Female Condoms Improve Public Health in Madagascar

The availability of female condoms is associated with more condom use, and thus better protection against sexually transmitted infections (STIs), according to results of a USAID-supported study in Madagascar.

When female condoms were added to a male-condom distribution system for sex workers, the use of protection with paying partners increased. The proportion of sex acts in which male or female condoms were used rose from 78 percent to 88 percent among paying partners. Use of protection with nonpaying partners remained steady at fewer than 30 percent of sex acts. The prevalence of STIs in the study population declined from 50 percent to 40 percent.

The scientists also found that peer counseling was sufficient for successful promotion of the female condom. Participants who were randomly assigned to receive supplemental clinic-based counseling on male and female condoms did not experience further increases in condom use or reductions in STI prevalence.

Although the study was not designed to prove a causal relationship between the use of female condoms and changes in condom use or STI prevalence, the findings suggest that increasing the availability of female condoms can improve public health.

This study followed 1,000 sex workers for 18 months. Male condoms were promoted for the entire period and female condoms were introduced for the final 12 months. The study was a collaboration among scientists from Family Health International, the University of Antananarivo in Madagascar, the Madagascar Ministry of Health, and the University of North Carolina at Chapel Hill.

To read more about this study in the International Journal of STD & AIDS, click here. For more information about the counseling intervention, detailed in Sexually Transmitted Infections, click here.

Sources
Hoke TH, Feldblum PJ, Van Damme K, et al. Temporal trends in sexually transmitted infection prevalence and condom use following introduction of the female condom to Madagascar sex workers. Int J STD AIDS 2007;18(7):461-466.

Hoke TH, Feldblum PJ, Damme KV, et al. Randomised controlled trial of alternative male and female condom promotion strategies targeting sex workers in Madagascar. Sex Transm Infect 2007;83(6):448-453