FC & FC2 Female Condom
Country Profile:
B R A Z I L
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FC female condom was first introduced in Brazil in 1997 by the social marketing company DKT. In 1999 the National AIDS programme (NAP) began distributing FC in the public sector. Unlike in many other countries, FC has been accepted as a mainstream component of the national sexual and reproductive health programme in Brazil, and FC distribution has now reached approximately 4 million units per year. The National AIDS Programme intends to increase this volume still further over the next 3 years. Lessons learned from Brazil are important in identifying factors which are critical not only to the successful introduction of FC but maintaining FC demand over time.
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The Female Condom in Brazil – the National AIDS Programme
At the end of 2003, there were approximately 2 million people living with HIV/AIDS in Latin America and the Caribbean. Although the region has not experienced the high prevalence rates of Sub Saharan Africa, globally the relative increase in HIV/AIDS infections was highest in the Caribbean (30%), followed by Latin America (10%) in 2003. Trends indicate that HIV/AIDS is beginning to spread from high risk groups into the general population. An increasing emphasis is therefore being placed on developing HIV prevention programmes.
Brazil’s response to AIDS has benefited from consistently strong political support from the highest levels of Government. This has been translated into regulatory policies as well as a very clear and permanent allocation of resources at the national, state and local levels. There are clear signs that the incidence of HIV/AIDS has stabilised. A UNAIDS assessment of the situation in 2001 estimated an adult HIV/AIDS prevalence rate of 0.65%.
FC female condom was first introduced in Brazil in 1997 by the social marketing company DKT. In 1999 the National AIDS programme (NAP) began distributing FC in the public sector. Unlike many other countries, FC has been accepted as a mainstream component of the national sexual and reproductive health programme in Brazil and FC distribution has now reached 4 million units per year. The National AIDS Programme intends to increase this volume still further over the next 3 years. Lessons learned from Brazil are important in identifying factors which are critical not only to the successful introduction of FC but maintaining demand over time.
Prior to the introduction of FC in Brazil, a large-scale acceptability study was carried out to identify potential users and to develop strategies to reach them. The Ministry of Health conducted this study over the period of a year interviewing 2,400 women who used public health services from varying cultural backgrounds. The results from the study exceeded the Ministry of Health’s expectations with an acceptability rate of 70%. The strategy behind the MoHs FC implementation programme was to increase the prevention options available to women and thereby increase the number of protected sexual acts.
Women were prioritised in groups – CSWs, HIV+ women, IDUs, women users of health services and women with STDs. Key messages focused on gender inequalities and cultural factors – that “risky” behaviour was encouraged in society. The sexual partners of these women were also included in prevention programmes. Men in Brazil, like so many counties in Africa and Asia, have a dominant voice in sexual relationships, so prevention programmes actively encouraged their participation. An erotic magazine was developed promoting the advantages of FC which was distributed in places where men gathered such as at football matches. The National AIDS programme also recognised that the doors of family planning clinics and health services had not been traditionally “open” to men so targeted NGOs which specifically worked with men.
One factor that has influenced the success of FC programmes world-wide has been addressing service provider bias in promoting FC use. In Brazil, service providers in public clinics were trained on how to introduce and demonstrate the use of FC. Additionally outreach workers were also trained. Acceptability of the female condom in Brazil was found to be highest amongst men and women who were reached through community based organisations. Research from Zimbabwe, one of the few African countries to have integrated the female condom into its mainstream reproductive health programme, also found that interpersonal communications were an important factor in determining the success of female condom programmes.
The National AIDS Programme has also established monitoring and reporting systems to ensure that clinics and NGOs have both the capacity and knowledge to promote FC as well as effective training in place. The National AIDS Programme distributes FCs to the municipalities (e.g. Sao Paolo has 14 municipalities). If a municipality does not have a FC training programme then they do not receive any condoms.
Each municipality selects health centres and NGOs on the basis of their geographical location, capacity and socio/economic factors. 2 members from each health centre and NGO are then required to attend a 2 day training programme focusing on gender issues and HIV/STDs. Clinics and NGOs then follow up attendees. This allows them to assess reasons for low usage or discontinuance of FC use as well as maintaining figures on FC distribution. The National AIDS Programme evaluates each municipality annually.
In addition to the Ministry’s free distribution of the female condom, DKT, a social marketing organisation have also implemented a successful campaign to distribute the female condom in urban outlets under the brand name “Reality” as opposed to the Ministry’s name of “preservative feminine”. This has been important in widening the audience of the product and ensuring that FC has not been stigmatised as a “free hand-out to sex workers”.
Since 2000, the Ministry of Health has expanded its national programme, distributing over 8 million female condoms to date. DKT have also reported sales of over 2 million. Initially increased FC volumes were used to consolidate existing FC programmes, now additional target audiences are being included to increase the overall number of women protected. The Government’s strong commitment to HIV prevention programmes has undoubtedly contributed to the success of FC in Brazil. Allocation of resources has ensured a consistency of supply that has not been mirrored in other countries. Additionally service providers have been trained to promote the use of the female condom and monitoring and reporting systems have allowed providers to address obstacles to FC use. The integration of FC into existing health services and a combination of public and private distribution systems have also created a wide target audience.
To download the above Case Study as a PDF, click on the image to the right. 
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Posters:
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"The female condom has arrived... because love involves protection" - a poster from the National AIDS Programme FC promotion campaign.
Research Reports/Studies:
XV International AIDS Conference. Bangkok, 2004
The following poster and power point presentation are from the XV International AIDS Conference, in Bangkok 2004. It depicts the results of a randomized trial to determine the effectiveness of female and male condoms in preventing exposure to semen during vaginal intercourse.
Click on the image to view a 2-page poster PDF highlighting the presentation.
Click on the image to view the Power Point presentation of this study.
Brazil Ministry of Health--Acceptability Study
Prior to introducing the female condom, the Ministry of Health carried out an acceptability study to determine demand and acceptability for FC as well as to identify strategies to introduce the device to users. The study was carried out over a year and questioned 2400 women from varying cultural backgrounds who used public health services. Acceptability for FC was 70%. To view the full report you may select from the following formats
Acceptability of the Female Condom in Different Social Contexts.
Complete Research Report, 2000 [White Paper – PDF]
Summary of Study:
Acceptability of the Female Condom in Different Social Contexts.
Presentation,1999.
Available as the complete presentation in Power Point with navigation to the three sections or as three separate documents for each section:Presentation [Power Point]
Introduction: Objective, Criteria, Design, etc. [PDF]
Statistical Results: Charts, Graphs, etc. [PDF]
Conclusions. [PDF]
