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Preventing HIV/AIDS
Both male and female condoms are key components
of prevention efforts among the sexually active.
Programmes can encourage the use of condoms to protect
against unintended pregnancy and other STIs as well as HIV,
and inform clients that nonbarrier
contraceptives do not prevent HIV transmission.
Correct and consistent use are critical: in a Uganda study,
none of the 350 women who reported consistent condom
use became HIV positive, but incidence was significant
among women who reported inconsistent use.(20)
But the challenges to wider
condom use are significant. There are massive shortfalls in
supply compared to current needs, frequent stock-outs, and limited resources
for programming to instil safer sexual behaviours.
Pervasive myths, misperceptions and fears about
condoms also inhibit their use.
Ensuring a steady, affordable supply of highquality
condoms involves forecasting needs,
procurement, logistics management and quality
assurance. Promotion of condom use also requires
an understanding of people’s needs and preferences,
and of the sociocultural environment of communities
and countries.
THE FEMALE CONDOM. Introduced in the 1990s, the
female condom has added to women’s limited choice
of means of protection. Wider use has been hampered
by its price, which is 10 times higher than a male
condom.(21) While evidence suggests that the female
condom can be reused up to seven times if properly
washed with disinfectant, WHO currently recommends
one-time use until more data are available on
the safety of reuse.(22)
More than 19 million female condoms have been
supplied in more than 70 countries. Brazil, Ghana,
Namibia, South Africa, Zambia and Zimbabwe all have
large programmes. A study in Costa Rica, Indonesia,
Mexico and Senegal found that the female condom is
most acceptable where men already support family
planning and perceive that their peers would support
use of the method, where sex workers already have
skills in negotiating safer sex, and where the female
condom is considered preferable to the male condom.(23)
This suggests that “marketing should focus on women
who can successfully negotiate female condom use
with their partners, as well as encouraging men to
accept the device.” (24)
Research in this area continues, and there are
indications that a new generation of less-expensive
female condoms could be available within a few years.
DIFFICULTIES NEGOTIATING CONDOM USE. Data from
the United Republic of Tanzania show that HIV/AIDS
prevalence is greater among married, monogamous
young women than among sexually active unmarried
women. Married women, particularly young women,
often cannot negotiate condom use even if they know
their husband now has or previously had multiple partners; they are more able to do so if condom use is
widely accepted as an important component of overall
protection.
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COMBINING FAMILY PLANNING AND HIV PREVENTION IN ZAMBIA |
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A project in Lusaka, Zambia, that provides condoms for HIV prevention recently expanded to offer other contraceptives
requested by clients, because family planning services were inadequate. Condom use remained high. In fact, programme staff found that users of other types of contraception were
more likely to use condoms as well, and that condoms users were twice as likely to start using other forms of contraception when offered. “All we had to do to increase contraceptive use
was to make it easy to get,” said the director of the project.
To advertise these new services, according to the director,
couples who came to the centre were recruited to be outreach workers. “We paid them to go to their friends and spread the word about what we were doing. We also distribute invitations
to the centre door to door, and about one third of the people who receive them come in.” See Sources
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Research in South Africa found that women who
used a condom the last time they had sex were almost
twice as likely as women who did not use one to know
that condoms prevent HIV.(25) Women most likely to
use condoms were also young, more educated and
lived in urban areas. Women with casual partners
were four times more likely and women with regular,
non-marital partners were twice as likely to have used
a condom than women who last had sex with their
husbands.
Family planning and antenatal care providers
need to assist clients in developing communication
and negotiation skills to use with their partners so
that they may adequately protect themselves from
HIV transmission.
DUAL PROTECTION. Providers should be familiar
with dual protection, a strategy for preventing both
transmission of HIV or STIs and unintended pregnancy,
through the use of condoms alone, the use
of condoms combined with other methods for extra
protection against pregnancy (dual method use), or
the avoidance of sexual activities considered highrisk.
The dual protection message can be expanded to
include the safeguarding of fertility through STI prevention and control, a particularly relevant message
for young women who have not begun childbearing.(26)
MICROBICIDES. Microbicides to protect women
against HIV transmission are under development but
are several years off. For those who lack the ability to
negotiate condom use, introduction of a microbicide
would greatly increase their ability to protect themselves
against infection. The Global Campaign for
Microbicides estimates that a product could be
available as early as 2007 and that 2.5 million HIV
infections could be averted over three years if a
microbicide that is 60 per cent effective were used
in developing countries.(27)
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