|Female Condom Use in Vietnam (UNAIDS - Best Practice Digest, 2001, 3 p.)|
Summarised from the report Needs and Acceptability of Female Condoms among Women in Thanh Xuan Commune and Dong Da District, Hanoi, UNAIDS, STI/HIV/AIDS Prevention Centre (SHAPC), WHO. Hanoi, August 2000
For further information, contact Dr. Laurent Zessler, UNAIDS, 44B Ly Thuong Kiet Street, Hanoi, Vietnam. Tel: (84) 934 3417
The number of people infected with HIV/AIDS has increased in Vietnam. The epidemic is now spreading in all 61 provinces of the country.
AIDS has become one of the leading causes of death among women in developing countries. Women at every age have a higher risk of being infected with HIV than men, mainly through sexual intercourse. STIs have increased the infection rate among women. Gender inequality exists in Vietnam. In sexual and intimate relations, women are expected to be passive and to obey their husband or lover. Therefore, it is difficult for them to persuade their partners to use male condoms to prevent pregnancy and HIV infection or other STIs.
The increase in sex workers has also contributed to the spread of infections. Due to poor knowledge and low awareness, many men do not use condoms when having sex with sex workers. Others believe that sex workers from rural areas and pregnant women cannot be infected with STIs.Sex workers cannot always persuade their clients to use condoms.
In such circumstances, female condoms can be an effective alternative to help women be active in the prevention of pregnancy and STIs, including HIV/AIDS. In Vietnam, the first female condoms appear to have been introduced in 1995-6 but there had not been any studies carried out to evaluate the need and acceptability of female condoms for Vietnamese men and women.
Study on the need and the acceptability of female condoms
This study is the initiative of UNAIDS and WHO. In accordance with UNAIDS and WHO policies to strengthen the involvement of private research groups, the STI/HIV/AIDS Prevention Centre (SHAPC) received financial and technical support to carry out the pilot study on the need and acceptability of female condoms in Vietnam.
The main purpose of the study is to explore the attitude of selected groups of women towards female condoms. Specifically, it attempts to understand the need and acceptability of these condoms on the part of women that have contracted STIs. The study was carried out in Thanh Xuan ward, Thanh Xuan District, where there is reportedly a high density of sex workers. It was also conducted in other wards of Dong Da District, Ha Noi, which has many restaurants, hotels, massage parlours and bars. Many of these are involved in the sex trade. In Dong Da District, there are also many private clinics that provide treatment and consultation for STI patients.
The study began in March 2000 and was completed in June 2000.
SHAPC is the implementing agency. It is an NGO established in the country since 1997. All staff members are medical professionals, including professors, doctors and teachers who work as volunteers in HIV/AIDS and STIs prevention. All of them have experience in such fields as research, motivational training, counselling, communication education on STIs/HIV/AIDS, reproductive health and family planning.
The team of interviewers consisted of 22 women. Five staff from SHAPC were selcted as supervisors, all experienced in research. The interviewers of women in the community were chosen from family planning motivators. Five peer-educators from among the female sex workers peer-team interviewed the sex workers. Medical professionals interviewed STI patients.
Some 600 women were recruited for the study, from three social groups:
· Female sex workers, mostly working in restaurants, hotels, karaoke bars and massage parlours.
· Female STI patients, living in different parts of Ha Noi but receiving treatment in the clinics of Dong Da District.
· Community women, including 300 living in the Dong Da District. Most of them were married and of reproductive age.
The interviews only took place after the interviewer had obtained the verbal consent of the women.
Two sets of questionnaires were developed to collect information before and after the trial of the female condoms. The study was carried out in three steps:
· Step 1: interview the target groups before the trial
· Step 2: trial of female condoms
· Step 3: interview after trial
After their training, interviewers were provided with five copies of the questionnaire to conduct pilot interviews. The questionnaire was revised according to the difficulties and problems that arose in the pilot interviews, and then the first questionnaire was presented to interviewees. At the end of the interview, those women who agreed to participate in the trial were provided with three to five female condoms and a brochure of instructions. They were scheduled to meet for the second time to answer the second questionnaire after the trial of female condoms (within three to four weeks).
The group of supervisors, the project director and the technical consultants and staff of UNAIDS supervised and closely followed all the projects activities.
Among the 481 women who agreed to try the female condom, 428 actually used it. These women were willing to share their feelings and impressions and made comments and suggestions on the future distribution of the female condom. More than half of these women affirmed that female condoms were acceptable and 230 said they will continue to use them if they are provided free of charge, or if they can buy them at a suitable price. STI patients and sex workers were particularly interested in trying and in continuing to use female condoms. These figures were encouraging and exceeded the study expectations since this is the first time female condoms have been introduced officially in Vietnam to a considerable number of women.
One of the important feelings highlighted by the women is that female condoms helped them feel active and safe. Some older women said female condoms make them more comfortable without detracting from their pleasure.
The major reason for some women not wishing to continue using these condoms was that the internal circle of the female condom is big and hard and painful for some women.
Due to economic difficulties, lack of time and insufficient knowledge, many women rarely have gynaecological medical examinations. Some of them had contracted STIs but did not know how to protect their husbands; they thought that female condoms were only for protection against pregnancy. After the first interview in the study, many women in the three groups understood that the female condom was an important choice actively contributing to the prevention also of STI/HIV/AIDS. After using the condoms provided, some women went to the office of SHAPC and asked for more condoms.
A highlighted point is that among the three target groups, sex workers had the highest rate of trying female condoms (100%) and their desire to continue using them was also high (84%).
· Strengthen the education activities concerning female condoms in public mass media.
· Continue providing female condoms to users. Give priority to sex workers and women with STIs in order to help them prevent the spread of STIs and HIV/AIDS.
· Continue studying the acceptability and need of female condoms on a larger scale.
· Free provision or sale at promotion price to help poor women use them.