FC & FC2 Female Condom
Female Condom Promotion by SWAA Ghana
Objectives of Project
(click on image to enlarge.)
Heterosexual spread remains the main mode of transmission in Ghana accounting for 75 – 80% of HIV infections. Although awareness of HIV/AIDS is high, around 99%, this has not translated into behaviour change and reported condom use is low, estimated at 16%. Women are far more vulnerable to HIV infection than men. Cultural and gender norms relegate most decision-making within relationships—including sexual relations—to men. Women are rarely able to refuse sex or to demand protective measures such as the use of a male condom even when they suspect their partners of infidelity. Within this context, the need for female controlled prevention methods cannot be overemphasized. The project therefore sought to increase access to the female condom in five regions of Ghana by establishing distribution sites which could educate and train both men and women in the proper use and advantages of the female condom. Effective monitoring and evaluation strategies were also put into place.
Main Activities Undertaken
i. BASELINE STUDY
At the outset of the project a baseline study was implemented to assess the Knowledge, Attitude and Practices (KAP) relating to the use of the female condom in the five regions. Two hundred men and women from each region participated in focus group discussions which were subdivided into groups of young and elderly males and young and elderly women. 250 women from the same communities took part in in-depth interviews. In dividing the groups along gender lines, it was possible to identify the different issues and obstacles around female condom use. The data collected was important in shaping strategies and messages for the project.
The baseline study indicated that 96% of respondents were aware of HIV/AIDS as well as modes of transmission. Personal risk perception was also high at 78%. However, only 16% of people interviewed claimed they had ever used a female condom, although the majority were aware of its existence. Advantages of the female condom were also largely unknown to most of the respondents. Issues of mistrust and infidelity were also identified by the study, many men feared that the use of the female condom by their partners would promote promiscuity.
ii. TRAINING AND SENSITIZATION
Strategies used to promote the FC included community sensitization workshops. A Training of Trainers approach was adopted so that they could serve as master trainers in the regions and thereby increase project capacity at a local level. Selected journalists were trained to increase reporting of HIV/AIDS and the FC in both the print and electronic media. Puppetry, drama, video shows, posters and leaflets were also developed to raise awareness of the female condom and educate end-users in its proper use. Importantly the project targeted at least 20% male involvement in all activities, recognizing the need for the tactical involvement of men, as well as to ensure a fair gender representation. Encouragingly, over 40% male involvement was achieved and men felt comfortable purchasing the female condom at advocacy meetings and training workshops.
iii. FINAL EVALUATION
A KAP evaluation of the project was commissioned in June 2003 to assess the impact and effectiveness of activities and to make recommendations and develop best practices for future FC promotion programmes. A total number of 259 participants were interviewed for the study, 227 of whom were general beneficiaries. The main findings of the study were very encouraging. 81.1% of respondents cited a SWAA training programme as a source of information about the FC. When asked about the steps for the proper use of the FC, 90% of respondents could cite 3 of the 5 steps. Nearly 80% of respondents indicated they had successfully negotiated use of the FC with their partners and of these 63% had used it. Participants were also questioned on their perceptions of the FC. Although 33% of respondents still believed that the FC would encourage promiscuity and infidelity, 88% thought it should be available for young girls and women.
Outcomes and Recommendations
To date, a total of 127,500 female condoms have been distributed through sales, sensitisation meetings and free distribution, as well as through other organizations collaborating with SWAA. Distribution is still on-going so it is likely that this figure will be exceeded. Over 10,000 people have been directly reached through training programmes.
The adoption of education/entertainment approaches have been very effective in communicating at a community level, while the translation of IEC materials into local languages has tackled the prevailing belief that the FC is for educated women only. Research from other countries in the region has indicated that users of the FC tend to be those reached through interpersonal communications and community outreach.
Male involvement at each stage of the project has ensured a more holistic impact on communities and addressed gender issues that may have militated against the success of the entire project. The need to continue to involve men in FC programmes is therefore essential, as well as to address the stigma associated with condom use that exists amongst both men and women.
SWAA Ghana’s promotion of the FC has been effective in raising awareness of the FC as a dual protection method and campaign messages and activities have successfully tackled obstacles to FC use. While the impact of this project should not be underestimated, there is a need to continue and intensify FC promotion activities to build on progress made to date and to sustain the interest generated in the FC so far. Consistency of supply has been a major factor in the success of FC programmes elsewhere in the region. There is also a need for more collaboration between organizations to facilitate information exchange and to extend the reach of FC promotion campaigns into more districts, regions and communities. The inclusion of the female condom in sexual and reproductive health programmes as an added contraceptive and disease prevention technology is essential as HIV prevalence rates continue to rise and women shoulder a disproportionate burden of the disease.
