What Works for Women and Girls

“It is always men who dictatewhen and how to use the condom.We cannot really decideon our own.”—HIV-positive woman, Uganda(Kyomuhendo and Kiwanuka,2007: 6)Condom use can be increased among all groups, including youth, discordant couplesand sex workers. Promoting condoms to prevent STIs that may result in infertility may bea promising way to make condom use more socially acceptable within long-term or marriedrelationships (Delvaux and Nöstlinger, 2007). In addition,promoting condoms for pregnancy prevention aswell as for HIV prevention can increase condom use. “Forwomen who do not currently desire pregnancy, the dualmethod approach—combining condoms for HIV/sexuallytransmitted disease (STD) prevention with longer-acting,more effective contraceptives for added protection againstpregnancy—simultaneously prevents both heterosexualand perinatal HIV transmission” (Mark et al., 2007:1201).However, increasing condom use among women ultimatelyrequires the cooperation of men (Foss et al., 2007), whoneed to be persuaded to use male condoms or to support women’s use of female condoms.Limited access to condoms and inadequate supplies of condoms are also a challenge toprevention of sexual transmission of HIV (Haddock et al., 2008). In 2004, the Global HIVPrevention Working Group noted that only 42 percent of people who wanted to use a condomduring sex could obtain one. Of the estimated 18 billion condoms needed in 2006, donorsprovided just 2.3 billion (UNFPA, 2008 cited in Haddock et al., 2008). In addition, campaignswhich discredit condom use for HIV prevention can have negative impacts. For example, astudy in Russia using qualitative, quantitative and epidemiological data found an increase ofnew HIV cases where a government media campaign stated that condoms were unreliable ascompared to other regions where campaigns promoted condom use. In the area that used theslogan, “Condom protects but does not guarantee,” the numbers of new HIV cases was higher(Alekseeva et al., 2008b).Condom Distribution and Programming is Critical to HIV PreventionEvidence from South Africa demonstrates that condoms distributed to the public are in factused in sex and not wasted. Public sector male condom distribution rose from six million in1994 to 198 million in 1999 as part of the government’s condom promotion efforts for HIV/AIDS prevention. The government is the largest distributor of condoms in South Africa, withsocial marketing programs and commercial retailers together distributing an additional 10 to20 million male condoms in 1997. A prospective study was undertaken during 1998–1999at 12 representative public health facilities where a total of 384 participants and the 5,528condoms they received were followed successfully. After five weeks, 43.7% of the condomshad been used or broken in sex, 21.8% had been given away, 8.5% had been lost or discarded,and 26% were still available for use. Those who had actively procured condoms (rather thanpassively receiving them) had increased rates of use. After five weeks, less than 10% had beenwasted (Myer et al., 2001).Expanding access to female condoms allows women greater control over protecting themselvesand could even be preferred by some men as well. “Men may prefer using the female52 CHAPTER 3 PREVENTION FOR WOMEN