What Works for Women and Girls

Correct use of the female condom has been estimated to reduce the per-act probabilityof HIV transmission by 97% (Trussell et al., 994 cited in Fernandez et al., 2006).(Gray II) (female condoms)Modeling exercises have estimated that perfect use of the female condom for one yearby a woman having sexual intercourse twice per week with an HIV-positive partnercan reduce her risk of acquiring HIV by more than 90% (PATH and UNFPA, 2005).(Gray V) (female condoms)“Studies of female condoms show that their…ability to prevent disease transmissionare similar to those of male condoms” (Nelson, 2007 in The Lancet). (Gray V) (femalecondoms)Promising Strategies:3. Expanding distribution of female condoms may increase female condom use, thus increasingthe number of protected sex acts and preventing HIV acquisition and transmission.A study in Brazil on the introduction of the female condom also showed that makingthe female condom available increased the number of protected sex acts (Barbosa et al.,2007). A 1998 to 1999 preparatory study at 20 sites in six cities in Brazil preceded anational effort to introduce the female condom into public health services. The State andMunicipal Health Departments in each city signed an agreement to ensure female condomavailability at the end of the study. The twenty sites represented a range of different HIVepidemics within Brazil. Professional teams generated educational and training materialsto use in the clinics, with availability publicized in the media. The health workersreceived a standardized 48-hour training program three times at each clinic. Followingan educational session, 2,832 women volunteered to use the female condom and reporttheir experiences. Of those seen fifteen days later, 1,782 had used the female condom atleast once. Among those seen at the 90-day follow-up, 1,453 women had used femalecondoms at least once, with 1,296 stating that they liked the female condom and wantedto continue to use it, an acceptability rate of 54% (1,296 out of the original 2,342). Amongthese 1,296 women, barrier use at last intercourse, either with a male or female condom,increased from 33% at baseline to 70%. “The advent of the female condom substantiallyraised the proportion of sexual intercourse acts that were protected... The reasons are...not well understood, but may be due to the dialogue between partners stimulated byintroduction of the female condom...or couples may prefer to alternate the method ofprotection …Access to an alternative to the male condom makes it possible to increasewomen’s capacity to negotiate their protection from HIV and other STIs” (Barbosa et al.,2007: 265). (Gray III) (female condoms, Brazil)A study with sex workers in Kenya found that adding female condoms to a male condompromotion and distribution peer education program for 151 sex workers over the courseWHAT WORKS FOR WOMEN AND GIRLS55