Expanding Access and Ensuring Availability

"In 2007, the number of new HIV infections was 2.5 times higher than the increase in the number of people receiving antiretrovirals, underscoring the pressing need for a stronger commitment to HIV prevention^.299"

In the fight against HIV and AIDS, all aspects of comprehensive prevention are critical. Condoms – both male and female – and contraceptives are key technologies in the fight against HIV. According to a 2003 assessment, only 42 percent of people worldwide who wanted to use a condom during sex could obtain one,³⁰⁰ and unmet need for contraceptives—including among HIV-positive women—remains high. Supportive policies, strong evidenced-based programs and adequate resources are needed to ensure access to and availability of condoms and contraceptives.

The Comprehensive Condom Programming Framework can guide scale up of condom programs-and also applies to contraceptives

In 2007, a coalition of organizations produced a Comprehensive Condom Programming (CCP) framework that includes attention to 1) Leadership and coordination, 2) Demand, 3) Supply, and 4) Support [See Box 10: Comprehensive Condom Programming Framework].³⁰¹ The framework provides 10 steps to guide programming in identification and redress of gaps in provision and use of condoms. The framework links barriers to demand for condoms with supply issues and targeted marketing strategies. The framework also stresses the need for strong program management, linkages and integration with other services, monitoring and evaluation, and the need for quality service delivery. UNFPA, WHO and PATH (2007) have produced an operations manual for condom programming for HIV prevention, which is endorsed by UNAIDS.³⁰²

Leadership and coordination—for advocacy and policy dialogue, resource mobilization and capacity building – provides the foundation for the framework. Donors should support governments in setting and reaching national goals, while involvement of civil society is crucial to the development of effective local and national plans for condom and contraceptive programming. Governments and local authorities must implement their commitments to expanding condom and contraceptive access to their populations, including young people. Strong coordination among governments, donors, and community stakeholders can help maximize the use of available resources and the impact of activities to promote condoms and contraceptives.

Box 10: Comprehensive Condom Programming Framework³⁰⁴

Leadership and coordination (at global, regional, national and community levels)

• advocacy and policy dialogue for political awareness, government ownership and commitment so as to reduce barriers to male and female condom access and use including ignorance and stigma
• resource mobilization for adequate human, financial and technical resources
• capacity building and institutional strengthening including national regulatory authorities
  
Demand
• social, sexual, behavioral, operations and epidemiological research to develop a strong evidence base and to guide programme development including more effective policies and intervention design in BDD, IEC and health promotion
• market research to understand consumer needs and wants for targeted condom promotion and distribution via public, private and NGO channels and client-centered traditional and non-traditional outlet
• IEC including mass media campaigns and interpersonal approaches to raise awareness concerning HIV/AIDS and the importance of behavior change such as partner reduction
  
Supply
• social marketing programs to create demand and expand access to attractive and affordable condoms via commercial channels and outlets
• community-based distribution approaches to reach poor and hard-to-reach rural areas
• strengthened public sector capacity to address the needs of individuals not served by private and social marketing approaches
• logistics management (including product selection, quality procurement according to ISO standards and the WHO/UNFPA specification, quality assurance during receipt, storage, distribution, LMIS and consumer feedback mechanisms)
  
Support
• programme management including needs assessment, strategic planning, technical coorperation, sustainability, effective coordination mechanisms at all levels and training to strength human resources
• links to or integration with other programme strategies including VCT, PMTCT, STI treatment, ARV treatment programmes and MCH and family planning to enhance breadth and depth of reach while improving sustainability
• mointoring and evaluation as part of the Three Ones
• service delivery and quality of care

The same comprehensive programming framework can apply to the provision of contraceptives as a key aspect of preventing mother-to-child transmission of HIV. The same components are needed for strong programming—beginning with leadership and coordination to ensure strong policies that integrate contraceptives into HIV prevention, to provide adequate resources for contraceptive provision, and to enhance capacity for policy and program implementation. Determining the demand and ensuring supply of contraceptives are vital, and programs must be supported by strong management, links with other programs, monitoring and evaluation and high quality services.

Please see the Appendix for this section's end notes.