Preventing HIV Infection

Condom Programming for HIV Prevention

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What Can UNFPA Do?

UNFPA is expected to lead the UN system in the area of condom programming. As such, the Fund must intensify efforts to ensure adequate supplies of quality condoms as well as support national efforts to promote individual knowledge and skills to protect against STIs/ HIV and unintended pregnancy. In collaboration with other UN agencies, governments, non-governmental organizations and partners UNFPA should continue its work to:

Advocate for condoms as a means of HIV prevention, targeting political, religious, community, and legislative leaders. Persuasive and persistent advocacy for condoms has the potential to enlist the support of key leaders. Even against the staunchest opposition, well thought out, targeted and persistent strategies can be effective. Many leaders have altered their positions significantly when presented with accurate information on the benefits of condom programming within the framework of a comprehensive prevention strategy. Religious groups are more receptive to promoting condoms when they are presented within a framework of disease prevention. Introducing research findings that sexual health education (including information on condom use) more often results in delayed sexual activity as well as making existing sexual behaviour safer may be a useful approach. Women’s groups can be instrumental in advocating for and creating awareness of the benefits of male and female condoms, empowering women, and bringing men into the equation to support condom use. Influential leader endorsement can create positive new perceptions – for example, condom use demonstrates concern to protect loved ones.

Identify barriers to access and use, and then employ innovative strategies to address them. Conduct research to understand sexual behaviour patterns, myths, misperceptions and fears held by potential male and female condom users and by providers, and design innovative strategies to address them including behaviour change communication. Dual protection must also be promoted.

Ensure that quality condoms in sufficient numbers are procured4. To ensure the quality of the condoms it buys, the Fund strictly follows procedures prescribed by the World Health Organization (WHO). These include pre-qualification of interested manufacturers to remove weak suppliers from the bidding process and batch-bybatch quality testing according to internationally agreed standards. UNFPA should continue to procure sufficient quantities of quality condoms to meet the requests of governments, other UN agencies and partners. As a component of condom programming, projected estimated resources required for male condoms for STI/ HIV prevention will grow from US$297 million in 2002 to US$557 million in 2015. UNFPA should be on the cutting edge of emerging issues, supporting such initiatives as standardization and updating of quality control labs and research into female condoms, microbicides, and vaccines.

Adapt and upscale best practices from successful condom programmes. For example, use of youth-friendly facilities, usually using peer educators, has helped to increase the distribution of condoms by making youth feel at ease in such an approachable setting. Youth groups and youth-serving organizations are particularly valuable to condom programming initiatives and should participate from design to implementation phases. In the Pacific region, satisfied and experienced condom users are trained to promote and counsel potential condom users. Thailand increased use and drastically reduced infection rates among sex workers through its 100% condom use programme. Innovative distribution schemes have put condoms in reach of those in need. In Mozambique, social marketing was used to improve the image of condoms while at the same time increasing channels of condoms distribution. Vietnam’s condom cafes serve clients in a non-health clinic setting.

Conduct condom needs assessments. Needs assessments can identify at-risk groups, barriers to condom access and use, channels of distribution, and procurement requirements essential to effective programming. Assessments should address the epidemiological, socio-cultural, and behavioral aspects of male and female condom use as well as the political climate. Market segmentation better ensures tailor-made programmes that address user needs. For example, little attention has been devoted to the particular needs of maintaining safe sexual activity within marriage, especially given pressures to have children. Needs assessments can uncover unfavourable images of condoms and feed into strategies employed within communities to create a more positive image and agreeable product. For example, as a product, condoms can be offered in lively colours, flavours and textures. Packaging might also include educational messages endorsing their health benefits. Celebrities can be engaged to promote condoms in a positive light.

Increase the channels in which condoms can be distributed. Individuals are more inclined to use condoms if they are easily obtainable. Channels include social marketing, public facilities, dispensers - which permit greater anonymity, peer educators, CBDs, taxis, bars and hotels. Complementing public sector services, social marketing of condoms makes use of commercial marketing techniques to promote and sell condoms at a subsidized price providing convenient and private access to the commercially advertised product. Social marketing, however, is limited by the ability of the client to pay, and by donor subsidies, and is not a panacea for condom distribution.

Strengthen technical knowledge, skill and capacity of programme managers and service providers. Capacities should be strengthened to increase condom awareness among clients; to provide accurate information on condoms’ role in STI/HIV prevention; and to develop gender-sensitive counselling techniques that will increase familiarity with sexual and reproductive health issues, instruct how to make personal risk assessments, and help empower women and youth to negotiate condom use.

Given the immeasurable burden and cost of the pandemic in terms of human life and suffering, and given the proven effectiveness of condoms to prevent STIs/HIV, UNFPA, in collaboration with its partners, must make a convincing plea to countries to place condom programming high on the STI/HIV prevention agenda and to allocate the necessary human and financial resources. Despite the challenges inherent in condom programming, the need to increase use of this effective prevention tool must overcome the obstacles regardless of their source.

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