1. Expanding Safer Sex Options: Introducing the Female Condom Mitchell Warren The Female Health Company December 2001

2. What was said in 1997 “The public health rationale for introducing a method that provides protection against pregnancy and STI/HIV is clear. Globally, health and human rights advocates have been demanding that scientists develop fertility regulation methods that are safe and reversible, under the control of the user, not systemic in action, which protect the user against STIs and HIV, and do not need to be provided by a health service. The female condom comes closer to these requirements than any other family planning method.” WHO/UNAIDS Information Pack, 1997

3. What was said in 2000/1 UN Target to reduce new HIV infections 25% in 15-24 year-olds in most-affected countries by 2005, and globally by 2010 Women are at greatest risk UN agencies highlight urgent need to “ intensify efforts to prevent HIV and STIs in women by providing women and girls with female-initiated protection methods ” UNGASS Declaration calls for increased support for the female condom

4. Experiences to date Enormous interest in the female condom has been generated at policy making, programming and user levels… …but it has not always been clear how to turn this interest into protected sex. Clearly, it’s not just a product… …and the programme cannot just be a procurement exercise

5. Experiences to date Over 70 countries in Africa, Asia, Eastern Europe and Latin America since the UNAIDS/FHC Partnership began in 1996 Of these, over 30 are new in the last year Initial sales tend to be for pilot projects… …which can evolve into substantial, annual programmes IF strategic planning and advocacy take place (i.e. Brazil, Ghana, Namibia, South Africa, Zimbabwe)

6. The Global Public Sector In 1996, UNAIDS and FHC establish Global Public Sector (GPS) Price of £0.38 per female condom CountriesFemale Condoms 199712866,000 1998273,729,000 1999383,920,000 2000404,043,000 2001556,879,000

7. The Zimbabwe Experience First large scale FC intervention Superb case study of advocacy – the WASN petition drive Introduction through both social marketing (as Care Contraceptive Sheath) and the public sector (as The Female Condom) Sustained, substantial increase in female condom availability from 1997 to the present

8. Key Issues in Zimbabwe Contraception vs. disease prevention position Increased protection – 27% of married women never used a MC before using a FC, and 20% of consistent FC users were not consistent MC users prior to trying the FC Need face-to-face contact – train peer educators, clinicians and pharmacists to provide information & support services! See “The Female Condom: Dynamics of Use in Zimbabwe” from PopCouncil

9. Strategic introduction – practice UNAIDS, WHO and FHC developed and tested The Female Condom: A Guide for Planning and Programming – a step-by- step guide to help design, implement and monitor programmes that incorporate the female condom Outlines a process to be followed

10. Strategic introduction- practice Planning Develop a team Stakeholders meeting Assess user needs and service capabilities Draft strategic document Implement pilot Feedback, revision, going to scale Programming Strategy for integration Programme costing Select target audience Gather information Advocacy Distribution Communications Training Monitoring & evaluation

11. What makes a success? The Context Political commitment AND community advocacy Partnerships, including NGOs and CBOs One or more individuals committed to “making it happen” Understanding complexity of introducing a new contraceptive & disease prevention method Integration into existing activities

12. What makes a success? The Programme Specific target audience(s) and specific ways to reach the target with the product, education/training/promotion Enough initial supplies to provide a consistent supply over time Outreach mechanism that provides users with a place to go with questions, concerns, issues

13. What makes a success? The Programme Training, introduction & outreach that –addresses provider potential bias –encourages “practice makes perfect” –does not over-complicate FC use –incorporates anatomy, sexuality, communication & negotiation –respects women and provides opportunities for control & empowerment

14. What makes a success? The Programme Involve men Distribution, training & outreach on multiple levels – public sector, private sector, social marketing, community Feedback mechanism to adjust as needed

15. The bottom line Introducing a new method is more complex than just promoting a new type of condom Expanded access to and use of the female condom requires targeted advocacy and strategic planning and programming

16. Key Policy Issues Increase in the number of protected sex acts –Thailand: CSWs with access to both FC & MC had reduced STD incidence of 23% compared to CSWs with only MC –Zambia: Couples with both FC & MC reported more than twice the level of protected acts –US STD Clinic: intro of FC increased overall barrier method use & number of protected acts –US risk-reduction hierarchy showed choice of FC results in increased protection over MC alone

17. Key Policy Issues Cost & cost-effectiveness –Cost continues to be barrier ($.55 per FC compared to $.06 per MC) –Increasing volume will reduce price –By targeting high prevalence areas & people practicing high-risk behaviours, FC can be not only cost effective but also cost saving. –Study in SA found FCs are good candidate for public sector subsidies as they reduce disease transmission and can actually save public funds.

18. Key Policy Issues Involving men Promoting dual protection Re-use –Research suggests that the female condom can withstand several washes in bleach, soap and water. –Draft protocol for disinfection, washing, drying, storage and re-lubrication is currently being tested.

19. Expanding Access THE Initiative: Expanding Access to and Use of the Female Condom Financial, technical and commodity support to implement the Guide at country level UNAIDS, UNFPA, WHO, DFID, FHC Partnership Rapid Response Fund & Team Resource Centre

20. What more is needed Understanding complexity of method intro Donor commitment to prevention Listening to women (and men) in the “real world” Documenting lessons learned for application to other future technologies (i.e. microbicides) Advocacy at all levels Strategic planning Addressing adolescent issues

21. Final thoughts It’s the programme, not the product! The challenge of resource allocation, the importance of female-controlled prevention methods and the right of women and men to have access to and choice among a range of methods are not at all unique to the FC – they are central issues to how we confront HIV/AIDS and protect and empower women and men.