The document discusses the role of condoms in public health and examines successes and challenges of condom use globally and in Sri Lanka. It outlines the history of condom programming in Sri Lanka involving organizations like the Family Planning Association and National STD/AIDS Control Programme. While condom use among high-risk groups has increased, gaps remain. The concept of "Comprehensive Condom Programming" is presented, but there are doubts about its applicability in Sri Lanka given established condom promotion efforts through targeted interventions and STD clinics.

1. Comprehensive condom
programming?
Dr. G. Weerasinghe
Consultant Venereologist
NSACP
17th October 2015

2. Objectives
• To discuss the role of condoms in public health
• To examine successes and challenges of condom
use in controlling STI/HIV in the world
• Condoms in Sri Lanka
- History
- Achievements
- Gaps, challenges & steps ahead
• To discuss the concept of “Comprehensive
Condom Programming” and its’ relevance to Sri
Lanka

3. Condoms & public health…..
Background
In 2013,
• an estimated 2.1 million people became newly
infected with HIV
• an estimated 500 million people acquired
chlamydia, gonorrhoea, syphilis and
trichomoniasis
• there were approximately 80 million
unintended pregnancies

4. Condoms in public health
Three public health priorities where condoms
play a central role;
• Prevention of HIV
• Prevention of sexually transmitted infections
• Prevention unintended pregnancies

5. Male & female condoms
• Condoms - an impermeable barrier to particles the size
of sperm and STI pathogens, including HIV - proven by
laboratory studies
• Research among sero-discordant couples have shown
that consistent condom use significantly reduces the
risk of HIV transmission both from men to women and
women to men
• Consistent and correct use of condoms also reduces
the risk of acquiring other STIs and associated
conditions, including genital warts and cervical cancer
• When used consistently and correctly, condoms are
very effective in preventing unintended pregnancy
(with a failure rate of about 2%)

6. condoms in prevention of STI/HIV in
the world
• India – Avahan project studies conducted in
Karnataka & Andra Pradesh
• Thailand – 100% condom programme
increased condom distribution to sex workers and
their clients in combination with other prevention
interventions were associated with reductions of
transmission of both HIV and other STIs.
• Zimbabwe and South Africa - increased condom
use was found to contribute to reductions in HIV
incidence

7. 100% Condom Programme, Annual Number of STI Cases
Reported, Thailand
Epidemiology & Implications for VCT
0
10
20
30
40
50
60
70
80
90
100
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
0
100
200
300
400
500
Clients using condom
STD cases reported
100500
400
300
200
100
0
80
60
40
20
0
Source: Ministry of Public Health, Thailand 2000 Module 1 Sub Module 3 – PPT02
STD cases reported ( thousands)
% using condoms

8. 100% Condom Programme, Annual new HIV infections,
Thailand
Epidemiology & Implications for VCT
0
20,000
40,000
60,000
80,000
100,000
120,000
Male Female Child
100% condom
programme begins
Thai Working Group on AIDS projections 2000 Module 1 Sub Module 3 – PPT02

9. What has been achieved globally?
• A recent global modelling analysis estimated
that condoms have averted around 50 million
new HIV infections since the onset of the HIV
epidemic
• For 2015 - 27 billion condoms were expected
to be available globally

10. Condoms in Sri Lanka -
History

11. FPASL –
pioneering role
• Inaugural meeting of the FPA was held on 15th
January 1953
• First family planning clinic of FPA was inaugurated on
2nd September 1953 at De Soysa Maternity Hospital
(DMH) and it provided contraceptive services
including condoms.
• In early 70s - condom social marketing programme
and introduction of the brand name ‘preethi’

12. FHB
• Since 1960 the FHB has been in the forefront in
bringing modern methods of FP including condoms
to grass-root level through family health care
workers who are supposed to be the main link
between maternal, child and reproductive health
services and community.
• The promotion of condoms as a FP method is one of
the major task that has been carried out by FHB.

13. NSACP
Since 1988
• 1988 – 89 – 20,000
• 1990 – 94 – 30,208
• 1995 – 99 – 238,655
• 2000 – 04 – 135,546
• 2005 – 09 – 93,118
Taken from pharmacy records of Central STD
clinic – (may not accurate)

14. Present situation of condom
distribution in Sri Lanka
Government sector
• FHB
• NSACP
Commercial sector
• FPASL
• Other players

15. Condoms in numbers (in millions)
Year FPASL FHB NSACP Others
(including
condoms
procured
through GF
funds)
Total
(Department
of census
and
statistics)
2010 7.8 3.6 0. 25 3.58 15.23
2011 7.9 - 0.18 4.95 13.03
2012 9.5 7.5 0.27 4.54 21.81
2013 10.5 6.0 0.31 9.57 26.38
2014 10.8 4.5 0.32 0.97 16.59

16. Comprehensive condom programming
• A concept presented by UNFPA in 2010
• In supporting this effort, UNFPA employs a 10-
Step Strategic Approach to scale up CCP

17. 10-step approach of CCP
• Step 1: Establish a National Comprehensive Condom Programming Task
Team
• Step 2: Undertake a Situation Analysis – a country background information
about HIV and CCP
• Step 3: Develop a Comprehensive and Integrated National Male/Female
condom programming strategy and cost each component
• Step 4: Mobilize Resources
• Step 6: Develop and implement a Human Resource capacity strengthening
plan
• Step 7: Develop a Commodity Security Plan and warehousing
• Step 8: Develop a condom promotion plan to increase access and
utilization.
• Step 9: Implement the 5 year Strategic Plan (Walk the Talk)
• Step 10: Monitor programme implementation routinely and evaluate
outcomes (M & E)

18. Condoms, STIs & HIV/AIDS in Sri Lanka
R – 9 GF funded programme based
on NSP ; 2007 – 11
For the period of 2011-15
• Peer-led targeted
interventions
- BCI
- Promotion of care
seeking behaviour
- Provision of condoms
& lubricants
6.5 millions of condoms
procured
NFM GF funded programme based
on NSP ; 2013-17
For the period of 2016-18
• Peer led targeted
interventions
- BCI
- Promotion of care
seeking behaviour
- Provision of condoms
& lubricants
How many condoms are
planned to procure ? – 13.5
million

19. Condoms use – at last sex with a client
Sri Lanka behavioural
surveillance survey 2006-7
Integrated biological and
behavioural surveillance
survey 2014
FSW 90.5% 93%
MSM (Colombo) 63.7% 64.6%

20. Sources of condoms
• FSWs in Colombo (87%), Galle (45%) & Kandy
(81%) buy their condoms, but, 30-50% have
received condoms from health centers or NGO
• MSMs in Colombo (90%), Galle (66%) &
Anuradhapura (71%) buy their condoms,
though 20-32% have received from health
centers or NGO also

21. What do we do in Sri Lanka
• There is an established condom market
• There are major players with public health objectives
as well as commercial
• Biggest players are driven by market rules
• Though there are gaps, SL has achieved successes in
promoting condoms among FSW & MSM
• Condom promotion is an identified strategy in the NSP of
NSACP and that is implemented through peer led targeted
interventions and country-wide network of STD clinics
• In this context, there are doubts about the necessity of a
brand new CCP for Sri Lanka (though some UN partners
may think so) and it might cause even adverse effects by
attracting un-necessary attention to ongoing activities

22. References
• UNFPA, WHO and UNAIDS: Position statement on condoms and the
prevention of HIV, other sexually transmitted infections and unintended
pregnancy, 07 July 2015
• Comprehensive Condom Programming - A guide for resource mobilization
and country programming 2010
• Sri Lanka behavioural surveillance survey 2006-7
• Integrated biological and behavioural surveillance survey among key
populations at higher risk of HIV in Sri Lanka 2015
• National HIV/AIDS strategic plan 2007 – 11
• National HIV/AIDS strategic plan 2013 – 17
• National STD/AIDS Control Programme Sri Lanka, Annual Report 2014/15
• Family Health Bureau
• Sri Lanka Family Planning Association
• Department of population census and statistics
• Pharmacy records – Central STD/AIDS clinic, Colombo