4 Condom and Lubricant Programming
4.1 Introduction
2012 Recommendations: 1 Evidence-based Recommendation 2
The effective supply, distribution and promotion of male and female condoms and lubricants are essential to successful HIV prevention interventions with sex workers. Condoms have been recommended as an HIV prevention method since the mid-1980s and remain the most effective tool for sex workers in preventing HIV transmission. Condom programming therefore occupies a central place in any package of HIV and sexually transmitted infection( STI) prevention, care and treatment services for sex workers. Condom programmes 2 have been successful in increasing condom use in a variety of sex work settings.
Condom programming involves:
• establishing accessible male and female condom and lubricant supplies for sex workers by:
›› forecasting and procurement planning
›› procurement and stock management
›› distribution
• multi-level promotion of male and female condoms and lubricants
• creating an enabling environment for condom programming.
Condom programming for sex workers is a complex task with multiple steps. It requires a partnership of national government, local governments, local nongovernmental organizations( NGOs) and sex worker-led organizations, among others. The meaningful involvement and leadership of the sex worker community 3 are also essential. Respondents to the values and preferences survey 4 unanimously supported condom promotion and distribution to sex workers, stressing the need to make condoms and lubricants more available( particularly in sex work settings), more affordable and of higher quality.
When condom programming is successful, sex workers are provided with stable, ongoing and adequate supplies of condom and lubricant products that are acceptable to them in material, design and pricing. Sex workers are also provided with information and communication messages to reduce barriers to condom use, as well as the skills to correctly and consistently use condoms. Programmes should also create an enabling environment for condom programming that addresses social and legal barriers to expanded condom and lubricant access and use, such as laws and practices that cause sex workers to fear carrying condoms, poor living and working conditions for some sex workers, and lack of support for condom use in the general population and among male clients of sex workers.
1 Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries: recommendations for a public health approach. WHO, UNFPA, UNAIDS, NSWP, 2012.
2 Wherever“ condom programmes” or“ condom programming” is discussed, this refers to programming for male and female condoms and lubricants. Although this tool uses the generic term“ condom” for simplicity, high-quality programmes should include all three of these commodities, as each is important to the prevention of HIV and other STIs. Similarly, when“ condoms and lubricants” are referred to, the term“ condoms” includes both male and female condoms.
3 In most contexts in this tool,“ community” refers to populations of sex workers rather than the broader geographic, social or cultural groupings of which they may be a part. Thus,“ outreach to the community” means outreach to sex workers,“ community-led interventions” are interventions led by sex workers, and“ community members” are sex workers.
4 A global consultation conducted with sex workers by NSWP as part of the process of developing the 2012 Recommendations.
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