August 4, 2008
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This is Terri Wilder with TheBody.com. I am at the session on HIV Prevention for Women and Girls. I've just listened to a presentation on a female condom program in India.1 I'm here with the speaker.
Can you please introduce yourself?
Hi, I'm Kavitha Potturi, the national program manager for Hindustan Latex Family Planning Promotion Trust [HLFPPT]'s female condom program in India.
We primarily work with NGOs [non-governmental organizations] in the six high-prevalence states [Andhra Pradesh, Gujarat, Karnataka, Maharashtra, Tamil Nadu and West Bengal] in the country. We work with NGOs working with female sex worker-targeted intervention. They already have an HIV prevention program happening in their area of operations.
The distribution: HLFPPT stocks five lakh [500,000] female condoms. The NGOs raise an indent [this is a British term meaning to order goods, especially from abroad] along with the DD -- that's a demand draft, an advance payment for the female condoms that they need to acquire. They send it to HLFPPT. HLFPPT sends the female condoms to the NGO. The NGO gives them to the peer educators and from the peer educators it goes to the community members.
The NGO procures the female condom at three rupees. They sell it to the peer educator at three rupees 50 paise. The peer educator sells it to the end customer, that is the FSW [female sex worker], at five rupees. That is the social marketing aspect of it.
Each client actually purchases the female condom.
Each female sex worker purchases the female condom and the peer educator, who is actually the social marketing agent in the program, makes two rupees on the sale of every female condom.
What are some of the barriers to the female sex workers getting the female condoms?
Access is not an issue, because the distribution is pretty good.
As I said, we had introduced the female condom program into the existing intervention areas of HIV prevention. They had never had female condoms before.
In India, across the board, when they said "condoms," they meant only male condoms. We had to do a lot of advocacy with the NGOs to get it known that there are also female condoms, because they would be the ones to procure the female condoms. They have a very limited fund. The social marketing fund is very limited.
So far, they had been using that fund to buy male condoms. When we started this pilot and we told them that they needed to use the same fund to buy the female condoms, they found it extremely challenging.
We had to go through this entire exercise of making the NGO understand that if they do not plug the gap in male condom usage, their HIV rates and their STI [sexually transmitted infection] rates would continuously increase. They would not be achieving their intervention objectives. Once they were clear on that, they used part of their social marketing fund to buy the female condoms. That was a challenge.
What are some of the barriers to the female sex workers actually using the female condoms once they purchase them?
One is when they do not have a clear idea of the insertion process. When the first time use was difficult for them, they left it. They didn't use it again and they dropped out of the program. We had to go back and build the capacities on usage. So usage is one barrier.
Second is the appearance of the product. When they looked at it initially, they felt it was too big and things like that.
The third barrier is the price. When we started introducing the program, these women said, "We have about 20 encounters in a day. Twenty times five is 100 rupees. We can't spend 100 rupees on the purchase of female condoms."
That's when we took them through this process. They don't have to use a female condom in every encounter. They need to use the male condoms primarily and use the female condoms only when male condom usage was not possible.
Then we took them through this whole process of rationalizing the price. It was a small exercise. We said, "How much do you spend for makeup? How much do you spend for flowers? How much do you spend for perfumes?" They do a lot of these self-imagery things. When they actually calculated, they realized that they spent more on all those things -- which didn't protect their health -- than they would be spending on the female condom.
That's when it really clicked. Once the economics clicked, then it was easy. But for us to take them through that entire process of understanding the economics of the whole thing, that was quite challenging.
Thank you so much.
This transcript has been lightly edited for clarity.
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