Source: TrustLaw
When women in Zimbabwe visit a beauty shop, many will leave with more than a new hairdo. Some 1,500 hairdressers around the country prominently display and sell female condoms.

 

They also provide women with on-the-spot lessons in how to use them, not just as protective shields against HIV nfection but as seductive elements in sexual activity.

Part of an innovative program integrating family planning, HIV testing and counseling, this unusual salon offering is just one key to Zimbabwe’s success in reducing HIV infection rates from 30 percent of the population in 1999 to just under 14 percent today, Dr Karin Hatzold, senior director of HIV services for Population Services International (PSI)-Zimbabwe in Harare, told TrustLaw.

Begun in 2009, PSI-Zimbabwe’s program has a four-pronged approach aimed at preventing: HIV infection among young women; transmission of HIV through unintended pregnancy; transmission of the infection from HIV-positive mothers to their infants and support for mothers and their families.

“Traditionally, the Preventing Mother to Child Transmission (PMTCT) programs have focused on prongs three and four. Now people are waking up and realizing that prong two is also so important to prevention,” said Hatzold, referring to contraception.

Funded primarily by the Dutch government, USAID and the UK’s Department for International Development, PSI-Zimbabwe operates 18 centers for family planning, HIV testing and counseling, along with 23 outreach teams who travel daily to more remote areas. There are also 15 centers providing post-testing support services and advice on antiretroviral therapy (ART). The centers currently do not provide the ART drugs, but hope to do so in the future, she said.

PSI-Zimbabwe’s early success with integrated programming, reflected in increased HIV testing, condom use as well as access to and use of ART, provides a template for best practices that can be adopted by other countries, particularly in hard-hit southern Africa where one in three people between 30 and 35 years old are HIV-positive, said Hatzold.

Integrated programming stresses the use of dual protection, in which couples use both a male or female condom along with another family planning method, such as the birth control pill, a contraceptive injection or implant or an intrauterine device (IUD).

The female condom – less likely to break than the male condom – has been a focus of PSI-Zimbabwe. It introduced the promotion of female condoms at hair salons since, if a woman can afford a haircut, she can probably afford to purchase a pack of two condoms for 1 U.S. dollar, said Hatzold.

She emphasised that with a female condom a woman is in control, noting that if a man is drunk he might not even notice that a woman is using it. On the other hand, women can put it on in advance or even use putting it on as part of foreplay.

“Men say it’s definitely pleasurable to have sex with a female condom as opposed to the male condom,” Hatzold said, noting the only complaint is that the female condom tends to be squeaky.

The role of family planning in the battle against HIV/AIDS, while long recognized, is receiving greater emphasis and gaining momentum in the drive toward more integrated services, she said, noting the attention given to integrated programming at the recent 2011 International Conference on Family Planning: Research and Best Practices in Dakar, Senegal.

As a result, long-standing hurdles to integrating family planning with HIV services, such as diverse funding mechanisms, different administrative departments at the national level and different physical points of delivery at the local level, are “slowly disappearing,” said Hatzold.

Hatzold pointed out that in 2005 only 20 percent of Zimbabweans went for HIV testing, a figure that now stands at 63 percent, closing in on the national target of 80 percent.

“If people know their HIV status, especially in these discordant couples (where one is HIV-positive and the other is not), they are more likely to protect the other partner.”

“This, together with the female condom, the male condom and the behavior change has greatly contributed to the success story in Zimbabwe,” said Hatzold.

Every month, the centers reach over 35,000 people, including 12,000 new people accessing HIV counseling, according to PSI-Zimbabwe.

Another area of focus for PSI-Zimbabwe has been male circumcision, a procedure that reduces HIV transmission by about 60 percent. In a region where the fear of HIV is widespread, that statistic is a strong motivation, Hatzold said.

“The other selling point is not only HIV prevention, hygiene and less STDS (sexually transmitted diseases) but also you can last longer—so the partner is happier,” she said, referring to the fact that apparently circumcised men can retain erections longer.

She noted that a new song composed about “the pleasure and coolness” of men who have been circumcised is slated for debut this week at the International Conference on AIDS, which opened Dec. 4 in Addis Ababa, Ethiopia.

 

• Zimbabwe