Guest guest Posted October 1, 2005 Report Share Posted October 1, 2005 Dear All, Over the past fourteen years, Population Services International (PSI) has been working with brothel-based women in prostitution (WIP) in Mumbai. In August 2004, the female condom was introduced in the red light districts of Mumbai, Vashi and Bhiwandi. As a novel product, the female condom has faced various vicissitudes with regard to levels of awareness, acceptance and usage among WIP. It has been a year since we launched the female condom, and we would like to share our insights and experiences with the health community. If you are interested in further information on the female condom, or if you would like to share your experiences with us, please contact Arundati Muralidharan at arundati@.... Thank you very much. Sincerely, Dr. Shilpa Merchant PSI India, National HIV/AIDS Coordinator Email- shilpa@... RISHTAA - THE FEMALE CONDOM Over the past fourteen years, Population Services International (PSI) has endeavored to decrease the overall incidence of HIV/AIDS in brothel-based women in prostitution (WIP) in Mumbai. The main objectives of PSI’s Mumbai Red Light District (RLD) Project are (a) to increase correct and consistent condom usage with paying and non-paying partners ( to augment the number of women who seek STI treatment from a qualified medical practitioner and complete the treatment In August 2004, based on continual need assessments and situational analyses, the female condom was introduced in the red light districts of Mumbai, Vashi and Bhiwandi. As a novel product, the female condom has faced various vicissitudes with regard to levels of awareness, acceptance and usage among WIP. Description of the Female Condom[1] Ø The female condom is a loose fitting polyurethane sheath about 6.5 inches long with a flexible ring at each end. Polyurethane is a soft, thin, supple plastic which is approximately forty times stronger than latex. It also conducts heat, so when the condom is inserted, it conducts body heat. Sex therefore, feels very pleasurable and natural with the female condom. Ø The female condom adheres to the walls of the vagina during intercourse and acts as a barrier protection against HIV, STIs (Sexually Transmitted Infections) and unintended pregnancies. Ø The female condom is pre-lubricated with silicone. A glycerin-based lubricant is provided for additional lubrication. The lubricant is water based and does not contain spermicide. The lubricant allows for easy entry of the penis into the vagina. Ø The female condom can be inserted up to four hours prior to sex, and therefore does not interrupt sexual spontaneity. The Necessity for the Launch of the Female Condom Ø Although the male condom has been extensively promoted and widely distributed by various health organizations in the red light area for over a decade, inconsistent condom usage is still a significant problem. Ø The actual level of condom usage is markedly lower than the reported level of condom usage. Ø Due to financial constraints and coercion from gharwalis, or brothel-owners, the women engage in unprotected sex acts with intoxicated and unwilling customers who refuse to wear a condom. Ø WIP do not adequately perceive risk with their husbands, and if they do so, they are apprehensive that insistence on condom usage will result in a breach of trust and jeopardize their relationships. The decision-making authority with regard to condom usage lies predominantly in the hands of the male partner. The Main Objectives of the Introduction of the Female Condom In August 2004, PSI introduced Rishtaa, the female condom, to brothel-based WIP in Mumbai, Vashi and Bhiwandi to (a) widen the basket of preventative products available ( ameliorate overall levels of protected sex acts which would reduce the incidence of HIV/AIDS, STIs and unwanted pregnancies © strenghthen the decision-making abilities and condom negotiation skills of WIP Triggers and Barriers to Female Condom Usage Triggers Barriers Provides protection against HIV/AIDS and STIs Pain and expectation of pain during intercourse Comfort due to additional lubrication during sex Cumbersome and time-consuming to insert the female condom. Pleasure for the client/husband during sex The method of insertion considered challenging. Dual advantage – provides a preventative option with drunk and unwilling customers as well as increased earnings (usually WIP turn away clients that refuse to wear a condom) Fear related to the anticipated response from paying and non-paying partners The women are able to use the female condom without the client being aware Communication in the Field Ø In order to convey the benefits of the female condom, various innovative tools and materials, or IEC (Information, Education, Communication) materials, were comprehensively developed to emphasize the female condom as another preventative option available to WIP. Ø Inter-personal communicators (IPCs) promote and distribute female condoms, while concurrently addressing the barriers to female condom usage in one-to-one and one-to-group sessions, and through the implementation of IEC materials. Ø In order to identify positive reactions and address the barriers to female condom usage, PSI established a stringent follow-up system in the initial introduction phase, which tracked the experiences of WIP who had procured the female condom. Ø The female condom is available at a subsidized rate of Rs. 2 per condom Behavioral Change Impact Survey – A Research Study In December 2004, a comprehensive baseline study was carried out with 489 respondents, which also assessed the knowledge, attitudes and practices of WIP with regard to the female condom. The focal findings were: (a) The proportion of WIP aware of the female condom was 81%, out of which 54% had ever used it ( Out of those WIP who had ever used the female condom, 81% currently use it © The primary reasons for discontinued use of the female condom were pain during use, the female condom was not available at the time of sex, and the lack of perception of necessity for the female condom (d) Out of those WIP who had ever used the female condom, a majority (71%) did so with unwilling clients, 29% with intoxicated clients, 17% with regular customers and 8% with their husbands (e) Majority of the WIPs (68%) intend to use the female condom in the future Since December 2004, PSI has taken into consideration the research findings, and in order to fill the need gaps, PSI has planned and implemented significant modifications in communication and field strategies. Although there has been perceptible progress, particularly with regard to levels of awareness of the female condom, it is imperative to increase sustained levels of female condom usage, so as to augment the overall number of protected sex acts in the red light area. Reminiscent of the male condom, the female condom needs to supersede inexorable barriers as a new product, and more importantly, as an entirely novel approach to protection and contraception. [1] The content of this section is a direct quotation from a brief provided by the Female Health Company (UK manufacturers of the female condom) Quote Link to comment Share on other sites More sharing options...
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