This 4-page research summary highlights findings from a Horizons/Population Council study that examined the role of the female condom as a method of prevention against HIV and other sexually transmitted infections (STIs) among female sex workers in Campinas, Brazil. These women received increased access to the product and to product information through an educational and social marketing intervention that was conducted by the Ministry of Health and DKT, a social marketing organisation. This document evaluates the strategic use of communication, including social marketing, to help promote use of the female condom in a specific population.

The intervention involved using entertaining modes of communication to promote and provide the female condom through theatrical performances on the streets and in selected sex establishments. Following the performances, actors provided the audience with female and male condoms and information on the female condom, which included a list of nearby sales outlets. DKT also published stories in popular magazines and newspapers. Every 2 weeks the project team conducted educational activities with small groups of sex workers from each of the 4 study sites. A pelvic model was used to demonstrate how to insert the female condom, and participants were given the opportunity to practice with the model, ask questions, and discuss relevant issues. In addition, a cellular telephone "help line" was set up to enable sex workers to talk with a health promoter about usage problems and health concerns, or to find out how to access female condoms.

Despite the fact that these educational and promotional activities motivated some women to try the female condom, there is no evidence that the intervention led a sizable number of women to use this contraceptive or to use protection (either male or female condoms) for each sex act with all partners. [Click here to access impact data from this evaluation, which used a pre-/ post-intervention evaluation of female sex workers from 4 different socioeconomic settings at baseline (n = 211) and at 6-month follow-up (n = 216)]. Evaluators identified several barriers to use of the female condom, including:

• Cost - during the project period there was a severe downturn in the economy that likely affected sex workers' ability to buy female condoms, which sold for more than 6 times the price of a male condom. Most women reported using condoms they received for free. Future work might include: efforts to offer the female condom at prices similar to the subsidised male condom.
• Nature of the product (e.g., its size and appearance) - According to one sex worker, "In the beginning I was ashamed because of the size and to have to insert it in front of the client. It was terrible....I think by the fifth time I was not ashamed anymore." Future work might include: interventions that highlight its advantages for sex workers and help women gain confidence about using the product. "Such interventions should also build upon sex workers' preference for using the female condom with regular clients and boyfriends, partners with whom male condom use has been problematic because of its association with a lack of trust and intimacy."