Round Up: Condoms

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ROUND UP

Condoms Concept mapping to identify factors driving adolescent sexuality, Peru

Consistent condom use is based on habit, Croatia

A context of sexual activity with low knowledge and low condom and contraceptive use contributes to poor adolescent health in Peru. This study in 2006, using concept mapping sessions, examined individual and environmental factors that 63 Peruvian adolescents aged 15–17 from a low-income community near Lima perceived to be related to sex, sexuality and sexuality-related outcomes. Brainstorming produced 61 items, which participants grouped into 11 clusters. The highest-rated clusters were personal values, respect and confidence in partner relationships, future achievements, and parent–child communication. High importance was placed on self-esteem, including general, body-, peerand family-related self-esteem, as well as on personal will, honesty, personal responsibility and maturity. Being a good student and meeting future goals was considered highly important. The importance of teachers, the community and the media was not as common as in previous studies. The pathway of decision-making about having sex primarily contained items rated as only moderately important. Fear of negative consequences of sex, such as sexually transmitted infections, dissuaded many adolescents from having sex. This study identified important under-studied factors, new perspectives, and possible pathways to safer sexual behaviour. The findings underscore the importance of directly integrating adolescent voices into future sexual and reproductive health research, policies and programmes.1

This study investigated the mechanisms underlying regular condom use. In 2009, 1,145 sexually active individuals aged 18–65 years were surveyed online, after being recruited via an e-mail message circulated at a Croatian university and posted on social networking websites. Participants' mean age was 28.1 years and 51.6% were women. The study investigated whether the frequently observed association between condom use at first and most recent sexual intercourse could be best predicted by: (1) norm-oriented behaviour – strong adherence to social norms which expect that sex should not take place without a condom; (2) calculative decision-making – that condom use is governed by rational decisions based on costs and benefits; or (c) habit formation – that condom use is a habit that forms early on and is sustained by non-deliberation. Calculative use significantly decreased the odds of condoms being used at both occasions, whereas habitual use increased the odds. The habitual modality of condom use significantly predicted consistent condom use with both casual and steady sexual partners. Age, being in a relationship, and the number of lifetime sexual partners were negatively associated with habitual condom use. The finding that habit plays a substantial role in consistent condom use suggests that condom use should be introduced before sexual activity starts, and programmes should focus on developing habitual condom use.1

1. Bayer AM, Cabrera LZ, Gilman RH, et al. Adolescents can know best: Using concept mapping to identify factors and pathways driving adolescent sexuality in Lima, Peru. Social Science and Medicine 2010; 70(12):2085–95.

1. Štulhofer A, Baćak V, Adjuković D, et al. Understanding the association between condom use at first and most recent sexual intercourse: an assessment of normative, calculative, and habitual explanations. Social Science and Medicine 2010;70:2080–84.

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Universal access to female condoms: programmes in Cameroon and Nigeria The Universal Access to the Female Condom (UAFC) Joint Programme is a collaboration between Oxfam Novib, the World Population Foundation, IDA Solutions, and the Netherlands Ministry of Foreign Affairs which aims to make female condoms widely available through support for advocacy, programming and research. The initiative has launched programmes in Cameroon and Nigeria which are run by a national steering committee and implemented by local actors: civil society organisations, the government, UN agencies and the private sector. In Nigeria, the Society for Family Health is the lead organisation and already holds 80% of the male condom market. The programme provides female condoms largely through the private sector (pharmacies, hairdressers, beauty parlours) while the government and UNFPA work within the public sector (family planning clinics). Cameroon is one of the first countries in the sub-region where studies have been conducted on accessibility and perception of female condoms. The lead partner is the Association Camerounaise de Marketing Social, which has worked on female condom programming since 2002, though not on a large scale. The Joint Programme will pay special attention to communicating the benefits of female condoms to a large audience.1 1. Universal Access to Female Condom Joint Programme website. At:

Development and approval of new female condom designs There is limited research on female condom functionality, and in many published studies events such as breakage and slippage are based on equivalent definitions for male condoms. Failure modes for female condoms (aside from breakage) are more complex and have only recently been understood and described. Since the approval by the US Food and Drug Administration (USFDA) of the first female condom (FC1) in 1992, several types have become available or are in development. FC2, the secondgeneration female condom made from synthetic 224

latex rather than polyurethane, was approved by the USFDA in early 2009 and will replace FC1. The International Organisation for Standards has developed a clear standard for male condoms that provides essential guidance on specifications and test methods used to verify quality. The international standard for female condoms is under preparation – due to be published in 2011. Without regulatory approvals, many female condom manufacturers cannot enter the market and be considered for procurement by donor agencies. Male condoms are designated as Class II medical devices (requiring special controls like product labelling) by the USFDA while the female condom is considered Class III (requiring premarket clinical trials in addition to special controls). Hence, the effectiveness and safety of any new female condom design has to be evaluated by experts on an individual basis. The new guidance will greatly assist, and although there is still some way to go, the path to getting new designs through manufacturing, into production, and through regulatory approval is becoming clearer.1 1. Beksinska M, Potter B. Development and approval of new female condom designs: negotiating the regulatory process. Cervical Barrier Advancement Society (CBAS) Newsletter, June 2010. At: .

Thailand's new condom crusade Thailand's first free condom campaign in the early 1990s was so successful that it was widely copied. Within three years of the campaign, condom use among sex workers increased from under 25% to over 90%. Between 1991 and 2001, new HIV infections dropped from 143,000 per year to 14,000. The HIV/AIDS budget for preventive activities was increased almost 20-fold to US$44 million in 1993. However, government funding for free condoms was cut back in 1998 when the Asian financial crisis struck. Since 2000, Thailand's HIV/AIDS containment programme has faltered, and funding has been directed at treatment rather than prevention. In 2008 with the election of the new Prime Minister, there was a renewed focus on HIV prevention with free condom distribution again. An accelerated plan for HIV prevention is being drafted

Round Up: Condoms / Reproductive Health Matters 2010;18(36):223–225

by the National AIDS Committee but some believe it is “too little, too late”. A series of television advertising campaigns using the slogan “Proud to carry condoms” was launched in 2007. But the campaign was harshly criticised by conservative social and parental groups, and the advertisement was withdrawn, ostensibly for budgetary reasons, despite strong financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.1 1. Treerutkuarkul A. Thailand's new condom crusade. Bulletin of WHO 2010;88(6):404–05.

Public irritated by another condom shortage in Uganda

1. Uganda: public irritated by yet another condom shortage. IRIN PlusNews, 29 June 2010.

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Several districts in Uganda have run out of condoms after the National Medical Stores' stocks were revised downwards. In the past, the Stores had a minimum stock level of six months and a maximum of 12 months, but this has been

changed to a maximum of six months' worth of condoms due to storage space issues. “The procurement process is very long and the delivery is not at regular intervals so sometimes we underestimate their arrival,” said the head of the condom monitoring unit in the Ministry of Health. “We need a condoms- or contraceptives-only warehousing facility and a contracted exclusive distributor for these commodities.” The government estimates that to cover all risky sex acts, the country needs 208 million condoms per year. Many people cannot afford condoms sold in pharmacies, which cost between US$0.25 and $2 for three. The Global Fund to Fight AIDS, Tuberculosis and Malaria and the US and UK governments are donating 96 million, 15 million and five million condoms respectively, while the National Medical Stores is expecting a consignment of 45 million by the end of the 2010.1

Teenagers learning about safer sex, Madagascar, 2003 225