Condoms

As the 2010 World Cup kicks off this Friday, thousands of football fans will arrive in South Africa to cheer on their favourite teams.

HIV awareness and prevention is also a high priority during this time. HIV can spread particularly among young people, through the dangerous combination of alcohol and unsafe sex.

As HIV can be spread through unprotected sex, condoms are vital to protecting people from HIV infection. Male and female condoms are the most efficient, available technologies to reduce the sexual transmission of HIV and other sexually transmitted infections.

And to reduce the risk of HIV transmission, advocates count on making condoms readily available. Previously successful campaigns have included free condoms in match venues, hotels, stadiums, bars, and clubs. As one fan said, “condoms are more useful with me than in a warehouse.”

Condoms are a key component of the combination prevention package to reduce the sexual transmission of HIV. Other components include delay of sexual initiation, abstinence, being mutually faithful to each other when both partners are uninfected, and reducing the number of sexual partners.

UNAIDS commends the South African government’s commitment to distribute condoms during the World Cup. We support the efforts carried out by the South African National AIDS Council (SANAC) and civil society groups, including the Treatment Action Campaign and AIDS Consortium, to ensure that condoms and HIV information are made widely available during the tournament.

Each day, 7 400 people are infected with HIV worldwide. In South Africa, the host of this year’s World Cup, 5.7 million people are living with HIV ─ the largest number worldwide.

This story was first published on UNFPA.org

Clients at Kevin's Reflextions have an opportunity to talk about HIV.
Credit: Carina Wint

Barber shops across Georgetown, Guyana, are buzzing with chatter about the latest trends, community happenings, neighbourhood gossip and now, ways to protect young people from AIDS. The United Nations Population Fund (UNFPA), in collaboration with UNAIDS Secretariat, has identified barber shops and beauty salons as information hubs, and is using them to spread the word about HIV prevention.

The project involves the training of shop staff to answer simple HIV-related questions, pass out informational material, dispense both male and female condoms to clients – and even provide on-site counselling and testing. As a result, young people in Guyana are given access to information and resources not readily available elsewhere in their communities. And this is important because their small country (population 751, 223) has one of the highest HIV prevalence levels in the region: about 1.6 per cent for pregnant women, according to UNAIDS. Among sex workers, prevalence rises up to 26.6 per cent.

Male and female condoms are available at selected hair salons.
Credit: Carina Wint

Juanita Huburn, a customer at DJ’s Magic Fingers, a hair salon that participates in the programme, described Guyanese society as “closed” when it comes to issues regarding sexuality. “You do not talk about sex, they just say you should not have sex, but this is not realistic,” she said.

Shops and salons were chosen based on their location in malls, parks, popular attractions, or low-income communities. Owners who opened their doors to the project got added marketing exposure for their small businesses and were provided with incentives, such as access to promotional materials. “Shops were informed how their companies would be promoted through the project, and the economic value of participating,” said UNFPA Guyana Liaison Officer, Patrice La Fleur “They would most importantly provide safe places to discuss sexuality and the prevention of HIV.”

Once the locations were identified, two employees from each shop were sent for training on basic HIV education and prevention means. They were also taught to properly monitor the project and introduced to safe practices within the context of their own work (for example, ensuring the sterility of hair cutting machines, razors, needles for stitching and weaving, manicure and pedicure implements, and tattooing and body piercing equipment).

In addition to training participants about sexual and reproductive health and gender issues, the project also focuses on building life skills such as communication, healthy relationships, and leadership. “Participants expressed personal gains in their quality of relationships with friends, family, and clients,” said UNFPA Programme Officer, Babsie Giddings who monitors the project.

DJ's Magic Fingers hair salon is another venue for building awareness of HIV prevention.
Credit: Carina Wint

Since the programme was put in place businesses report a steady boost in clientele and more shops have come on board. “Business has increased about 5 per cent since we joined this programme,” said Kevin John, owner of the Barber Shop Kevin’s Reflections. He believes it may be partly because people know his salon equipment is sanitized. Currently over 7000 male and 400 female condoms are distributed monthly by requests in the shops and salons.

Work on the project was initiated last year through efforts of the UN Country Theme Group and it has been fully funded by UNAIDS. Also collaborating on the project is a local NGO, Youth Challenge Guyana.

UNFPA provides continuous support with regular follow-ups and monitoring for participating barber shops and salons. The project aims to afford some 2000 young people access to information, skills, services and supplies they can use to protect their health.

With support from UNAIDS, 2 public service
announcements broadcast in English,
French and Chinese are being shown in
waiting area in Olympic Polyclinic. These
feature German soccer player and UNAIDS
Special Representative Michael Ballack,
and Chinese Basketball player Yao Ming.
Credit: UNAIDS

As part of a joint HIV prevention campaign, some 100,000 high-quality condoms are being made available to athletes free of charge in health clinics in the Olympic Villages of Beijing, Qingdao and Hong Kong. Athletes are also able to find useful information on HIV from thousands of posters and leaflets in English, French and Chinese.

In the waiting room of the polyclinics, HIV prevention videos with UNAIDS Special Representative and German footballer Michael Ballack and Chinese basketball star Yao Ming are being shown in three languages. In addition, all athletes competing in the 2008 Olympic Games have received flash sticks that include fact sheets on HIV.

These HIV prevention and anti-discrimination efforts are part of the 2008 Olympics HIV campaign “Play safe – Help stop HIV” launched by UNAIDS, International Olympic Committee (IOC), and the Beijing Organizing committee of the Olympic Games (BOCOG). The objective of the campaign is to educate athletes participating in the Beijing Games about HIV and encourage them to be ambassadors of AIDS response.

IOC President, Dr. Jacques Rogge (left)
greets Dr. Bernhard Schwartländer, UNAIDS
Country Coordinator (centre) during the
launch of the Beijing Olympics HIV and
AIDS Campaign "Play safe – Help stop HIV".
Credit: UNAIDS 

“Athletes should know about how HIV can be transmitted, how it does not transmit and how HIV can be prevented. This will help them educate their peers and fight discrimination against people with HIV. It really is a topic relevant to sport,” said Campaign Ambassador and Egyptian swimmer Rania Elwani.

The campaign not only aims to benefit the many athletes taking part but also members of the national delegations and the more than 100,000 volunteers.

Today about 33 million people are living with HIV worldwide. Young people, 15–24 years of age, account for around 45% of all new HIV infections in 2007. However, many young people still lack accurate, complete information on how to avoid exposure to the virus.

Many young people are involved in sport, either as spectators or participants. Through this global sport gala of the Beijing Olympics, messages about AIDS can reach out to communities, especially to youth, to promote safer sexual behavior and to stop stigma and discrimination.

The objective of the 2008 Olympics HIV
campaign “Play safe – Help stop HIV” is to
educate athletes participating in the
Beijing Games about HIV and encourage
them to be ambassadors of AIDS response.
Credit: UNAIDS

“Famous athletes can play an important role to bring across messages about HIV prevention, care and support as they are regarded as role models by young people," said IOC President Jacques Rogge. UNAIDS Country Coordinator Dr Bernhard Schwartländer said, “We know that sport and the Olympic Games are universal languages that can play a very important and positive role in raising AIDS awareness and reducing stigma and discrimination of people living with HIV.”

In 2004, UNAIDS signed a Memorandum of Understanding with the IOC, combining efforts to enhance the role of sports organization in the AIDS response at community and national levels, and to organize AIDS awareness activities with coaches, athletes and sport personalities.

The condoms factory uses natural latex
collected by local rubber tappers and it
will be able to supply the Brazilian
government with 100 million condoms a
year. Photo credit: UNAIDS/J.Spaull

The use of condoms in Brazil is preventing the spread of HIV and it might also be helping to save the rainforest thanks to a condom factory opened in April in the Amazon region. This unique factory uses natural latex collected by local rubber tappers and it will be able to supply the Brazilian government with 100 million condoms a year.

The company which runs the factory – Natex - is a joint venture between the local state of Acre, the Ministry of the Environment and the Ministry of Health. It represents Acre’s new vision for the Amazon - “Florestania” - which seeks to increase the living standards of its inhabitants whilst also preserving the rain forest, through increasing the value of the products extracted from it.

The factory is located in Xapuri, made famous by the environmentalist and rubber tapper Chico Mendes who was assassinated there twenty years ago, and it is a direct legacy of his life’s work. Threatened with the destruction of their livelihood by the cattle ranchers who were clearing the forest, Mendes’s great achievement was to forge an alliance between the interests of the rubber tappers and the environmentalists. Mendes saw the rubber tappers as the natural custodians of the forest.

The factory provides employment for around 100 people and the latex is supplied by around 700 rubber tappers. As well as payment for the latex, the rubber tappers receive a fee for “environmental services”, recognising their importance in safeguarding the forest. This has greatly improved the living conditions of rubber tappers such as Chico Mendes’s cousin Sebastiao Teixeira Mendes who gets a guaranteed income for his latex which is higher than he could get elsewhere. He sees the rubber tappers as the “soldiers of the forest – patrolling and managing the forest”.

At the opening of Natex, the then Minister of Environment Marina Silva - the daughter of rubber tappers herself – was in no doubt of the significance of the factory: “This is a project where high technology will help to preserve the soul of the forest”. Adding, “The forest will remain the forest and the rubber tappers will remain rubber tappers through a new way of working and producing”.

As well as the environmental and social aspects of the factory, the other main driver of the project has been the Government’s need for an increasing supply of good quality condoms. The distribution of free condoms coupled with a national campaign for their usage has been at the core of the Brazilian Governments AIDS prevention strategy.

The distribution of free condoms coupled
with a national campaign for their usage
has been at the core of the Brazilian
Governments AIDS prevention strategy.
Photo credit: UNAIDS/J.Spaull

Since 1994, 1.5 billion free condoms have been distributed and it is projected that 557 million will be distributed this year reaching out to 52% of the population. The change in people’s attitudes can be seen from a national study, which showed that the percentage of those who used condoms during their first sexual encounter rose from 10% in 1986 to 47.8% in 1998 and 65.8% in 2005. In another study in 2004 showed that 96% of the adult population cited the use of condoms as the best method of preventing HIV transmission.

In 2007, the Government of Brazil imported one billion condoms and plans to purchase an additional 1.2 billion by the end of the year. It is expected that the factory will eventually increase its annual production from 100 to 200 million condoms and diversify into female condoms, therefore greatly reducing the Government’s reliance on importing condoms.

Whilst the condoms will be slightly more expensive to produce than importing from Asia, it is a cost that the director of the National AIDS Programme Dr Mariangela Simao believes is well worth paying as it “reflects the social benefits of increasing the income of the autochthonous population and a sustainable way of managing the native rubber trees”.

UNAIDS Country Director Mr Pedro Chequer, who was previously the National AIDS Director and as such was involved in the planning stages for the factory believes that it “represents the Government’s high level political commitment to maintain HIV as a priority agenda for the Country”. The world, he notes, faces a huge shortage of condoms. “As far as male condoms are concerned the annual deficit would be around 30 billion if we consider half of the world male population using a condom once a week. Of course the initial production of 100 million condoms will not have much affect on the world scenario, but it will help the country have guaranteed access to the production of condoms”.

It is a model that he believes Brazil could export through joint ventures with other Latin American Countries.

Sebastiao Mendes and the local community have a name for Natex that sums up how they feel about the factory - “The love factory”. It is easy to see why there is such enthusiasm for the factory - a factory that is helping in the response to AIDS, but also helping to improve the living conditions of the local population whilst at the same time preserving the endangered rain forest.

On 1 December 2006, UNAIDS joined with a broad range of UN and Thai partners to organize a World AIDS Day event with a difference.

As well as hosting a packed celebration event, Thailand captured international attention with an attempt to create the world’s longest chain of condoms.

And at the end of March, confirmation arrived—at 2,715 metres long, the condom chain sets a new Guinness World Record™.

The tying of the world’s longest chain of condoms was one of the events of the “Condom Chain of Life Festival”, a unique celebration of World AIDS Day, held at Lumpini Park in Bangkok. The festival was organized by the United Nations Educational, Scientific and Cultural Organization (UNESCO) Bangkok in collaboration with the Thai Red Cross, PLAN Thailand, UNAIDS and local NGOs as part of efforts to promote the acceptance of condoms, emphasize the need for safe sex, and encourage strengthening of national policies for comprehensive treatment, care and support for people living with and affected by HIV.

UNAIDS Special Representative Senator Mechai Viravaidya, well known for his groundbreaking HIV prevention efforts in Thailand, led the tying of the chain.

Here, UNAIDS Country Coordinator for Thailand, Patrick Brenny, tells (click on link below to listen to the interview) www.unaids.org about how the World Record attempt came about and its importance to the Thai AIDS response.

Photo: Daniel Delaunay

Thousands of condoms pile in the corner. Buckets of paint lie on the shelf. She cuts, twists, shapes, melts, pastes, colors, crochets and sculpts, with her fingers and nails stained black. 365 hours later, a colourful elegant gown made of 6,500 condoms debuts.

Adriana Bertini, a Brazilian artist living in São Paulo, uses expired or defective condoms as raw material to make pieces of art. Her creations include ornate evening dresses, vivid bikinis, elegant shawls, flowery carnival costumes, and other plastic arts.

"I want my art to be visible everywhere, reminding people of the necessity of HIV prevention" Bertini says. “I prefer working more with the figurines, because I noticed that they make people think about the meaning of ‘Wear against AIDS’.”

Bertini started her career at Brazil's fashion houses, and made her first dress from condoms in 1997. Since then, the designer has made around 200 sculptures, 80 tapestries and 160 figurines from condoms. The most condoms she has ever used on a gown - around 80 thousand - was on one wedding dress.

"My idea is to promote condom use not as a commercial fashion but as a conceptual fashion, be it conscious or subconscious. The idea is to wear them at the right time, not just as a trend, on clothes" says Bertini.

Bertini started working in HIV prevention in 1994, after she spent time with HIV positive children as a volunteer for GAPA, an HIV prevention group. "In the beginning, I worked with condoms but not necessarily in the context of AIDS," the designer says "The AIDS issue came along with my work with children living with HIV. I realized that I could use fashion for AIDS awareness."

“I volunteered to do the HIV prevention work,” says Bertini, who at the time did not know anyone living with HIV. “Then I made friends who were HIV positive and this stimulated me even more to promote prevention.  Today, I have already lost some dear people to AIDS. I think this is the minimum I can do, being a conscientious person faced with a problem of this magnitude. ‘If you have conscience, act'.”

Adriana Bertini. Photo: Rodrigo Cibantos

Bertini’s designs can be seen at fashion shows and in magazines, or are exhibited in museums. “The focus is not on wearing my gowns, but on introducing condoms into everybody’s lives, breaking taboos and giving the public a chance to ponder.”

While Bertini’s designs are often shown in Brazil, she has also had important international exposure. Her work was exhibited at the International AIDS Conference in Barcelona, Spain, in 2002, and at the 15th International AIDS Conference in Bangkok, Thailand, in 2004, among others. She has also proposed an exhibit in the cultural programme of the 16th AIDS Conference in Toronto this coming August: “I am waiting for the selection to be finalized.”

Reactions of the public to her designs vary. Some people whisper about it, others laugh or dismiss it as inappropriate, and then there are those who want to meet her and tell her their problems.

“There a lot of parents who want to thank me because it was through my art that they’ve reached out to their children to talk about sexuality,” she says.

All her material comes from condom manufacturers, and the proceeds from the sales of dresses - prices range from $700 to $5,000 - go directly to organizations involved in the fight against AIDS. Bertini and her HIV-positive apprentices do not make their living directly from their work, but instead rely on sponsors.

"I'm not doing this to make money but rather as a social act, as art aimed at others. I hope that by using condoms to create something new, I can inspire reflection, foster discussion, and challenge taboos." says Bertini who is quickly becoming well-known in international activism circles.

The 34 year-old was awarded with the Nkosi Johnson Community Spirit Award in 2004 by the International Association of Physicians in AIDS Care, Washington DC, (IAPAC) in recognition of her 10 years of artistic activism. "You understand, condoms must become as basic as a pair of jeans and as necessary as a great love," Bertini emphasizes.

Related links

Adriana Bertini official website

Geneva, 3 February 2012—The World Health Organization (WHO) will later this month issue further guidance on the reported link between hormonal contraceptives such as the pill, injectables, implants and HIV.

On 31 January and 1 February, WHO convened a technical consultation WHO and Partners Stakeholders' Meeting on Hormonal Contraception and HIV Infection: A review of the evidence and implications for service delivery and priority research, made up of 53 experts from 20 countries to review the body of published evidence on the use of hormonal contraceptives and HIV acquisition, progression, and transmission. The review was prompted by new findings in 2011 that implied a possible increase in HIV infection among women at risk of HIV who use hormonal contraception, or increased transmission to an un-infected partner when a woman is living with HIV and using hormonal contraceptives.

The outcomes of this meeting will now be assessed by the WHO Guidelines Review Committee (GRC) –  the body that oversees the production of WHO public health guidelines for countries. The Committee will meet on 15 February and announce its recommendations the following day.  

However, WHO guidelines clearly state, and call on health service providers to remind their patients, that neither hormonal contraceptives nor intrauterine devices (IUDs) offer protection against HIV or other sexually transmitted infections (STIs). Condoms are the mainstay of dual protection against both unwanted pregnancy and STIs including HIV.

As outlined in WHO's recent guidance in 2009, based on the best evidence available at that time, The Medical Eligibility Criteria for Contraceptive Use, 4th Edition 2009 (MEC) says that women at high risk of HIV infection and those who are living with HIV can safely use hormonal methods.

All WHO information can be found at: www.who.int

More information on the WHO Department of Reproductive Health and Research can be found at: http://www.who.int/reproductivehealth/about_us/en/