Research to Improve Product Attributes
- Research is needed to determine the optimal shape, size, modulus and thickness of condoms. More desirable condoms would cause less constriction of the glans, have lower modulus for strength and increased sensitivity, be more robust and able to withstand "heavy use" including vigorous, prolonged or non-vaginal intercourse, and be easier to put on and remove. Studies to determine consumer preferences for different condom designs and formulations must accompany these manufacturing modifications. Valid evaluations of variations in product attributes should be comparative, properly masked, and include different populations of users (such as those with and without experience). The goal is to develop affordable, high quality, condoms that couples prefer to use.
- Both the private and public sectors should continue to support research leading to the development and approval of male and female non-latex condoms.
- Studies are needed to evaluate the best lubricants to use in the manufacture of condoms. Evidence suggests that the right quantity, type and placement of lubricant is important for condom functionality, acceptability and safety. In addition, the added value and risk presented by spermicidal lubricants and by dry finishing powders (e.g. talc or cornstarch) should be critically examined.
- Maintaining and improving standards for quality assurance testing remains a priority. Refinements in the test protocols for water leakage, package integrity, and air burst tests are welcome for examination and validation. The more accurately these tests ensure a quality new product and predict success in human use the better. Industry should work with the public sector to develop additional tests that will better approximate the demands placed on condoms during human use, such as a meaningful coital model, and tests of pre-stress and fatigue.
Research to Improve Understanding of Acceptability and Use
- Further behavioral research on human sexuality is urgently needed. Using more sophisticated qualitative methods can help distinguish the reasons why people are unprepared to try condoms from the reasons why people stop using condoms or do not use them correctly and consistently over time. The existing body of research has not gone far enough to tease apart these critical issues. The reasons given for non-use overlap with the reasons given for disliking condoms, and the most important ones have a great deal to do with the dynamics between sexual partners.
Women often assume that their partner will dislike the feel of a condom or fear the consequences of suggesting a condom because of implied infidelity, his or her own. Either partner may not use a condom, assuming it will not work or will break, or they are not at risk. And in the delicate circumstances of an unfolding sexual encounter, where the man often directs the script, he may dislike the feel or genuinely find a condom too tight, fear losing his erection, want to rush to penetration without adequate lubrication, or handle or use the condom roughly with the result that it breaks or slips and both partners lose confidence in it.
A more in-depth analysis of couples' actual experiences would identify the behaviors which may be amenable to change through improved education and counseling. In addition, means could be sought to minimize the negative aspects of condom use and build condoms into scenarios of sexual excitement and mutual partner satisfaction.
- The role of mass media, marketing and other strategies, which encourage condom use, should continue to be examined. FHI/AIDSCAP has distributed some 250 million condoms over the last six years, more than 85 percent of which were sold through social marketing. This impressive distribution has often taken place in the face of social strife, government or religious objections, and in environments of serious resource constraint. Thus marketing as a discipline, once permitted in a country, clearly addresses resistance to condom use.
Even so, we still do not understand what specific factors overcome cultural barriers in countries heretofore resistant to condom promotion, and in which media advertising and education campaigns were previously prohibited. Research is needed to evaluate the constellation of situational factors and other enabling conditions that overcome these barriers. In particular, what kind of information and education is needed by, and effective with, principal decision makers -- government officials, religious leaders and service providers. These findings could then assist efforts at changing behaviors.
The success of mass media and social marketing is salutary. However, it is also important that these strategies not reinforce existing stereotypes about condom use and condom users. Several campaigns that have exploited stereotypes of male dominance and virility simply perpetuate negative gender norms. Parallel efforts to cultivate improved couple communication and negotiating power for women in sexual interactions are thereby undermined.
- We could learn more from successful condom users. Qualitative studies that examine what characterizes a satisfied and accomplished condom user would supply useful information about the skills and personal and relationship attributes that lead to success. Existing data indicate that "experienced" users break condoms infrequently, while "inexperienced" users are prone to breakage. But they tell us little about what transforms the "inexperienced" into the "experienced."
- We need to know more about the relative importance of counseling and mass marketing of condoms in terms of users' understanding of how to use them correctly. With correct information and experience, condoms can be easy to use. However, data on the many ways in which people misuse condoms suggest that throughout the world many would-be users have an inadequate understanding of how to use them correctly. More research is needed into the most successful approaches to counseling and advertising, in terms of form and content, which lead to correct and sustained condom use. Likewise, more research is needed on the behaviors that contribute most frequently to condom failure.
- Condom distribution networks would benefit from increased knowledge of recent research findings about how to handle and store condoms to maximize their reliability. Logistics managers should collaborate with service providers to develop systems to track condom failure in field conditions and correlate these with laboratory measures of quality.
- Sharing non-proprietary product information would be useful. Useful information emerges from the condom industry's post-marketing surveillance of its condoms, especially related to user experience and satisfaction. Everyone would benefit from greater coordination among manufacturers and sharing of this type of information.
by Erin T. McNeill
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