Transcript HIV RISK ASSESSMENT

Implementing Male and Female
Condom Programmes at the
Community Level:
Experiences from Nigeria and
Zimbabwe
By
Chris Oyeyipo (UNFPA, Nigeria) and
Daisy Nyamukapa (UNFPA, Zimbabwe)
Objectives of the Session
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Share with participants basic information on male
and female condoms
Discuss information on the relationship of condom
programming and dual protection against HIV/AIDS
and unintended pregnancies
Outline basic steps required to promote condoms at
community level
Share examples of successful community
involvement in CCP from Zimbabwe and Nigeria
Basics on Male and Female
Condoms
Male condom
 Made of latex, natural membrane, polyurethane
 Offers dual protection against HIV and unintended pregnancies
 Requires an erect penis for usage
Female condom
 Made of polyurethane or synthetic latex (nitrile) sheath
 May be inserted into the vagina up to 8 hours before intercourse
 Provides dual protection against STI/HIV and unintended
pregnancies
 May provide better protection against STIs due to skin infections
 Durable and offer women greater control
Epidemiological Context
Zimbabwe
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Zimbabwe is in an advanced state of a generalized HIV epidemic.
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Sexual Transmission accounts for 80 to 90% of all HIV cases
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Of the 1.6 million living with HIV & AIDS in Zimbabwe, 56% are women
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Preliminary results of the 2005-2006 DHS indicates a disparity in adult
prevalence rate between males and females (21.1% females compared to
14.5% in males)
Nigeria
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Sero-prevalence currently at 4.4 %
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Sexual Transmission accounts for about 90% of all HIV cases
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An estimated 2.9 million people live with HIV & AIDS in Nigeria - 3rd highest
figure in the world
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Prevalence in the age group 15-24 is currently at 5.2%
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Adolescent girls twice more vulnerable than boys
HIV Prevalence Among Couples in
Zimbabwe:
(Zimbabwe DHS 2005-06 Preliminary Report)
Man positive,
woman
negative
8%
Both
negative
72%
Both
positive
15%
Woman
positive, man
negative
5%
Social Context: Zim. & Nigeria
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High prevalence of rural/urban separation of spouses
Sexual roles for men and women are defined differently and
are unequal
Unequal power relations in sexual relationships leads to
difficulties in negotiating for safer sex
Women’s weaker economical position increases dependence
on men
Limited choices of HIV prevention methods esp. those that
women control
Women often subjects of sexual violence i.e. rape
Suggestions of condom use may result in violence
Relatively wide promotion of the male condom, but this is
controlled largely by men, thus insufficient in addressing
women’s HIV prevention needs
Condoms and Dual Protection
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Condoms are the only devices that offer dual
protection
Only devices that protect against sexually
transmitted infections including HIV
Consistent use reduces HIV risk by about 90%
With perfect use, pregnancy rate for male and
female condoms is between 3-5%
Steps to Effective Condom
Programming
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Understand condom clients and environment e g
acceptability studies, Situation analysis etc
Assess condom programmes and create action plans e g
participatory development of national condom strategy and
operational plans with NGOs/CBOs/FBOs
Procure high quality condoms and manage pipeline
Expand distribution points (Hair saloons, CBDs, Peer
counselors, male motivators)
Promote condoms (BCC and IPC and negotiation skills for
safer sex)
Monitor programmes with involvement of stakeholders
including NGOs/CBOs/FBOs
Strategies in NGO/FBO/CBO
Involvement
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Coordination-Formation of condom stakeholder
group
Capacity building to include personnel of NGOs
Participatory development and distribution of
promotional materials
Commitment/partnership through linking
NGOs/CBOs/FBOs for condom supply to the
public sector and social marketing supply
pipeline.
Operationalizing the Male/Female Condom
Strategy, Within the Context of the National
AIDS Strategy and RH Programme
Male/Female condom
programme
Supply
Demand
Support
Forecasting and
Procurement
Behavioral Change
Promotion
Regulations and Policy
Receiving, Warehousing,
Storage
Strategic targeted
Distribution
Coordination and
Management
Distribution
Advocacy and Social
Mobilisation
Capacity building
Quality Management
Monitoring and
Evaluation
Logistics MIS
Ongoing Research
Promoting Condoms at
Community Level
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Expand service delivery points within the community, e.g. village
condom holders, hair salon “Care’ (FC) promoters
Counseling and educational materials should be gender sensitive
and address underlying gender issues
Counselors should have gender skills
Integrate condom programme into RH and HIV/STI prevention
programmes e.g. VCT, PMTCT, ANC, and MCH/FP
Conduct advocacy with men’s groups, community and religious
leaders
Work with men (male motivators) and community leaders as
advocates and role models for FC use
Create community dialogue between men and women
De-stigmatise condom use and promote consistent use
Monitor programmes
Phases of the Zimbabwe FC
Strategy
Phase 1: 2006-7
Consolidation
Phase 2: 2008
Targeted Expansion
Phase 3: 2009-10
Generalized Distr.
Target
Groups
Women who are:
Married
Pregnant, breast
feeding, & LWHA
in cross-generational
& discordant relations
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Phase 1 target groups
CSW
clients at STI clinics.
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Public
Sector
Distr.
Channels
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All clients from Phase 1
STI Clinics
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Hair salons,
growth points,
commercial farming &
mining, areas, high-risk areas
(hot zones
Further expansion &
consolidation of sales in
phases 1 and 2.
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Soc. Marketing
Sales
Channels
Current sites
FP, ANC & PMTCT
Clinics
Peri/post
menopause
YP at tertiary
colleges
Pharmacies,
Supermarkets, tuck-shops,
bottle stores), hair salons
& post-test clubs
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Target groups from phase 1
&2
all sexually active clients
seeking C&T
All sexually active
persons choosing to use FC.
Active distribution sites
from phase 1 & 2
All public sector. HC.
Achievements to Date
Zimbabwe
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Established TSG on condom
programming
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Undertook FC situation analysis
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Developed FC strategy
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Developed a draft FC manual
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Trained 40 master trainers (TOT)
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Trained 145 Community based
Distributors
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Trained 92 District AIDS Coordinators
and programme officers
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Trained 90 Nurse trainers
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Trained 61 Group leaders
Nigeria
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Established FC stakeholders
group
Established National condom
TSG
Undertook FC situation analysis
Drafted integrated condom
strategy document
Developed a draft FC manual
Trained 80 master trainers (TOT)
Trained 200 Community based
Distributors
Trained 50 male motivators
Trained over 700 FC service
providers and counsellors from
public sector and NGOs
Zimbabwe Female Condoms
Sales/ Distribution By Year
Social Marketing and Public Sector
2,500,000
Number of condoms
2,000,000
1,500,000
1,000,000
500,000
0
2000
2001
2002
2003
2004
Year
PSI
ZNFPC
Total
2005
2006
FC Distribution-Nigeria (2003-06)
Behavioural change and declining HIV incidence/prevalence in Zimbabwe
HIV prevalence decline
X
Mortality
Emigration of
PLWHA
HIV incidence decline
?
Increased mortality
among persons with
high infection risk
?
Abstinence
-No clear trend
- Age of debut among highest
in Africa since 1980s
Behavioural
change
Emigration of
persons with
risky life-style
?
?
Other factors:
STI treatment: possibly YES
Trends in MC, blood safety: NO
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Other
Faithfuln./# of partners
Condom use
- Decrease in mean number of
partners; but no trend data
on concurrent relations
- Polygamy stable up to 1999
- Steady increase in
distribution and sales data
- Increase in use with
non-cohabiting partners
intravaginal practices,
widow inheritance,
girl-child pledging, rape
Little programme focus on
faithfulness, prevention in
marriage, polygamy
Public sector
and social marketing
condom programmes
Little programme focus
on addressing these
risk factors
- No trend data on
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Programmes on delayed
debut: FBOs, NGOs,
education system
Basic knowledge and personal experience of morbidity and mortality
Monitoring and Evaluation of Condom
Programmes at Community Level
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No of young persons accessing condoms
Percentage of clients reporting correct and
consistent use of MC/FCs
MC/FC stock out rate in distribution outlets
Quantity of MC/FC distributed in the last 12
months
MC/FC at last sex with cohabiting/noncohabiting partner(s)
Challenges and Barriers
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Challenges
Human resource constraints
Limited availability of funds, especially hard currency
Donor dependence
Barriers
Myths and misconceptions
High cost of the female condoms (Nigeria)
Power imbalance between men and women
compromising negotiation for safe sex
Limited availability in underserved communities (Nigeria)
Lessons Learnt
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The unequal distribution of power between men and women, their
ability to negotiate and respect each other’s freedoms influences
utilisation of the female condom
Without involving men and empowering women with negotiating
skills, the same issues influencing low-utilisation of the male
condom, likely to affect the FC
Need for alliance/partnership building not only at national level
(between donors, govt. and civil society), but also at operational
level with male community leaders, male role models ensures
sustainability
Role of Government in facilitating a conduce policy and regulatory
environment critical
Promotion messages for the FC should be designed in a way that
does not undermine the male condom to ensure complimentarity of
the two methods
Asante
Tatenda
Thank You