Introducing Female Condoms to Female Sex Workers in Central America

Abstract

The female condom could play an important role in reducing HIV infection among female sex workers and their clients in Central America. Acceptability studies have shown that Central American sex workers are amenable to using the female condom, 1-3 but programs have not always successfully promoted long-term use. For example, promotional efforts by the Pan American Social Marketing Organization (PASMO) produced different results in different countries in the region: In Nicaragua in 2005, only 300 female condoms were distributed, and program staff reported acceptability to be low. In contrast, almost 12,000 were distributed in El Salvador from 2003 to 2005; once the supply of female condoms had been depleted, sex workers continued to ask when more would be available. 4 Given that the female condom could increase sex workers' overall number of protected sex acts 5-9 and protect them from STIs (including HIV) and pregnancy, 6,10-14 efforts to promote female condoms effectively to this specific target population are needed 15 -especially because exposure to mass-marketing campaigns does not necessarily translate into uptake. 16,17 To date, successful female condom programs for multiple populations have used provider training; targeted marketing; face-to-face communication with target populations; comprehensive training, including insertion practice and partner negotiation skills; practice with an anatomical model; encouragement; testimonials by satisfied users; integration of female condom use into HIV and STI prevention communications; a sustained supply of female condoms and low-cost distribution through public and private sector channels. [18][19][20][21][22] To encourage uptake and sustained use, program efforts should place particular emphasis on correct and consistent use of female condoms and partner negotiation skills. 12,23,24 In order for access and uptake to be sustained over the long term, programs must create and measure demand, 18 as well as ensure a steady supply of female condoms through the support of governments and donors. [25][26][27] Female condoms should also be easily accessible; in countries where the female condom is available, women have been able to obtain the device from pharmacies, hairdressers, HIV and AIDS support groups, and peers, as well as health clinics. 27 To inform strategies for promoting the female condom to female sex workers in Central America, we conducted formative research with sex workers at three sites in El

The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept

“…6 Most of the eight studies reviewed took place in developing countries and/or higher HIV-prevalence settings. Findings suggest that female condoms can be sexually acceptable to many women (especially sex workers) by way of enhanced level of lubrication (Mack, Grey, Amsterdam, Williamson, & Matta, 2010;Mathenjwa & Maharaj, 2012), greater pleasure and sensation than the male condom (Mathenjwa & Maharaj, 2012), clitoral stimulation through the outer ring (Mathenjwa & Maharaj, 2012), capacity to comfortably accommodate all penis sizes (Mack et al, 2010), ability to insert prior to sexual activity (Mathenjwa & Maharaj, 2012), and better smell than male condoms (Mack et al, 2010). Indeed, women's experiences of greater pleasure and sexual sensations helped predict long-term use of female condoms among 255 women in Brazil (Telles Dias, Souto, & Page-Shafer, 2006).…”

“…Initially, women in one study reported that the method's design, particularly the internal ring, made it difficult (and painful) to insert and remove. However, after several uses, more than half of participants preferred the female to the male condom (Mack et al, 2010). Among female condom users, the most common complaint (30%) was poor sexual satisfaction associated with use.…”

“…Women in smaller studies reported pain during intercourse (Okunlola et al, 2006), and a number of women who had not used it were concerned about insertion-both in terms of difficulty (Latka et al, 2008;Okunlola et al, 2006) and in touching one's genitals (Latka et al, 2008). However, women can grow more comfortable with insertion through practice, and several studies show that the more women use female condoms, the more they like them and/or prefer them to male condoms (Mack et al, 2010;Telles Dias et al, 2006;Van Dijk, Pineda, Grossman, Sorhaindo, & García, 2013). In sum, female condoms can be a sexually acceptable option to many women and a unique woman-controlled dual-prevention technology.…”

Gendered innovations: harnessing the creative power of sex and gender analysis to discover new ideas and develop new technologies

“…Currently, female condoms are the only woman-controlled HIV prevention option, but they are detectable and may require partner consent. They are also less available and more expensive than male condoms (Mack et al 2010). …”

The Female Condom: Knowledge, Image, and Power

“…While many risk factors have been associated with hiv/aids infection rates, several studies have linked the spread of infection among the African American female population to knowledge, awareness, and the gender ratio imbalance among African American women and African American males (Broaddus, Morris, & Bryan, 2010;Laub, Somera, Gowen, & Diaz, 1999;Weeks, Coman, Hilario, Li, & Abbott, 2013). Considerable research suggests that a relationship exists between female condom usage, acceptability, and gender dynamics (Mack, Grey, Amsterdam, Williamson, & Matta, 2010;Small, Weinman, Buzi, & Smith, 2010;Wingood & DiClemente, 2000).…”