Use skills training to boost female condom use
While female condoms may be a powerful tool in preventing transmission of sexually transmitted diseases (STDs), women need education to use them effectively. Results from a newly published study indicate that skills training can increase female condom use and the overall level of protected sexual acts.1
Using a randomized trial with a sample of 409 U.S. women recruited from northern California family planning clinics in Concord, Mountain View, Santa Cruz, and San Francisco, researchers looked at whether female condom skills training would successfully lead to an increase in sustained use of female condoms and protected sex. Women in the study were randomly assigned to a four- session female condom skills training intervention or a comparison four-session women's general health promotion intervention. Both groups were followed for six months. When compared to those in the comparison group, women in the experimental group reported increased female condom use but no reduction in male condom use.1
The female condom is important because it gives women another option, says the study's lead research scientist, Kyung-Hee Choi, PhD, MPH, a professor in the Center for AIDS Prevention Studies at the University of California, San Francisco. There are many women who have partners who don't like to use the male condom, so if they have another option, such as the female condom, that gives those women an alternative, she explains.
"If a woman's partner says, 'You know I don't like male condoms,' then the woman can say, 'OK, if you don't like male condoms, I have female condoms, so why don't we try it?'" Choi observes. "I think that's why it is important for women to have other options."
The importance of female condoms cannot be overstated, because female condoms are the only game in town for women who are unable to get their partners to use male condoms, states Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta.
Use education sessions
In the study, researchers designed identical formats and time periods for the experimental and comparison interventions. Three sessions of both interventions were delivered individually by a health educator. The first two sessions lasted two hours each, and the fourth session lasted 30 minutes. The third session of both interventions was conducted in small groups of six to 10 participants and was facilitated by two health educators. This session lasted for 2½ hours.
The experimental intervention demonstrated how to use the female condom on a female pelvic model. It was followed by self-insertion and removal practice with three samples in a private area, as well as discussion of difficulties that arose during the practice. The comparison intervention demonstrated female condom use only with a pelvic model. All participants received monetary incentives after completing each session, with $20 each paid at the first two sessions, $30 at the third session, and a $10 gift card at the final session.1
During the study, participants received male and female condoms regardless of their intervention assignment. When women concluded the first intervention session, they received condom supplies based on their reported amount of sexual activity. One month after completion of their last intervention session, women received condom supplies by mail; for the next four months, condom supplies were mailed once a month. Support for the study was provided by the National Institute of Child Health and Human Development.
How to increase use?
Choi's research team has just finished the pilot phase of a three-phase study designed to develop a network intervention aimed at increasing female condom use among ethnically diverse women. It looks at training peers as health educators, providing them with education on how to use the female condom and benefits of the method, and allowing them to disseminate that information through peer networks, explains Choi.
U.S. studies have found low levels of lifetime use, ranging between 3% and 6%.2-4 The time to increase use of the female condom is now, states a report released by international agency Oxfam and the World Population Foundation. The report, "Failing Women, Withholding Protection," was released at the August 2008 International AIDS Conference.
In 2007, about 423 male condoms were produced worldwide for every female condom, the report states.5 One impetus may be cost; female condoms have a unit cost about 18 times above that of male condoms.2 The levels of investment and programming needed to increase the choice of available female condoms, to lower prices and to expand production are highly feasible, the report states.5 Prices in the United States for female condoms might drop if the second generation of the FC Female Condom, produced by the Female Health Co., is approved for use in the U.S. Made of nitrile, the FC2 condom carries a less expensive manufacturing cost. [Patient handout on the female condom.]
Farah Karimi, an Oxfam spokeswoman, said in a statement accompanying the report's release that the only method that women have to protect themselves from HIV/AIDS is the female condom. "It has been embraced in many countries and cultures, it works, and it is cost-effective," she said. "Political leadership and funding are needed now. No more excuses."
References
- Choi K-H, et al. The efficacy of female condom skills training in HIV risk reduction among women: a randomized, controlled trial. AJPH Oct. 2008; embargoed until 8/13/08.
- Hoffman S, Exner TM, Leu CS, et al. Female-condom use in a gender-specific family planning clinic trial. Am J Public Health 2003; 93:1,897-1,903.
- Van Devanter N, Gonzales V, Merzel C, et al. Effect of an STD/HIV behavioral intervention on women's use of the female condom. Am J Public Health 2002; 92:109-115.
- Witte SS, El-Bassel N, Gilbert L, et al. Promoting female condom use to heterosexual couples: Findings from a randomized clinical trial. Perspect Sex Reprod Health 2006; 38:148-154.
- Oxfam International and World Population Foundation. Failing Women, Withholding Protection. August 2008. Accessed at www.oxfam.org/files.
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