Preventing HIV Infection

Condom Programming for HIV Prevention

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What Should Be Our Guiding Principles?

“The promotion and the reliable supply and distribution of high quality condoms should be come integral components of all reproductive healthcare services…”
- ICPD, 1994

“By 2005, ensure: that a wide range of prevention programmes…is available in all countries…aimed at reducing risk-taking behaviour and encouraging responsible sexual behaviour, including abstinence and fidelity; expanded access to essential commodities, including male and female condoms and sterile injecting equipment; harm reduction efforts related to drug use; expanded access to voluntary and confidential counselling and testing; safe blood supplies; and early and effective treatment of sexually transmittable infections.”
- UNGASS Declaration of Commitment on HIV/AIDS paragraph 52

Condom use needs to be promoted as part of a comprehensive prevention agenda. An inter-related STI/HIV prevention package includes advocacy, educating the public on STIs/HIV, promoting responsible and safer sexual behaviours, empowerment of women, improving attitudes toward and utilizing behaviour change communication to increase condom use among men and women, providing voluntary counselling and testing services and appropriate referral for treatment and care.

Condom programming should be based upon the needs, perspectives, and sexual behaviours of those at risk of HIV infection and of the surrounding community. Central to ensuring consistent and correct use of condoms is a people-centred approach, which strives to understand user needs including through addressing the socio-cultural and political environments which help shape beliefs and practices. Condom programming should provide information about STIs/ HIV prevention, strive to bridge the gap between knowledge and behaviour, instill a desire to use condoms, ensure correct and consistent use, and monitor user attitudes that might act as barriers to use.

While not sufficient to ensure use, provision of adequate supplies of a quality product is critical. Provision of quality condoms must be dynamic to stay abreast of the ever-changing requirements. Condom stock-outs are detrimental both to potential users and to existing user’s expectations and future compliance. Quality 3 is imperative to ensure effectiveness in STI/HIV prevention, as is the user perception that a quality condom is indeed a reliable product. Adequate supplies of quality condoms requires infrastructure, resources and planning to address forecasting of needs, production of quality condoms in sizes and styles acceptable to users, procurement from certified manufacturers, and logistics management (including safe and timely delivery, safe storage facilities, inventory management, and userfriendly distribution points).

A supportive political, legislative and community environment is an essential component; this includes governmental officials, legislative bodies, religious institutions, community leaders, health providers, teachers, parents, and individuals. Directed advocacy campaigns can help reassure sceptics that condoms are an effective means of protection from serious infection, and that they should be promoted within the context of a comprehensive prevention programme that emphasizes informed, responsible and safer sexual behaviour.

Essentials of Condom Programming

Comprehensive condom programming addresses demand and supply of male and female condoms and the related support for women and men, youth and adults to enable them to protect themselves from STIs/HIV and unintended pregnancy. It should explicitly address gender perspectives and power dynamics in using condoms, considering particular vulnerabilities of youth, especially girls, and reaching out to boys to help shape gender roles to include responsible and healthy behaviour.

It entails orchestrating a range of inter-related elements including:

  • Assessing and meeting diverse user needs

  • Overcoming barriers to access and use including individual’s misperceptions and fears, often through behaviour change communication

  • Promoting consistent and correct use

  • Creating a supportive political and socio-cultural environment

  • Ensuring product acceptability, availability, affordability and quality

  • Forecasting, financing and procuring condoms according to internationally accepted standards and specifications

  • Distribution including logistics management, information systems, transport and storage

  • Making channels of distribution appropriate to user needs, and

  • Monitoring the impact of programming on condom use and ultimately HIV prevention.

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