Speak Your World: HIV prevention by FC
Article from the HDN Key Correspondent Team 15 July 2009
by Kintu Evarist Ivan
The female condom (FC) is the only female-focused method to prevent HIV and sexually transmitted infections (STIs) whose efficacy and acceptability with specific groups has been well documented.
It was first marketed in Uganda in 1998 by Marie Stopes International, a British-based NGO, following a successful study. However, the practice of using FCs registered little success. Now, the Ministry of Health (MOH) intends to develop a strategy to re-launch the FC in Uganda.
Ministry of Health representative, Vastha Kibirige, shared recent FC survey findings during an advocacy workshop hosted by the Centre for Health and Gender Equity and Global Campain for Microbicides in Kampala starting on June 23. The conference brought together civil society organizations with the ministry in hopes of forming a coalition to promote FC access in Uganda.
Kibirige explained that while the FC programme has adopted a strategic approach using existing structures, the programme lacked an explicit implementation strategy. Kibirige said a main gap in the programme is realistic provisions for funding to support training, community mobilization, demand, creation and distribution.
She said that according to the study there was no promotion strategy that was planned or executed, nor were target groups prioritized to optimize uptake through these existing channels.
Service providers were not able to provide interpersonal outreach which has been shown to be a key factor for successful trial and subsequent uptake. The majority of people interviewed across the country had never seen a female condom. It was difficult to find users who were not part of a FC study.
The study revealed that Commercial Sex Workers (CSW) honed their negotiation skills and successfully used the condom with clients. However, the cost of female condoms is an issue. Women with low incomes cannot afford the device. Other factors that discouraged use were partner refusal, aesthetics and cultural practices. No operational systems were developed for M&E, quality assurance and management oversight.
Stakeholders have no sufficient capacity to deliver the FC to a variety of target groups through existing structures and programmes. However, capacity gaps that relate to policy around allocations for FC programming, integrated planning, training of service providers, development of protocol and tools, coordination of the implementation effort and resource mobilization and allocation for sustained programming were all factors that led to the failure of the integration of female condom use.
The study suggests that, based on lessons learned in different countries, the adoption of using female condoms is likely to be more successful and more cost effective when the practice is provided as part of an integrated package of STI, HIV and pregnancy prevention services targeted to specific populations.
The United Nations Population Fund (UNFPA) has developed the Condom Comprehensive Programme (CCP) Framework to guide national planning and implementation of condoms. It promotes a multifaceted approach that includes condom promotion, behavior-change communication, market research and coordinated supply management. It makes optimal use of different entry points (i.e. voluntary counseling and testing prevention of mother-to-child transmission, reproductive health and other programmes. The use of this CCP could lead to success in Uganda as it re-launches its FC programmeme.
The UNFPA framework also recommends utilizing a complete market approach that involves the public and private sector and includes a social marketing plan. It also requires simultaneous action of policy direction on risk groups, settings and various levels: procedures for FC programming, linkages with related interventions such as voluntary HIV/AIDS counseling and treatement (VCT), STI prevention, preventing mother-to-child transmission(PMTCT), and antiretrovirals (ART).
Another recommendation is the development and dissemination of national policies and guidelines, and strengthening relevant technical and management capacities at the national level. There is also a need to support programme implementation by the public, private and NGO sectors at the district level providing the user/potential user with quality services at the operational/site level.
The new FC programme in Uganda will include the development of a comprehensive and integrated five-year national campaign; with specific objectives to increase availability and access to female condoms for sexually active men and women in Uganda. The programme will help to increase demand and utilization of female condoms in the prevention of HIV, STIs and unwanted pregnancies and also strengthen coordination, management and logistical support systems to ensure timely and consistent supply and distribution of female condoms in the country.