Peer support groups boost use of female condom
How can women at risk for sexually transmitted infections (STIs) protect themselves when their partners are reluctant to wear condoms? Initial unpublished research results from Brazil and Kenya show that when women are provided female condoms and allowed to share strategies through peer support groups, they are able to overcome obstacles to safe sex.
The study was coordinated by the Women’s Initiative of Family Health International’s AIDS Control and Prevention (AIDSCAP) Project in Arlington, VA. Supported by the U.S. Agency for International Development, scientists conducted the research from February to October 1996 in Brazil and from October 1995 to July 1996 in Kenya to gauge acceptability of the female condom in countries where it was unavailable.
While women may want to protect themselves from HIV and other STIs, negotiating condom use with male partners may prove problematic. Cultural differences may keep women from confronting the issue with their partners, says Wanjiku Mukabi Kabira, PhD, a gender training specialist at the University of Nairobi and one of the principal investigators of the Kenya trial.
Gender differences concerning sexuality have a strong influence in the use of protective and safer sex practices, say researchers with the Brazil study. By having an open forum in which to discuss female condom use and other sexual issues, peer support groups allow women to share strategies in an atmosphere of mutual respect, says Elisabeth Meloni Vieira, MD, PhD, senior program officer of AIDSCAP Brazil in São Paulo, who provided technical assistance in the Brazil study. Principal investigator for the Brazilian study was Suzana Kalckmann, MPH, fellow researcher with the Nucleus of Investigation on Women’s and Child Health of the Institute of Health of São Paulo State Health Department.
A total of 106 women were recruited for the Kenyan trial and 103 for the Brazilian study. Women were selected on the basis of age and socioeconomic status. Data were collected through initial and exit interviews, focus group discussions, peer support group meetings, and a focus group discussion with male partners. One female focus group meeting was held at the beginning of the study, followed by two peer support group meetings, with another focus group meeting at the end of the study. Coital logs were used to gather sexual activity information.
Women in the Kenyan study were split almost evenly in age difference: 54% were below age 25, and 46% were between 26 and 40. The average age of Brazilian participants was 26.5 years. Most of the women in the two research sites had steady partners.
Sharing secrets’ on condom use
Group support was an important element of the process, Kabira says. Women who were afraid or unsuccessful with initial use were prompted by others within the group to try different approaches. The element of group pressure spurred these women to try the new device. Brazilian women used the support groups as a chance to share "secrets," Vieira says.
"Different forms of mutual support appeared inside the groups, such as stimulating the use and curiosity in experiencing the female condom in different situations and positions, suggesting solutions for difficulties of insertion and manipulation, suggesting the additional use of lubricant, and giving support to the difficulties in the negotiation of its use with the partner," she says.
Women in Brazil found ways to counteract opposition to the female condom’s appearance from their partners. If faced with the comment, "it’s ugly," they would reply, "The condom doesn’t have to be pretty or ugly, it has to protect. If it works and doesn’t bother the intercourse, it’s OK!"
Some of the successful strategies discovered by the women in Kenya included:
• Laying the female condom on the bed. This tactic allowed the partner to bring up the subject of use. As one participant said, "I did not tell him that I wanted to try this. I put it on the bed. Then he saw it, and then he was the one who suggested that we try it. In that way, it was not really my suggestion; because it was his, it worked."
• Introducing the method as a form of pregnancy prevention. Women would tell their partners that their doctor had recommended the female condom due to negative side effects experienced with birth control pills. The men accepted this explanation, since they are in favor of reducing family size, do not want to risk their partners’ lives, and found that the female condom did not interfere with their sexual pleasure.
The appearance of staying within cultural norms is very important, Kabira says. If a woman brings up condom use, her partner may take it as a sign that she believes he is unfaithful or that she is having sex outside the relationship. By telling her partner the female condom is for pregnancy prevention, many women were able to negotiate its use. Even if that explanation was not the entire truth, many male partners accepted it.
"It looks like women would prefer to go around obstacles rather to attack them headlong," Kabira notes. "They want to use nonthreatening survival strategies."
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