Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 114

4 Condom and Lubricant Programming

Despite the many advantages of condom social marketing programmes, they should not be a
substitute for the distribution of free condoms and lubricants to sex workers. Condoms and lubricants
are essential protective tools for sex workers and should be widely distributed to sex workers as
a matter of policy. Condom social marketing programmes should complement and supplement
free distribution, improving the choice and desirability of condoms and lubricants and making them
more widely available. To coordinate these efforts, programmes can work together at the national
level to adopt a total market approach to condom programming, emphasizing segmentation of the
marketplace, coordination with the private sector and development of targeted branding strategies
for the various marketplace segments.
For more information on a total market approach to condom social marketing, see Abt Associates’
Total Market Initiatives for Reproductive Health (Section 4.4).

4.3 Condom programme management
4.3.1 Roles and responsibilities in condom programming
Figure 4.1 shows how condom programming is managed through partnerships and coordination
among organizations at multiple levels of government and NGOs.

4.3.2 Programme monitoring
Table 4.3 provides monitoring indicators and their data sources that may be used to manage a condom
promotion programme.

4.3.3 Evaluation
Evaluating the effectiveness of condom promotion and distribution with sex workers supplements
regular programme monitoring and provides key data on whether programmes have effectively
changed condom use behaviours of sex workers and clients. While a variety of evaluation
methodologies and tools may be used, the most common include routine collection of condom
distribution and sales data, behavioural surveillance surveys, condom coverage surveys, and process
evaluations using routine monitoring data.
Behavioural surveillance surveys are conducted at regular intervals (every 2–4 years) with both
sex workers and clients to determine the effect of interventions on health outcomes. These surveys
measure changes in self-reported condom use as well as changes in identified motivations and
barriers to condom use. Some behavioural surveillance surveys may also incorporate biomarkers
that measure HIV and/or STI prevalence.
Condom coverage surveys are generally employed by social marketing programmes. These surveys
use lot quality assurance sampling to measure levels of condom coverage and quality of coverage
in mapped enumeration areas.
A process evaluation using routine monitoring data may be an instructive way to measure progress
on condom programme outputs. In particular, condom supply indicators may be measured through
routine programme reporting and use of an LMIS. Review of these data at regular intervals helps
understand whether condoms are sufficiently available to sex workers.

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