Enhancing Support for HIV Prevention Beyond Condom Programming
Persistent gaps in condom use hinder countries from achieving HIV prevention goals. The initiative aims to improve aligned support for HIV prevention beyond traditional condom strategies. Condoms play a crucial role in reducing new infections, alongside treatment, biomedical interventions, behavior change, and societal enablers. The focus is on sustainable system-level fixes to enhance national prevention programs and promote healthier condom markets through targeted tools and talent development.
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Improving Aligned Support for HIV Prevention Condom Programming Beyond Condom Strategic Initiative Dr. Namwinga Chintu Program Innovation Prevention Treatment and Pediatrics UNAIDS, Geneva Rosemary Kindyomunda Programme Specialist, SRH/ HIV UNFPA ESARO, Johannesburg
Persistent gaps in condom use is Persistent gaps in condom use is preventing countries from achieving goals to achieving goals to reduce HIV incidence reduce HIV incidence. preventing countries from Democratic Republic United Republic of Mozambique Cote d'Ivoire of the Congo South Africa Zimbabwe Cameroon Botswana Tanzania Eswatini Namibia Ethiopia Lesotho Uganda Malawi Zambia Nigeria Angola Ghana Kenya Indicator Steep decline in New HIV Infections among AGYW in Steep decline in New HIV Infections among AGYW in GPC Member States (2010 GPC Member States (2010- -2020) Condom use with non-regular partners (men 15- 49, %) 46 id Knows condom as prevention method (women 15-49, %) Knows condom as prevention method (men 15- 49, %) Woman justified to insist on condom use if husband has STI (women 15-49, %) Woman justified to insist on condom use if husband has STI (men 15-49, %) Number of condoms distributed/sold (in millions) Number of condoms distributed/sold per couple- year* (age range 15-64 - 2021) Condom use with non-regular partners (women 15-49, %) 2020) Outcome 27 id 43 37 24 66 20 18 57 78 49 42 66 36 58 37 28 35 65 63 50 33 83 51 42 76 81 73 47 82 65 65 58 35 54 82 66 id 77 67 56 91 58 77 80 92 75 55 88 73 id 87 id 83 84 78 id 77 82 73 87 77 86 88 88 75 65 90 78 id 88 id 87 88 59 id 71 78 68 94 61 91 89 92 82 61 93 77 id 87 id 73 87 74 id 72 90 79 96 80 95 92 90 88 72 91 74 id 91 id 81 85 Output 6 17 33 49 0 12 0 id 88 0 63 120 0 43 557 380 72 15 109 1 24 4 6 id 7 id id 5 0 12 15 0 1 28 32 4 3 28 % of condom distribution need met (2021) 2 id 15 23 id 15 id id 24 1 47 42 0 5 65 100 17 10 88
Contribution to reductions in new infections by intervention category in UNAIDS global strategy Condoms are a proven, scalable, cost effective tool to reduce new infections Treatment (testing, ART, retention) Biomedical: VMMC and PrEP Behavior change condom use for general population comprehensive sexuality education economic empowerment Key populations: prevention services for FSW, MSM and PWID) Societal enablers (not shown) are critical to attaining target coverage levels ART to 95-95-95 VMMC & PrEP Key pop prevention Behavior Change 3 John Stover, UNAIDS Technical Consultation, 20-21 July 2023
The Bet on Stewardship The Strategic Initiative supports sustainable systems level fixes that underpin better designed and performing national prevention programs leading to healthier condom markets. Improve the design of programs that bring a Total Market Approach to the core, and address systemic constraints in the market. 1 Build out targeted tools & guidance improving program management and stewardship. 2 Nurture a talent pool of regionally-based consultants and institutions through mentoring, distance support, tools & approaches. 3 4 Provide on-demand technical support for condom programming.
New Generation Condom Programming The Stewardship Key Conducive policy & social environment Cement the role of condom in HIV prevention Integrated strategic planning Evidence - Size estimates, target setting Forecasting & quantification Integrated programme delivery Influence behaviour, create demand Public private partnerships Market segmentation and development Track - data for decision making Build community competence Engage, Increase knowledge on options People-centered Who needs a condom? Understanding population How feasible is consistent access Inequity lens Beneficiary engagement Consistent and correct use Skills, comprehensive knowledge Position in options package
Condom Strategic Initiative Focus- Build Capacity for improved Condom Programing The overall objective of the Condom Strategic Initiative is to: Objectives Catalyze improvements in the quality of condom programs -more differentiated, equitable, people-centered, which will lead to sustained increases in condom use amongst priority populations, and reduced # of HIV infections Total Budget: $5 million $4.3 million via UNAIDS UNFPA Implementing Partners Sub objectives: Strengthen national and sub-national institutions (NAC, MOH) and systems for improved condom program stewardship Increase innovation in demand creation and last-mile distribution, including through public-private partnerships FocusCountries Malawi, Mozambique, Uganda, Zambia (All are also receiving Matching Funds) 7
Implementation architecture Global Fund Secretariat Global Fund Country Teams Complementary support Oversight on country grants 44Technical Assistance Areas Reinvigoration of Condom Programming Structures Evidence based condom quantification and fore casting Strengthened last mile distribution mechanisms Relevant and effective demand generation Innovation and sustainability plans included in GC7 Applications Private sector engagement Grant to UNAIDS Global HIV Prevention Coalition (GPC) Secretariat Technical & Managerial Hub Global Coordinator of the Initiative Regional Support Manager Hosted by UNFPA Provides direct country support Hosted by UNAIDS Builds & manages overall partnership Continuous direct programmatic & management support Condom Technical Support (regional specialists integrated into TSM) Public-private innovation fund Support to priority actions and capacity-building on condom programme stewardship, last-mile distribution and innovative demand generation Scopes of work driven by identified country priority needs Cross-country learning & exchange Country focal point/ manager Country focal point/ manager Country focal point/ manager Country focal point/ manager Malawi Mozambique Uganda Zambia Other countries
New Generation Condom Programming: learning from implementation of the Condom SI The condom is appreciated but needs championing Structured stewardship is a prerequisite & feasible Tools key for institutionalized action PSAT, PSET, CNET, TMA, CP Planning Package Up-to-date evidence critical Domestic financing possible External funding streams are critical catalytic anchors Tracking the condom is feasible With improved LMD approaches Public Private Partnerships work exploit various angles Private-for-Profit Innovations for sustainable healthy markets Diverse LMD options the way to go Condom at HFs not reaching high risk groups No demand creation without LMD Differentiated, integrated programme delivery is feasible pop. specific Communities know better Empower for people-centered programmes
Overcoming Condom Programming obstacles: learning from implementation of the Condom SI Condom/lube still stigmatized Standardize output reporting on external funds? Lack of data impacts advocacy and programme decision making Invest in CP data analytics, evidence generation The free condom threatens transition to sustainable markets Free commodity increasing but handling capacity weak willingness to buy not well exploited Utilize external funding to grow the total market High unmet need YET low condom uptake Invest in innovative demand creation Competing interventions? Prioritize programming for CHOICE Inadvertent/subtle deprioritization Condoms/lubricant use at last sex by those not taking PrEP with a nonregular partner whose HIV viral load status is not known to be undetectable Defunding/declining social marketing Innovate around new business approaches
Overcoming Condom Programming obstacles: learning from implementation of the Condom SI Challenging to meaningfully integrate condoms into prevention and treatment portfolio (but essential) TMA more of theory than practice Advocate transformation of national tax regulations Condition free commodity support to development of healthy markets Major funding streams can do better Value for Money accountability linked to defined outputs If it is not measured, it is not done! How do we amplify focus on outputs before outcomes Weak local HR capacity/expertise for CP One-off TA limited to catalytic action Invest in HR for CP positioning/cadres Exploit mega trends Expand digital technological solutions Amplify CP under global Selfcare advocacy
Key Considerations Beyond the Condom SI Sustain the momentum we need to move faster, be more focused and more specific Support countries to meaningfully integrate condoms into all aspects of HIV programming (starting with integrating stewardship into the broader prevention response) Scalable catalytic interventions for responsive condom programming are possible, effective and urgently needed Oversight for institutionalization of condom programming coupled with accountability at multiple levels is essential Funding needs to be specifically earmarked for Stewardship demand generation and last mile distribution- Program smarter Funding streams for condoms need to pivot to a new generation of programing that is more differentiated, equitable, people-centered and goes beyond procurement to achieve 2025 and 2030 prevention targets and goals Re-energize global advocacy and action for the effective and responsive condom programming Global Condom TWG /think tank to revisit condom indicators that measure impact and coverage- Data on condom programming needs strengthening
