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This research is based on structured interviews, semi-structured interviews, and informal firsthand observation of women residents of Washington, DC who used crack and/or injected drugs during the previous 30 days. The study entailed introducing these women to the female condom, exposing them to an HIV risk reduction intervention teaching them how to use it and how to negotiate its use with their sexual partner(s). Women were tested for HIV and asked to return one week later for their results. They were asked to try the female condom within that first week. Upon returning for their tests results, ethnographers discussed with them their experiences with the female condom. They were reinterviewed for follow-up three months later to assess changes in behavior from baseline as well as their longer term experiences with and opinions of the female condom. The data presented in this paper are based on the interviews conducted one week after baseline. Of particular interest and concern to this research were: women's perceptions of the female condom prior to and subsequent to using it, women's partners' perceptions of the female condom after being introduced to it, and potential barriers to use. In all, 131 women, mostly African-American, took part in this study, which was conducted during the winter of 1997-1998.

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Social marketing is a proven private sector strategy to provide health-related products, including contraceptives. Pharmacies offer affordable, convenient, and rapid delivery of over-the-counter contraceptives directly to the consumer, providing wider availability and accessibility to family planning (FP) in sub-Saharan Africa. Pilot projects tested the feasibility of including CycleBeads®, the visual tool that supports the use of the Standard Days Method®, into Population Services International (PSI) social marketing programs. The purpose of this article is to review evidence to provide guidance for social marketing CycleBeads in pharmacies in sub-Saharan Africa. Literature on contraceptive provision through pharmacies in comparison to clinics was summarized from developing and developed country contexts, highlighting salient and relevant lessons for the African context in regard to pharmacists’ knowledge and perceptions of FP, clients’ perceptions of pharmacists’ FP knowledge and FP service delivery in pharmacies, and the impact of pharmacy access on contraceptive use. Descriptive data from PSI social marketing initiatives in several African countries, and commercial marketing information were reviewed. Evidence from CycleBeads sales suggests that there is demand for the product and it is affordable in comparison to oral contraceptives. In addition, there were high levels of correct use by women who purchased CycleBeads in pharmacies, suggesting that CycleBeads are an appropriate product for social marketing. Until awareness of and demand for the method increases, social marketing of CycleBeads requires continued subsidy to maintain viability. Training to update pharmacists’ knowledge and increase capacity to provide basic information, positioning of the method, and low profit margins for pharmacies present challenges.