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HOME: POPULATION ISSUES: PREVENTING HIV INFECTION: Strategic Guidance on HIV/AIDS Prevention
Preventing HIV Infection
Strategic Guidance
on HIV/AIDS Prevention
Purpose of the Guidance Note
Strategic Orientation for UNFPA Action
Integrating HIV/AIDS Issues into the Country Programming Process
Country Situations
Core Support
Creating an Enabling Environment for HIV Prevention
Advances in New Technologies and Issues
The Way Forward
Glossary
ICPD+5 Goals
Regional HIV/AIDS Statistics
Core Support

Preventing HIV Infections in Young People
Condom Programming in the Context of STI/HIV Prevention
Preventing HIV Infections in Pregnant Women

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Condom Programming in the Context of STI/HIV Prevention

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 transmittable infections."

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.


Demand

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 and fears.

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.


Supportive environment

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.


Supply

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 and specifications.

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.

Comprehensive condom programming:
Comprehensive condom programming

FOOTNOTES
5 Refer to Circular from UNFPA Executive Director – UNFPA/REP/01/99. Condom Programming for Prevention of HIV Infection.

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