FC & FC2 Female Condom
Promotion of the FC Female Condom amongst Commercial sex workers: Soeur a Soeur – (Sister to Sister)
Africa, with 10% of the world’s population is home to 70% of the world’s HIV positive adults and 80% of the world’s HIV positive children. According to a UN report published at the end of 2002, the face of AIDS has become that of a young African woman – seven out of 10 people with the disease are in sub-Saharan Africa, and 58% of infected Africans are female. An HIV prevalence study carried out by UNAIDS in Lome (the capital and largest urban area in Togo) in 1992 amongst Commercial sex workers (CSWs) indicated an HIV prevalence rate of 78.9%. No further statistics have been made available to date. UNAIDS estimated that there were 14,000 new HIV infections a day in 2002 in Africa; the need for targeted prevention initiatives, particularly aimed at those at high risk of contracting the virus, has never been more urgent.
In September 2000, with the support of the Togolese Government, Population Services International (PSI)/Togo and its NGO partner FAMME implemented an FC female condom programme (under the brand name Protectiv) in Togo. The Sister to Sister programme aimed to reduce the transmission of HIV/AIDS by empowering CSWs to practice safer sex by increasing access to FC along major transport routes in Togo. An important component of the project was peer education, focusing on HIV/STI prevention, correct use of FC and challenging the CSWs risky behaviour by increasing awareness of the routes of transmission of HIV/AIDS.
Peer education took place in brothels but it was also important to target the increasing number of CSWs who had moved out of them to work from the roadside or at social venues and were therefore more difficult to reach through central locations. The peer education system was flexible enough to adapt to this change as trainers knew CSWs by sight and could find them wherever they were. During the second year of the project 50 peer educators and 15 supervisors had 29,650 contacts with CSWs, their clients and members of the surrounding communities. Activities planned for Year 3 of the project include 2500 group discussions and 11,000 counselling sessions with CSWs as well as 5 community demonstrations.
A KAP study was carried out in March 2001 by PSI/Togo and the Association Togolaise Marketing Social to assess the CSWs personal perception of risk of contracting the HIV/AIDS virus and their knowledge and opinions on FC. Additionally it sought to identify strategies for CSWs to negotiate use of FC. Personal perception of risk was high with almost half of the 95 CSWs interviewed being aware that they were at risk from HIV/AIDS. All of the CSWs had heard of FC but 62% of them had never seen it. All of the CSWs except one thought that the FC was their “ami fidele” – faithful friend – in the fight against HIV/AIDS. One CSW said “The FC is more solid, I know it’s not going to burst during intercourse like the male condom”. They felt a security with the female condom which was lacking with the male condom. Most importantly, it gave them an additional option if men refused to wear a male condom. A CSW commented “The FC female condom is necessary because some clients put a male condom on and then take it off during intercourse”. 82% of the CSWs said they were willing to use the FC with all their partners – occasional and regular clients, their boyfriends or their husbands.
Negotiating use of FC was straightforward with those clients who already used the male condom. With those who did not the CSWs explained the advantages of the FC and highlighted the risks of not using protection at all. Many inserted the FC prior to intercourse without telling their clients. Where use was discovered by the client, the majority continued without insisting the FC was withdrawn. One CSW said “my client was so satisfied he took a female condom home with him to use with his wife”.
The Sister to Sister project has contributed to the efforts of the Government of Togo to prevent the transmission of HIV/AIDS by increasing use of the FC female condom particularly amongst high risk groups. A final evaluation of the project will be available towards the end of this year. However, it is essential that this work is continued. While CSWs are aware of the risks they face, this message needs to be reinforced and targeted at other high risk groups of the population. It is essential that at points of distribution and sales, AIDS awareness messages are reinforced, the advantages of the FC female condom are highlighted and demonstrations on correct use are given to all women. With a shift in focus in the African region to anti-retrovirals and the development of microbicides, it is important that HIV/AIDS prevention campaigns and condom distribution programmes are still high on the agenda in the fight against AIDS. A key factor in the continued success of the FC female condom in Togo and other countries will be the sustainability of programmes and the consistency of supply.
