What Works for Women and Girls

A two month prospective study from 2000 to 2001 of male and female condom useamong sexually active women in Zimbabwe found that reported use of female condomsincreased from 1% to over 70% two months later. Women were given a thirty-minuteone-on-one counseling program about HIV and safer sex conducted by a trained counselor,with practice on how to insert the female condom and condom negotiation skillsand were give a one month supply of no cost male and female condoms. Women reportedmore than 28% of sex acts were protected by female condoms. Women reported usingfemale condoms for both HIV prevention and for pregnancy prevention. Over 8% usedonly the female condom to protect all sex acts, with 67% using the female condom forat least a portion of sex acts. However, most of the women in the study used hormonalcontraception so that exclusive female condom use was lower (Napierala et al., 2008).(Gray III) (female condoms, counseling, Zimbabwe)4. Promoting the dual use of condoms as a contraceptive as well as for HIV prevention maymake use more acceptable and easier to negotiate.A three-armed randomized controlled trial at a VCT clinic in Lusaka, Zambia with 251couples found a threefold higher contraceptive initiation rate where family planningeducation and offer of contraceptives where available on site rather than by referral toan outside clinic. All couples receive a presentation on family planning methods andthe advantages of dual method use, along with a free, unlimited supply of condoms.HIV discordant and concordant couples are advised to use condoms with every act ofintercourse, with this information given during initial post-test counseling and repeatedat each subsequent visit. Trained nurses help couples overcome barriers to condomuse. The control group was referred to the Lusaka Planned Parenthood Association ofZambia for family planning methods, with all fees paid by the research project. Womenin the intervention group who desired Norplant or surgical sterilization were referredto University Teaching Hospital, with transport and service fees paid. Self reportedcondom use was assessed. Approximately half of the couples eventually wanted to havechildren. Self reported condom use remained consistent at between 58 to 63% (Mark etal., 2007). (Gray II) (HIV testing, family planning, contraception, condoms, Zambia)A study of 372 sex workers in Ethiopia, of whom 73% were HIV-positive, found moreconsistent and correct condom use when used primarily for pregnancy preventionrather than for STI prevention. Sex workers who were using condoms for contraceptionwere compared with others, more likely to use condoms consistently (65% compared to24% and less likely to be HIV-positive (55% compared to 86% (Aklilu et al., 2001). (GrayIII) (condoms, pregnancy, STIs, Ethiopia)5. Providing VCT along with condom negotiation skills may improve condom use by marriedwomen. [See also Chapter 6. HIV Testing and Counseling for Women]A 2000–2001 study of 394 married women in Harare, Zimbabwe found that condomuse increased from 1% prior to the intervention to almost 50% after a half-hour one-on-WHAT WORKS FOR WOMEN AND GIRLS57