Social Marketing & the

Female Condom
Sixth Annual Women & HIV/AIDS
Conference, New York, NY

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 Approvals
‡ FC is only female condom on the
WHO/UNAIDS Essential Products List
‡ Only female condom US FDA approval
Class III device in US
‡ Regulatory approval in US, Europe,
Australia, Japan, Canada and regulatory
registrations in multiple countries

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 —

   
 
    
     

  
   


 
 


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 Female condoms in prevention programs
increase overall condom use
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 Alabama, U.S.A.

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‡ Results
± Use of protected sex acts doubled from  before the study
to  immediately after the intervention
± About two-thirds of sex acts were protected during follow-up
± About one-third of women continued FC use thru follow-up
± Less than ¢ were exclusive FC users
± About one-third of women used MC or FC for all sex acts

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 From South Africa
‡ Women use it
±  from initial sites currently using
±  of ever users used more than ¢ times
±  of ever users experienced problems
using
± Problems diminished with additional uses
‡ More sex acts are protected
±  report using protection more often
± More control over protection they insert
± Perceived as being more effective than MC
(

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 From Zimbabwe
‡ Findings from Pop Council study one year after
social marketing launch of ¢ participants
±  of women said they would continue use of FC
versus  who would continue to use MC
±
 of users who were married women had never
used MC before using FC
±
¢ of consistent FC users were not consistent MC
users
± Use of the female condom was not replacing existing
male condom use but providing additional protection



   
 ]
 From Zimbabwe
‡ Use of the FC:
± Face-to-face contact important motivator of
use beyond initial trial.
±  reported always using the FC.
± Users often alternate between MC & FC
depending on context and partner.
± Need to train peer educators, clinicians and
pharmacists to provide information & support
services!
'

   
 ]
 From Zimbabwe
‡ Negotiation of the FC:
± Women more often than men initiate dialogue,
decide on its use, and procure the FC.
± But many males and females report joint
decision-making.
±  of women used the FC without partner¶s
knowledge.

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 ]
 From multi-site US study
‡ Key conclusion:
± Clinicians counseling women in the use
of the female condom need to provide
information, demonstrate its correct use
with their clients, and provide an
opportunity for their clients to practice
skills themselves.

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Positioning

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 Women Who Need Self- Initiated
Methods
‡Male partner refuses to wear a condom
‡Male partner is unable to wear a condom
‡Woman chooses/initiates use of female
condoms
‡Woman uses female condom in condom
negotiation in relationships with partners
& clients
‡Male partner is drunk, abusive c]
 Anal Sex
FC not approved by FDA for anal sex, however
there have been some studies:
‡ Safety outcomes (condom breakage, semen
spillage, rectal bleeding) were not significanlty
different for MC and FC condoms, but slippage
was more frequent with FC (Celum, et al)
‡ Most men in studies have liked using FC for anal
sex
‡ Of

 MSMs from six US cities, ¢
()had heard of using FC for anal sex (Gross,
et al) c°
 Positioning- Country Approaches
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Positioning ± Successful Programs
‡ The most successful interventions have included training
and introduction programs that address
± provider potential bias
± encourage ³practice makes perfect´
± do not over-complicate female condom use
± incorporate anatomy, sexuality, communication &
negotiation
± respect women and provide opportunities for control
and empowerment
± include men in the education process

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Positioning ± Successful Programs
‡ Successful programs incorporate all
stakeholders: government, NGOs, INGOs,
social marketing organizations, donor
agencies, UN agencies from the earliest
phases.

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Partnerships

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Public Private Partnerships


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Social Marketing

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 Social Marketing
Strategies used:
‡ Subsidized product sales in various venues with
media marketing to raise awareness
‡ Targeting: men, youth, women, couples, by
SES, by occupation (students, CSWs, factory
workers)
‡ Positioning: as a contraceptive vs. a method for
HIV/STI control in order to avoid product
stigmatization« or as a dual protection method
Kerry Richter, LESSONS LEARNED IN MARKETING THE FEMALE CONDOM, Unpublished.

]
 Social Marketing, Cont.
‡ Who uses? (Zimbabwe, Zambia)
‡ FC users are more educated, of higher SES and
more urban than male condom users
‡ The majority of FC users have already tried the
MC. (
-  are new users)
‡ The FC is most often used with regular partners.
‡ Approximately  of those who have
purchased FC discontinue use with the largest
reason being that their partners do not like it.
The majority of users continue to use it after the
first time.
]c
 Social Marketing, cont.
Key Lessons from SM:
‡ The most successful programs have a BCC
element
‡ The strategy to make the product attractive and
at a low price does not suffice
‡ Users must be not only interested, but also
comfortable with their understanding of insertion
‡ Media are not the most effective tools in
increasing the rate of utilisation because the
targets are very specific, however, media is
useful in de-stigmatizing the product and raising
general awareness. ]]
Cost-Effectiveness

]°
 Cost-effectiveness of introducing
FC to CSWs in South Africa
‡ Major Assumptions:
± ,¢¢¢ CSWs averaging ¢ acts/year
± HIV prevalence: ¢ CSWs,  clients
± FC used in
 sexual acts
± $¢¢
to distribute ¢¢¢ FCs
‡ Outcomes:
± Cases averted: .9 HIV,  syphilis,  GC
± $
,¢9¢ saved in HIV/AIDS treatment costs
± $ ,¢ saved in syphilis and GC treatment costs
± Net savings: ($
,¢9¢ + $ ,¢) - $¢¢
= $9, 

± Not only cost-effective, but cost-saving
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Lessons Learned

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 Kaler,
¢¢ Lessons Learned
Interviews of  stakeholders in USA and RSA
about the RSA FC experience

‡ Significance of Key Advocates

‡ Investment in large scaling-up crucial
‡ Address Health Workers discomfort with frank
talk about female anatomy and sex
‡ Positioning strategies important
‡ Use a long-term perspective
](
Source: Kaler, 
) 
* 
, Nov-Dec.
¢¢