Expanding Access and Ensuring Availability

Identifying ‘Sexual Geographies’ can lead to improvements in programming

According to Hirsch, “Just as the first major anthropological critique of HIV research called attention to risky acts, not risky people, here we are saying that it is time to go beyond an overly individualistic emphasis on preventing risky acts and consider the utility of working in risky spaces.”³²⁷ The premise of sexual geographies entails mapping risky spaces and planning spatially specific interventions to modify these risks. The MEASURE Evaluation Project developed the PLACE methodology for the purpose of identifying such places, such as bars, nightclubs, dance halls, etc.³²⁸ PLACE has been used in a number of countries, including, for example, Jamaica, Russia and Zimbabwe.³³⁶ Figure 4 shows an example of a program coverage map for condom availability in an area of South Africa.

Figure 5: Map from South Africa Showing Condom Availability at Sites – Generated from PLACE Methodology. Source: MEASURE Evaluation.

Social networks are powerful determinants of risk perceptions and protective behaviors

  Understanding the factors that affect individuals' perceptions of their risk and of acceptable risk-reduction strategies is an essential step towards curbing the spread of HIV. Social networks are powerful methods of transferring knowledge and information, and can have a major impact on how people perceive and respond to the threat of HIV. Longitudinal survey data from rural Kenya and Malawi shows that social networks have significant and substantial effects on risk perception and the adoption of new behaviors, even after controlling for unobserved factors.³³⁷ Analysis from Likoma Island, Malawi suggests that a substantial proportion of the island’s young people are linked in a large and robust sexual network.³³⁸ Evidence from Malawi also shows that increases in condom use among non-marital partners coincides with increased social pressure to report condom use.³³⁹ This evidence suggests that understanding the reach of social networks is important for fostering locally acceptable prevention strategies and for promoting condom use.

International standards need to be maintained to ensure high quality condoms

Most condoms procured and distributed with donor support are manufactured according to international standards [see Box 13: Condom Production]. Agencies such as the International Organization for Standardization (ISO), the Comité Européen de Normalisation (CEN), and the American Society for Testing and Materials (ASTM) have established condom manufacturing standards for size, quality, and packaging and labeling.³⁴⁰ The WHO and UNAIDS also provide guidelines for condom procurement that include these international standards. UNFPA, USAID and other organizations that purchase condoms in large quantities require their suppliers to conform to international standards and test condoms for quality assurance.³⁴¹

Box 13: Condom Production

Today, condom production takes place on nearly every continent and in approximately 15 countries across the globe. Most condoms produced are latex, while condoms produced from synthetic rubber account for seven to eight percent of the world’s condom market.³²⁹ Led by production efforts in China, India, Thailand and the United States³³⁰, the world’s condom manufacturers are producing an estimated 10 to 12 billion pieces annually.³³¹ Given the increase in the number of condom manufacturers in the 1990s³³², today there exist anywhere from 90 to 110 manufacturing plants.³³³ The majority of these plants are in areas that can offer competitive labor rates and are home to natural rubber latex plantations, but production efforts have also cropped up in places like South Africa and Iran. Together, these manufacturers supply condoms to an array of private companies, government entities, international donors, and multilateral organizations, as well as producing their own retail brands.

The growing capacity of some developing countries to produce condoms domestically and at low cost, particularly in Asia, plays an important role in meeting global demand. UNFPA has helped to facilitate this growth and improve quality and quantity of production, by providing assistance to condom manufacturing companies in developing countries. In China, Vietnam and India, UNFPA provides equipment to manufacturing companies, and supports condom testing and latex research.³³⁴ Today, some Asian condom producers are even supplying to USAID—a scenario unheard of before 2004 when USAID exercised for the first time its authority to waive a “buy America” law requiring that only American-made condoms could be distributed to its field programs, except under certain circumstances. When U.S. suppliers were unable to meet the demand of the USAID’s field programs, the donor agency began procuring additional condoms from companies in Thailand, China, and South Korea.³³⁵

Distribution of Female Condoms Needs to Increase Dramatically  

"Although the female condom is an effective tool for HIV prevention that is available today, this method is not readily accessible throughout the world due to cost, stigma and a lack of political will." (Sippel, 2008: 3, cited in CHANGE 2008).³⁴²

The number of female condoms distributed has been rising steadily—in 2006, the Female Health Company sold roughly 19 million condoms, as shown in Figure 5. Distribution has increased most in Africa, whereas in Asia female condoms remain rare. Compared to the estimated 10 to 12 billion male condoms produced annually, female condoms still only account for about 0.2 percent of the total global supply of condoms. Furthermore, although the female condom is available in 108 countries, in many instances it is not readily accessible.³⁴³ To generate demand and increase availability, greater support needs to be devoted to the strategic introduction, marketing and programming of female condoms in countries.

Please see the Appendix for this section's end notes.