Malawi: A guaranteed income

Outside a faded apartment in the capital Lilongwe stands Violet. She has traded sex for money since 2006. But now she is not selling sex; instead she is selling hairdressing services. Violet recounts her story:

‘Sometimes I cry myself to sleep when I look back at my life. I never thought I‘d measure a successful day at work by the number of men I had entertained in bed. I entered the sex trade at the age of 22 after losing both parents. I have five younger siblings to look after. I needed to work to provide for them, but there was nothing I was trained to do so I began to have sex for money.

As a young sex worker life was difficult. I was beaten by clients, robbed of money by older sex workers, had clients who refused to pay and was arrested by the police a number of times. All this for barely $3 a day.

Then I was given a life-changing chance by the Family Planning Association of Malawi (FPAM) – to learn a skill. I was given a choice to learn about catering, tailoring, hairdressing or mushroom farming. I opted for hairdressing. When I finished my training I was lent some money to start up my own hairdressing salon in a market. It’s called ‘Tithandizane’ which means ‘Let’s help each other’.

I now make enough money to support myself and my siblings. When I was a sex worker, I had no guarantee about clients, and many days I returned with nothing. Now, I go home everyday with money in my pocket.

Before I became involved with FPAM’s project, I knew little about sexually transmitted infections, family planning or HIV. But part of my training was also about how to look after my sexual health. FPAM’s clinic provides a number of sexual health services for sex workers, such as pregnancy tests, STI treatment, voluntary counselling and HIV testing. There are also free condoms! I am now a peer educator for the project. I help other sex workers and let them know about this clinic where they can receive healthcare from people who will not judge them. They too have the opportunity to learn some new livelihood skills, giving them the chance to earn money in other ways than selling sex.’

This is one of the twenty-four, real-life stories highlighting how IPPF's work is having a real impact in the lives of people around the world. 'In A Life' is available at: http://www.ippf.org/en/Resources/Reports-reviews/In+a+life+2010.htm 

Egypt: Knowing my HIV status

Organizations such as the Egyptian Family Planning Association (EFPA) are reaching out to young people. EFPA provides the sexual heath and family planning services that young Egyptians are often unable or too scared to ask for:

‘As a young man in Egypt I had never discussed HIV. After attending a seminar about it, I suddenly realized that my past sexual behaviour may have put me at risk. I desperately wanted to know my HIV status but at the same time I was afraid.

Some friends told me about a youth seminar that EFPA was holding at my school. They said it would be fun, so I decided to go.

At the seminar EFPA gave us information on HIV prevention and transmission. I didn’t know anything about HIV and was terrified because I hadn’t thought about it before and I’d had unprotected sex. Immediately after the session I decided to ask one of the young peer educators some questions because I was very anxious and needed answers.

I didn’t want to ask directly so I asked on ‘behalf of a friend’. When he finished answering the questions, he smiled and said “Tell your friend to come to the youth friendly corner at the clinic where he can ask questions and receive counselling and testing for HIV if he wants to. It is done in privacy and total confidentiality.”

After agonizing about it, I took the decision to visit the clinic.

When I arrived I saw the young peer educator from the seminar there. I told him that my friend wanted more information, but he refuses to come himself. We went to the information corner together. It was easy to talk to him and I suddenly forgot that I was asking these questions on behalf of my friend. I confided in him about all the unsafe sexual behaviours I’d practised. He told me about what I could do to find out my HIV status. At the end of the meeting I decided to have an HIV test. I was very scared until I had the post-test counselling.

When I received the test results, they were negative. I was very relieved but also very glad that I had been tested as I understand a lot more about HIV. I now know about the risk of unprotected sex and have decided to always protect myself in future. I’ve also told all my friends about the EFPA clinic. It is a place where you can confidentially talk about your sex life, get some good advice and services.’

This is one of the twenty-four, real-life stories highlighting how IPPF's work is having a real impact in the lives of people around the world. 'In A Life' is available at: http://www.ippf.org/en/Resources/Reports-reviews/In+a+life+2010.htm

The role of pleasure in condom programming

By Arushi Singh (IPPF SARO)

S-E-X. Hardly have three letters been so controversial. One would almost think that sex is not a central part of people’s lives, but the fact is that human beings are sexual beings.

People have sex for many different reasons; however, the pursuit of pleasure is often the primary motivation. As most new HIV infections are transmitted sexually, we need a prevention approach that is innovative and honest about the role of pleasure in sexual behaviour. We need a pleasure approach, one that takes a positive, liberating and sexy approach to safer sex.

Unfortunately, pleasure is a relatively unexplored avenue for safer sex promotion and HIV prevention, especially in resource-poor settings. This is due to many reasons, including societal norms about sex and sexuality that tend towards silence and shame. Gender roles, in mostly patriarchal societies, demand that women remain unaware of sex and be passive ‘receivers’ rather than active pleasure seekers. Equally, young people’s sexuality tends to be denied with limited information on the male and female body, sex, sexuality and relationships available to them. When it comes to people living with HIV, there is often heightened stigma surrounding their sexuality, some people are of the opinion that they shouldn’t be having sex at all – let alone for pleasure!

Condom programmes need to re-focus people’s attention on the ways in which condoms can enhance pleasure, not reduce it. In fact, evidence from around the world suggests that a sexier, more pleasure-focused approach to promoting male and female condoms could increase safer sex practices and lower rates of sexually transmitted infections worldwide . The Global Mapping of Pleasure, a publication by the Pleasure Project, provides exciting examples of a wide range of such initiatives.

The case studies show that creating an effective intervention requires getting specific information about the kind of sex the target audience is having – or wishes to have. Moreover, it requires getting specific information about how to have safer, pleasurable sex; using language more commonly used with sexual partners than with health providers or promoters. Providing extra thin, coloured, flavoured or textured condoms, along with water-based lubricants, can go a long way in promoting the use of condoms. And teaching people how to put on a condom with conviction – including with the mouth – can be both pleasurable and preventative.

The female condom presents similar options for promoting pleasure with its use for vaginal and anal sex and the possibility of using oil-based lubricants. In addition, non-penetrative sex can be just as exciting, pleasurable and kinky. Thigh sex, breast sex, mutual masturbation, sex toys, all with lots of lubrication thrown in, are useful tips for a peer educator to promote. If we are really going to address the HIV epidemic, we need to change mindsets about sex, sexuality and condoms. The Pleasure Project believes that you can have safer sex if you know how to have good sex.

Useful Internet resource:
• The Pleasure Project

Article available from IPPF HIV Update newsletter - Issue 23: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+23.htm

The condom gap: widening or narrowing?

By Taina Nakari (SUPPORT) and Dieneke ter Huurne (IPPF)

Condoms should be a critical element of any HIV prevention strategy. When used consistently and correctly, male and female condoms are approximately 80% effective in preventing HIV transmission. This is significantly more than male circumcision or current microbicide candidates. Moreover, condoms are the only dual protection method available for the prevention of HIV/STIs and unintended pregnancies.

Yet, the gap between the number of condoms needed and the number of condoms available is staggeringly high. In 2005, UNFPA estimated that at least 17.5 billion condoms were needed for HIV prevention and family planning. However, only 10.4 billion condoms were distributed that year – 22% of those through donor support (http://www.avert.org/condoms.htm). Male condoms make up the vast majority (99.6%) of globally distributed condoms. As a result, the condom gap for female condoms is even greater. In sub-Saharan Africa, for example, female condoms are only available at a rate of one for every 300 women per year.

Why is there a condom gap?
Donor support is a contributing factor. In low- and middle income countries, almost one in four people depend on donor-financed condoms to meet their HIV prevention and family planning needs. However, funding for condoms has stagnated in recent years – despite the fact that funding for the HIV response increased dramatically until 2008 (from $ 1.6 billion in 2001 to $15.6 billion in 2008). Donors appear to have lost interest in condoms and are shifting their resources and attention to newer and seemingly sexier issues.

In 2008, for example, donors spent $80 million on purchasing male and female condoms, while investments in research and development for an HIV vaccine and microbicides reached more than $1.1 billion (http://www.aidsmap.com/page/1435164). In their search for new methods, donors have overlooked condoms, which already exist as an effective prevention method and need to be scaled up. The choice to fund either new prevention research or condoms is a false dichotomy (often promoted by donors) and should not be the reason to neglect comprehensive and sustainable condom programming.

National governments often also fail to include commodities in their national budget, or reduce the money for condoms to fill gaps in other budget lines. IPPF Member Associations in Bangladesh, Tanzania, Uganda and Mexico took on this issue, and – through targeted advocacy – helped to increase government and state funding for reproductive health supplies by $11.5 million between 2008 and 2010. Such measures are all the more important as donors are now increasingly providing development aid through basket funding and budget support.

But there is more to the condom gap than funding for the commodity alone. Condom programmes need to be comprehensive in their approach to both supply and demand – ensuring quality, sound storage and distribution, and effective promotion. These components are often overlooked, or not carried out properly. This has resulted in inadequate supply and stubbornly low utilization figures.

With a growing population and the largest generation of young people in history becoming sexually active, the need for condoms is expected to increase significantly over the coming years. For the condom gap to be narrowed, efforts need to be exponentially expanded –by fully integrating condoms into existing HIV and sexual and reproductive health strategies and programmes.

As part of the UNAIDS Interagency Task-Team (IATT) on Comprehensive Condom Programming (CCP), SUPPORT and IPPF are working with UNFPA and other organizations to scale up global and national efforts. The IATT has developed a 10-step approach for CCP, and is finalizing guidance on strategic planning, training, demand generation and monitoring and evaluation. Moreover, SUPPORT offers pro-bono technical assistance to develop and implement programmes to increase the availability of - and access to - male and female condoms.

Useful Internet resource:
• UNFPA Comprehensive Condom Programming

Full article available from IPPF HIV Update newsletter - Issue 23: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+23.htm

HIV Update: Condoms

By Kevin Osborne

Over the past decade a great deal of attention, research and funds have been dedicated to the development of new HIV prevention technologies including male circumcision, microbicides, and vaccines. Yet it sometimes appears as if the most effective and proven strategy to prevent the sexual transmission of HIV and other sexually transmitted infections (STIs) has seemingly fallen off the global agenda – condoms.

The recent CAPRISA trial using a tenofovir gel as a microbicide is promising but, at present, condoms are still the most effective tool in our prevention package. However, without an increased investment by governments and donors the substantial discrepancy between the number of male and female condoms needed and the number available will grow ever larger. This ‘condom gap’ is also reflected in IPPF’s service statistics. In 2009, 122 Member Associations distributed over 151.8 million male condoms – a rate of approximately one for every 28 people of reproductive age per year. Only approximately 580,000 female condoms were distributed – that’s only one for every 3,740 people of reproductive age per year.

Generating demand for - and ensuring the ready availability of - condoms and lubricants is seen by many as the cornerstone of a dual protection strategy. In line with IPPF’s goal of linking SRH and HIV, the accessibility of male and female condoms helps prevent both unintended pregnancies and HIV. In many countries – particularly those with generalized HIV epidemics - this is surely the most basic of all solutions. In an environment of scarce resources this ‘back to basics’ approach for a renewed and re-energized focus on comprehensive condom programming needs to complimented by a sound strategy to ensure that the information given translates into practical accessibility for a variety of groups including young women and girls, men who have sex with men and people living with HIV. Advocates for the female and male condom, SRH and HIV programme managers, social marketing agencies and donors should ensure that, irrespective of other competing priorities, condom provision is not compromised. It should be a measure of real organizational and political commitment. No longer should we allow our collective attention to be swayed by a new or sexier topic while work on this basic provision remains to be done.

Pitting prevention against treatment is not a useful argument as both are mutually re-enforcing of each other. At IPPF we have an ever increasing and important role to play to ensure that every sexually active person has access to good quality condoms whenever and wherever they are needed, is motivated to use them appropriately, and has the knowledge to use them correctly. Maybe it is time for us to lead a stronger, sexier condom campaign, one which focuses on pleasure and creates demand for both male and female condoms, as well as lubricant.


Article from IPPF HIV Update newsletter - Issue 23: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+23.htm

HIV prevention revolution

UNAIDS have just launched a social media initiative to revitalize interest in HIV Prevention as every day more than 7000 people are newly infected with HIV worldwide.


Their aim is to inspire and encourage people using social media to know more about preventing HIV in the lead up to World AIDS Day.


Starting October 26 for six consecutive Tuesdays UNAIDS will introduce different themes related to HIV prevention via discussions on facebook, twitter, and AIDSspace.


What are the themes?

Week 1: Why do we need a PreventionRevolution? ● Week 2: Condoms ● Week 3: HIV testing ● Week 4: Knowledge and HIV ● Week 5: Gender Equality and Human Rights ● Week 6: Join the PreventionRevolution!

Each week there will be a different animated film, quizzes and polls as conversation starters. Follow this link to see the first film: http://bit.ly/aWYxoJ

If you like this:

• Re-tweet the key message: Everyday more than 7000 people are infected with HIV. We need a #PreventionRevolution. 
• Add a #twibbon to your avatar! http://twb.ly/a3LMUO
• Share the PreventionRevolution Facebook page—where people can find out about the initiative http://on.fb.me/95aBoI
• Add a sticker to your Facebook profile: http://twb.ly/bQSXBj
• Become an online advocate for the PreventionRevolution and help shape the initiative.
• Join the Google group http://bit.ly/cXDMEK

As this week's theme is CONDOMS, we will be posting articles related to condom programming.