What Works for Women and Girls

A nationally representative survey of young women in South Africa found that thosewho discussed condom use with their partners were more likely to use condoms for dualprotection, and to use them consistently (MacPhail et al., 2007). (Gray IV) (condoms,South Africa)A qualitative study conducted among 39 married couples in Uganda who reported100 percent condom use in the last three months suggests that stable couples shouldnot be ignored in condom promotion campaigns—particularly those that promote thedual protection nature of condoms. The study found that wives promoted condom useamong 22 of the 39 couples, in six cases use was initiated by the husband and amongthe remaining couples there was disagreement as to which partner initiated discussions.Women were able to convince their partners to agree to consistent condom useby being insistent and persuasive, refusing sex, or proposing condom use for familyplanning or to safeguard their children from becoming orphans. Men reported agreeingto condom use to please their wives, to protect their wives and children, to protect themselves,and to be able to maintain other partnerships (Williamson et al., 2006). (GrayIV) (condoms, sexual partners, marriage, Uganda)A study in three countries assessed the feasibility of a group-based couples interventionto increase condom use in HIV-serodiscordant couples in India, Thailand and Uganda.The intervention focused on communication, problem solving, and negotiation skills.Forty-three couples enrolled in the intervention (15 in India, 14 in Thailand, and 14 inUganda) and 40 couples completed all study activities. Participants were interviewed atbaseline and at one- and three-months post- intervention. The intervention consistedof two same sex sessions and two couples sessions with ‘homework’ to practice skillsbetween sessions. The same intervention modules were used at each site, tailored forlocal appropriateness. Participants at each site were enthusiastic about the intervention,citing information about HIV serodiscordancy and the opportunity to meet couples ‘likeus’ as important features. Participants reported increased comfort discussing sex andcondoms with their partner, although some participants remain concerned about situationswhen condoms might not be used (e.g. when drunk). At baseline, the majorityof Thai and Ugandan participants and one-third of Indian participants reported having‘ever’ used a condom with their regular partner. The percent of sexual contacts withcondom use reportedly reached 100% at all sites by the first follow up visit. Althoughsocial acceptability bias cannot be ruled out, researchers note that participants alsoreported that a primary benefit of the intervention was condom information, includingdemonstrations of correct condom use, and increased confidence in their ability todiscuss and use condoms with their partner (Mcgrath et al., 2007). (Gray V) (condoms,communication, India, Thailand, Uganda)60 CHAPTER 3 PREVENTION FOR WOMEN