Introducing female condoms to female sex workers in Central America
Female condoms have a potential role in reducing HIV infection among female sex workers in Central America. Research on how to introduce female condoms to this population is warranted. Two rounds of focus groups with sex workers (115 in round one and 81 in round two) were conducted in El Salvador and Nicaragua in 2007-2008. In addition, Mack and colleagues conducted structured interviews with 95 sex workers and direct observations of six health educators. Women reported that the design of the female condom made insertion and removal difficult to learn. About one-third of participants reported inserting it for the first time alone. Most women reported practicing 2-10 times before feeling skilled enough to use it with partners. Positive perceptions included lubrication, size, comfort and strength. Negative perceptions included the large package, initial physical discomfort and the possibility that the device would scare clients away. The participants preferred to learn to use female condoms from an instructional brochure plus instructor-led training in their workplace. They cited lack of exposure to female condoms among men and women as a barrier to female condom use and recommended education for both men and women; they also recommended distribution of female condoms at places where male condoms are available. If provisions are made for instructing women on female condom use in places where women will not feel stigmatized, and if supplies are easily and consistently available, uptake of the female condom among female sex workers in Central America seems likely. Health educators' use of promotional tools such as checklists and standardized messages is strongly recommended.
Editors’ note: With a new generation of female condoms on the horizon soon to break the monopoly position of FC2, including a tampon-shaped one for easier insertion, it is time to get serious about marketing strategies to bring this orphan product into the mainstream of HIV prevention options. This mixed methods study (using qualitative and quantitative methodologies) among sex professionals in El Salvador and Nicaragua is an excellent example of pre-market research. It reveals the communication channels, messages, and materials that would best complement skills-building to achieve excellent uptake and increase the number of protected sex acts among sex workers. Similar pre-marketing studies are needed with specific populations of women in this and other settings, including adolescents, young sexually active women, women in serodiscordant couples, university and college students, factory workers, and many others. With prices anticipated to drop with the advent of competition, it is high time for female condoms to be taken seriously by international and national policy makers, donors and other development partners, as well as women’s organisations, so that they enter centre stage to become a serious option for women worldwide.
