| Core Support
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Condom programming to prevent HIV
infection is complimentary to other preventive strategies
such as promotion of voluntary abstinence, delayed age
of onset of sexual activity, and fidelity. Condoms,
male and female, when used correctly and consistently
are a proven, effective and practical way of reducing
STI and HIV transmission. The presence of one or more
STIs has been demonstrated to greatly increase the risk
of becoming infected with HIV.
Condoms are equally important in
preventing unwanted pregnancy. This dual effect of disease
prevention and pregnancy prevention is commonly referred
to as dual protection.
The UNGASS Declaration of
Commitment on HIV/AIDS states that:
"by 2005, ensure: that a wide
range of prevention programmes… is available in all countries
aimed at reducing risk-taking behaviour and encourage
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
UNFPA aims at ensuring the availability
of, access to and proper and consistent use of high-quality
male and female condoms, taking into consideration the
needs and perspectives of users.
Within the United Nations system,
UNFPA is the lead organization for the procurement of
condoms and other reproductive health commodities. However,
condoms are more than just a commodity and ensuring
an adequate supply does not guarantee their use. The
readiness of clients to use condoms is equally important.
Globally, however, condom use falls short of estimated
needs for HIV prevention.
Central, therefore to an effective
condom programme is a people-centred approach, understanding
user needs and perspectives and systematically generating
and addressing demand.
Through the Global Strategy for
Reproductive Health Commodity Security (RHCS), of which
condom programming for STI and HIV prevention is a component,
UNFPA is committed to improving access to and use of
male and female condoms5.
The condom programming approach
is a comprehensive one, addressing demand, a supportive
environment, and supply.
While the supply of condoms is essential,
the readiness of sexually active individuals to effectively
use condoms is equally important. There are many barriers
to the receptiveness to use condoms including issues
of cost, provider attitudes and an array of myths, misperceptions
UNFPA should ensure the demand aspects
of condom programming are addressed including: promoting
the importance of its use among sexually active people;
ensuring that they are being used correctly and consistently;
and monitoring user attitudes so that attitudinal barriers
to use can be addressed.
The socio-cultural and political
environment that shapes user beliefs and practices and
thereby influences demand should also be considered.
Support should be provided for research to understand
sexual behaviour patterns, myths, misperceptions and
fears held by potential condom users and providers,
and based on the finding develop and implement innovative
and appropriate strategies to address these.
Without a supportive political,
legislative and community environment, condoms are unlikely
to get to those that most need them. Support must be
garnered from all levels to raise awareness and political
commitment for policy development and reform to remove
or mitigate barriers to effective condom promotion,
distribution, access and use. At a community level,
support is needed for the development of socio-culturally
sensitive condom awareness and promotion campaigns.
The UN system, donors and partners
are looking to UNFPA to provide leadership in condom
programming. This entails ensuring the sustainability
of national programmes in creating and meeting client
demands, including focused strategies to better ensure
the availability of and access to male and female condoms.
UNFPA should endeavour to advocate for and facilitate
increased collaboration and coordination in condom programming
among all partners, including other UN agencies, Governments,
donors, NGOs and the private sector.
Furthermore, UNFPA should endeavour
to mobilize funds locally and internationally for the
purchase of condoms in support of national STI/HIV prevention
programmes and/or population programmes, and advocate
for national budgetary allocations for the purchase
of condoms. UNFPA should also, especially in countries
where the Fund is the significant donor in this area,
allocate core funds for the purchase of male and female
condoms as part of its country programme of assistance.
While it is not sufficient to ensure
use, provision of adequate supplies of high-quality
condoms, male and female, is critical to establish and
sustain condom programming for STI/HIV prevention. As
condom needs increase in keeping with growing demand,
condom supplies must also increase. Condom stock-outs
are detrimental not only in the short term to potential
users, but also in the long run to user’s expectations
and future compliance. Beyond numbers, quality is also
critical to ensure effectiveness in STI/HIV prevention.
The perception that a legitimately high-quality condom
is indeed a reliable product facilitates its acceptance.
To ensure adequate supplies of high-quality
condoms, programming would continue to address forecasting
needs, production and procurement of high quality condoms
based on internationally recognized standards and specifications,
logistic management including safe storage and inventory
monitoring, and user friendly channels of distribution.
UNFPA is the largest international
supplier of condoms, and over the last 30 years has
procured quality condoms for developing countries on
behalf of many developmental partners and donors. UNFPA
should continue to procure sufficient quantities of
condoms meeting internationally recognized standards
UNFPA should continue to provide
support for training and guidance for forecasting condom
requirements for both STI/HIV and pregnancy prevention
and for ensuring that all partners, both global and
national, know the prevailing situation in countries
and can prevent shortfalls of male and female condoms.
In addition, such support would
include training and guidance in commodity logistics
management and, where appropriate, for strengthening
the capacity of quality assurance laboratories or providing
technical assistance to strengthen quality in countries
where there are no laboratories.
Special attention should be paid
to support the development of more efficient and client-responsive
promotion and distribution systems, such as social marketing,
social branding and community-based distribution. For
example, UNFPA could negotiate with national Governments
for a certain percentage of condoms supplied to the
national population programmes to be donated to existing
social marketing and social branding programmes.
5 Refer to Circular from UNFPA
Executive Director – UNFPA/REP/01/99. Condom Programming for
Prevention of HIV Infection.
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