Scientific Sessions 2015: Comprehensive condom programming (CCP)
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The document discusses the role of condoms in public health and examines successes and challenges of condom use globally and in Sri Lanka. It outlines the history of condom programming in Sri Lanka involving organizations like the Family Planning Association and National STD/AIDS Control Programme. While condom use among high-risk groups has increased, gaps remain. The concept of "Comprehensive Condom Programming" is presented, but there are doubts about its applicability in Sri Lanka given established condom promotion efforts through targeted interventions and STD clinics.
Scientific Sessions 2015: Comprehensive condom programming (CCP)
- 1. Comprehensive condom programming? Dr. G. Weerasinghe Consultant Venereologist NSACP 17th October 2015
- 2. Objectives • To discuss the role of condoms in public health • To examine successes and challenges of condom use in controlling STI/HIV in the world • Condoms in Sri Lanka - History - Achievements - Gaps, challenges & steps ahead • To discuss the concept of “Comprehensive Condom Programming” and its’ relevance to Sri Lanka
- 3. Condoms & public health….. Background In 2013, • an estimated 2.1 million people became newly infected with HIV • an estimated 500 million people acquired chlamydia, gonorrhoea, syphilis and trichomoniasis • there were approximately 80 million unintended pregnancies
- 4. Condoms in public health Three public health priorities where condoms play a central role; • Prevention of HIV • Prevention of sexually transmitted infections • Prevention unintended pregnancies
- 5. Male & female condoms • Condoms - an impermeable barrier to particles the size of sperm and STI pathogens, including HIV - proven by laboratory studies • Research among sero-discordant couples have shown that consistent condom use significantly reduces the risk of HIV transmission both from men to women and women to men • Consistent and correct use of condoms also reduces the risk of acquiring other STIs and associated conditions, including genital warts and cervical cancer • When used consistently and correctly, condoms are very effective in preventing unintended pregnancy (with a failure rate of about 2%)
- 6. condoms in prevention of STI/HIV in the world • India – Avahan project studies conducted in Karnataka & Andra Pradesh • Thailand – 100% condom programme increased condom distribution to sex workers and their clients in combination with other prevention interventions were associated with reductions of transmission of both HIV and other STIs. • Zimbabwe and South Africa - increased condom use was found to contribute to reductions in HIV incidence
- 7. 100% Condom Programme, Annual Number of STI Cases Reported, Thailand Epidemiology & Implications for VCT 0 10 20 30 40 50 60 70 80 90 100 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 0 100 200 300 400 500 Clients using condom STD cases reported 100500 400 300 200 100 0 80 60 40 20 0 Source: Ministry of Public Health, Thailand 2000 Module 1 Sub Module 3 – PPT02 STD cases reported ( thousands) % using condoms
- 8. 100% Condom Programme, Annual new HIV infections, Thailand Epidemiology & Implications for VCT 0 20,000 40,000 60,000 80,000 100,000 120,000 Male Female Child 100% condom programme begins Thai Working Group on AIDS projections 2000 Module 1 Sub Module 3 – PPT02
- 9. What has been achieved globally? • A recent global modelling analysis estimated that condoms have averted around 50 million new HIV infections since the onset of the HIV epidemic • For 2015 - 27 billion condoms were expected to be available globally
- 10. Condoms in Sri Lanka - History
- 11. FPASL – pioneering role • Inaugural meeting of the FPA was held on 15th January 1953 • First family planning clinic of FPA was inaugurated on 2nd September 1953 at De Soysa Maternity Hospital (DMH) and it provided contraceptive services including condoms. • In early 70s - condom social marketing programme and introduction of the brand name ‘preethi’
- 12. FHB • Since 1960 the FHB has been in the forefront in bringing modern methods of FP including condoms to grass-root level through family health care workers who are supposed to be the main link between maternal, child and reproductive health services and community. • The promotion of condoms as a FP method is one of the major task that has been carried out by FHB.
- 13. NSACP Since 1988 • 1988 – 89 – 20,000 • 1990 – 94 – 30,208 • 1995 – 99 – 238,655 • 2000 – 04 – 135,546 • 2005 – 09 – 93,118 Taken from pharmacy records of Central STD clinic – (may not accurate)
- 14. Present situation of condom distribution in Sri Lanka Government sector • FHB • NSACP Commercial sector • FPASL • Other players
- 15. Condoms in numbers (in millions) Year FPASL FHB NSACP Others (including condoms procured through GF funds) Total (Department of census and statistics) 2010 7.8 3.6 0. 25 3.58 15.23 2011 7.9 - 0.18 4.95 13.03 2012 9.5 7.5 0.27 4.54 21.81 2013 10.5 6.0 0.31 9.57 26.38 2014 10.8 4.5 0.32 0.97 16.59
- 16. Comprehensive condom programming • A concept presented by UNFPA in 2010 • In supporting this effort, UNFPA employs a 10- Step Strategic Approach to scale up CCP
- 17. 10-step approach of CCP • Step 1: Establish a National Comprehensive Condom Programming Task Team • Step 2: Undertake a Situation Analysis – a country background information about HIV and CCP • Step 3: Develop a Comprehensive and Integrated National Male/Female condom programming strategy and cost each component • Step 4: Mobilize Resources • Step 6: Develop and implement a Human Resource capacity strengthening plan • Step 7: Develop a Commodity Security Plan and warehousing • Step 8: Develop a condom promotion plan to increase access and utilization. • Step 9: Implement the 5 year Strategic Plan (Walk the Talk) • Step 10: Monitor programme implementation routinely and evaluate outcomes (M & E)
- 18. Condoms, STIs & HIV/AIDS in Sri Lanka R – 9 GF funded programme based on NSP ; 2007 – 11 For the period of 2011-15 • Peer-led targeted interventions - BCI - Promotion of care seeking behaviour - Provision of condoms & lubricants 6.5 millions of condoms procured NFM GF funded programme based on NSP ; 2013-17 For the period of 2016-18 • Peer led targeted interventions - BCI - Promotion of care seeking behaviour - Provision of condoms & lubricants How many condoms are planned to procure ? – 13.5 million
- 19. Condoms use – at last sex with a client Sri Lanka behavioural surveillance survey 2006-7 Integrated biological and behavioural surveillance survey 2014 FSW 90.5% 93% MSM (Colombo) 63.7% 64.6%
- 20. Sources of condoms • FSWs in Colombo (87%), Galle (45%) & Kandy (81%) buy their condoms, but, 30-50% have received condoms from health centers or NGO • MSMs in Colombo (90%), Galle (66%) & Anuradhapura (71%) buy their condoms, though 20-32% have received from health centers or NGO also
- 21. What do we do in Sri Lanka • There is an established condom market • There are major players with public health objectives as well as commercial • Biggest players are driven by market rules • Though there are gaps, SL has achieved successes in promoting condoms among FSW & MSM • Condom promotion is an identified strategy in the NSP of NSACP and that is implemented through peer led targeted interventions and country-wide network of STD clinics • In this context, there are doubts about the necessity of a brand new CCP for Sri Lanka (though some UN partners may think so) and it might cause even adverse effects by attracting un-necessary attention to ongoing activities
- 22. References • UNFPA, WHO and UNAIDS: Position statement on condoms and the prevention of HIV, other sexually transmitted infections and unintended pregnancy, 07 July 2015 • Comprehensive Condom Programming - A guide for resource mobilization and country programming 2010 • Sri Lanka behavioural surveillance survey 2006-7 • Integrated biological and behavioural surveillance survey among key populations at higher risk of HIV in Sri Lanka 2015 • National HIV/AIDS strategic plan 2007 – 11 • National HIV/AIDS strategic plan 2013 – 17 • National STD/AIDS Control Programme Sri Lanka, Annual Report 2014/15 • Family Health Bureau • Sri Lanka Family Planning Association • Department of population census and statistics • Pharmacy records – Central STD/AIDS clinic, Colombo