users were notconsistent MC users prior to trying the FC

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Need face-to-face contact – train peereducators, clinicians and pharmacists toprovide information & support services! See “The Female Condom: Dynamics of Use in Zimbabwe” from PopCouncil

Strategic introduction- practice

Planning

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Develop a team

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Stakeholders meeting

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Assess user needs andservice capabilities

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Draft strategic document

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Implement pilot

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Feedback, revision, goingto scale

Programming

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Strategy for integration

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Programme costing

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Select target audience

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Gather information

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Advocacy

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Distribution

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Communications

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Training

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Monitoring & evaluation

What makes a success?

The Context

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Political commitment AND communityadvocacy

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Partnerships, including NGOs and CBOs

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One or more individuals committed to“making it happen”

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Understanding complexity of introducinga new contraceptive & disease preventionmethod

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Integration into existing activities

What makes a success?

The Programme

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Training, introduction & outreach that^ –

addresses provider potential bias

encourages “practice makes perfect”

does not over-complicate FC use

incorporates anatomy, sexuality,communication & negotiation

respects women and provides opportunitiesfor control & empowerment

What makes a success?

The Programme

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Involve men

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Distribution, training & outreach onmultiple levels – public sector, privatesector, social marketing, community

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Feedback mechanism to adjust as needed

Key Policy Issues

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Increase in the number of protected sex acts^ –

Thailand: CSWs with access to both FC & MChad reduced STD incidence of 23% comparedto CSWs with only MC

Zambia: Couples with both FC & MC reportedmore than twice the level of protected acts

US STD Clinic: intro of FC increased overallbarrier method use & number of protected acts

US risk-reduction hierarchy showed choice ofFC results in increased protection over MCalone

Key Policy Issues

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Cost & cost-effectiveness^ –

Cost continues to be barrier ($.55 per FCcompared to $.06 per MC)

Increasing volume will reduce price

By targeting high prevalence areas & peoplepracticing high-risk behaviours, FC can be notonly cost effective but also cost saving.

Study in SA found FCs are good candidate forpublic sector subsidies as they reduce diseasetransmission and can actually save publicfunds.

Expanding Access

• THE Initiative: Expanding Access to and Use

of the Female Condom

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Financial, technical and commoditysupport to implement the

Guide at

country level

• UNAIDS, UNFPA, WHO, DFID, FHC

Partnership

• Rapid Response Fund & Team• Resource Centre

What more is needed

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Understanding complexity of method intro

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Donor commitment to prevention

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Listening to women (and men) in the “realworld”

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Documenting lessons learned forapplication to other future technologies(i.e. microbicides)

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Advocacy at all levels

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Strategic planning

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Addressing adolescent issues