Academic journal article International Perspectives on Sexual and Reproductive Health

Introducing Female Condoms to Female Sex Workers in Central America

Academic journal article International Perspectives on Sexual and Reproductive Health

Introducing Female Condoms to Female Sex Workers in Central America

Article excerpt

CONTEXT: Female condoms have a potential role in reducing HIV infection among female sex workers in Central America. Research on how to introduce female condoms to this population is warranted.

METHODS: Two rounds of focus groups with sex workers (115 in round one and 81 in round two) were conducted in El Salvador and Nicaragua in 2007-2008. In addition, we conducted structured interviews with 95 sex workers and direct observations of six health educators.

RESULTS: Women reported that the design of the female condom made insertion and removal difficult to learn. About one-third of participants reported inserting it for the first time alone. Most women reported practicing 2-10 times before feeling skilled enough to use it with partners. Positive perceptions included lubrication, size, comfort and strength. Negative perceptions included the large package, initial physical discomfort and the possibility that the device would scare clients away. The participants preferred to learn to use female condoms from an instructional brochure plus instructor-led training in their workplace. They cited lack of exposure to female condoms among men and women as a barrier to female condom use and recommended education for both men and women; they also recommended distribution of female condoms at places where male condoms are available.

CONCLUSIONS: If provisions are made for instructing women on female condom use in places where women will not feel stigmatized, and if supplies are easily and consistently available, uptake of the female condom among female sex workers in Central America seems likely. Health educators' use of promotional tools such as checklists and standardized messages is strongly recommended.

International Perspectives on Sexual and Reproductive Health, 2010, 36(3):149-156

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The female condom could play an important role in reducing HIV infection among female sex workers and their clients in Central America. Acceptability studies have shown that Central American sex workers are amenable to using the female condom, (1) (3) but programs have not always successfully promoted long-term use. For example, promotional efforts by the Pan American Social Marketing Organization (PASMO) produced different results in different countries in the region: In Nicaragua in 2005, only 300 female condoms were distributed, and program staff reported acceptability to be low. In contrast, almost 12,000 were distributed in El Salvador from 2003 to 2005; once the supply of female condoms had been depleted, sex workers continued to ask when more would be available. (4)

Given that the female condom could increase sex workers' overall number of protected sex acts (5-9) and protect them from STIs (including HIV) and pregnancy, (6), (10-14) efforts to promote female condoms effectively to this specific target population are needed (15)--especially because exposure to mass-marketing campaigns does not necessarily translate into uptake. (16), (17) To date, successful female condom programs for multiple populations have used provider training; targeted marketing; face-to-face communication with target populations; comprehensive training, including insertion practice and partner negotiation skills; practice with an anatomical model; encouragement; testimonials by satisfied users; integration of female condom use into HIV and STI prevention communications; a sustained supply of female condoms and low-cost distribution through public and private sector channels. (18-22) To encourage uptake and sustained use, program efforts should place particular emphasis on correct and consistent use of female condoms and partner negotiation skills. (12), (23), (24)

In order for access and uptake to be sustained over the long term, programs must create and measure demand, (18) as well as ensure a steady supply of female condoms through the support of governments and donors. (25-27) Female condoms should also be easily accessible; in countries where the female condom is available, women have been able to obtain the device from pharmacies, hairdressers, HIV and AIDS support groups, and peers, as well as health clinics. …

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