Tackling Taboos to Condom Use in Ethiopia and Elsewhere

Introducing condoms in communities where talking about such matters may be taboo requires innovative and culturally sensitive approaches. A new publication, HIV Prevention Gains Momentum, talks about ways of introducing female and male condoms in different cultural contexts.

For as far back as anyone can remember, the coffee ‘ceremony’ has been a comforting constant in the daily lives of Ethiopian women. After they finish their morning chores, the women congregate in the home of a neighbour for coffee and conversation in the hottest hours of the day.

The gatherings are leisurely because the traditional coffee-making process is slow. Three rounds or more provide ample opportunity to touch upon topics close to the heart of these and many other women worldwide—their children, their husbands and the trials and tribulations of running a household. But today’s conversation has taken an unusual turn. For the first time, the women opened up about their fears of HIV and talked about using condoms to protect themselves.

Marriage often puts women at risk

About half of the 33.3 million people infected with HIV today are women, and in sub-Saharan Africa, the share rises to 60 per cent. The large majority are infected through unprotected sex with their husbands or long-term primary partners. Marriage, once thought to protect women from sexually transmitted infections, puts many girls and women, especially those who marry much older and more sexually experienced men, at risk.

For married women living in rigidly traditional societies like Ethiopia, the very suspicion that they may be HIV-positive triggers not only anxiety, but also profound shame and a sense of stigma that can be devastating. And since even talking about sexuality, HIV prevention and condoms is taboo in some cultures, a woman who fears that her husband may infect her – or may already have infected her – can feel helpless and alone.

Breaking down social barriers

Breaking down these social barriers, getting condoms into the hands of the women and men who want them, and empowering them to use condoms is the theme of an important new publication by UNFPA. HIV Prevention Gains Momentum: Successes in Female Condom Programming is being launched this month and delves into efforts in countries on three continents to reach people ‘where they live’ with viable HIV-prevention tools.

In Ethiopia, married women, along with other vulnerable groups, are the target for UNFPA’s prevention efforts. Through a nationwide network of community-based organizations, housewives are being trained in reproductive health, HIV-prevention and the importance of using condoms. These ‘peer educators’ are also provided with a supply of condoms to share with their friends at the coffee ceremony.

Encountering resistance

At first, the women refused to listen. “They believe that the condom is for promiscuous people, for commercial sex workers, for unmarried people, and so on. So mostly they reject,” says Meron Negussi, a programme officer for UNFPA who works on HIV and AIDS. “‘No, it is not for us,’ they say. ‘We will not discuss this.’ So the coffee ceremony, which takes several hours to perform,is used as an orientation session. Once the discussion is started, a lot of issues come out and then the atmosphere is much easier.”

Rather than fear of HIV, the entry point for these discussions is family planning, since that is more socially accepted in Ethiopia, and also the suggestion that women can protect their daughters from risk. “Somehow, they become convinced,” says Ms. Negussi. “Women are drinking coffee and at the same time they are discussing all these issues freely.”

In fact, the coffee ceremonies have revealed that behind their shyness about sex, these women are living with very real fears. “They know they are at risk for HIV,” says Ms. Negussi, “even though they are afraid to discuss it openly in the beginning. As the discussion becomes more intense, you can sense how fearful they are of the virus—that they might have it.”

Breaking the ice

Another tactic to break the wall of silence, being used in Ethiopia as well as Burkina Faso, India, Nigeria and Thailand, has been humour. Working through The Condom Project, a US-based initiative of the Tides Center, UNFPA is partnering with local organizations to teach young people how to make their own 30-second videos about condoms. The video scripts, which are written by the participants, feature zany, unorthodox uses for condoms ranging from hair ties to balloons to containers for soup. The idea is simple – to get people laughing, to break the ice and to launch a conversation about the real purpose of condoms. The videos have been seen by thousands of people, projected on sheets hung from trees or on the side of a building, or viewed on a laptop. They have even been shown on television in Nigeria and Thailand.

“It’s about attraction, not promotion,” says Franck deRose, director of the Condom Project. “We create a framework for teachable moments when people are relaxed and the conversation really flows. Our programmes introduce condoms to people so that when they’re ready to be sexually active, they know about condoms and they see them as indispensible.”

Talking to men, too, in bars, truck stops and job training centres

As this new publication explains, UNFPA’s strategy is adjusted based on the HIV situation, the populations most affected, and a thorough understanding of a country’s culture and the mindset of the target group. In northern Nigeria, for example, UNFPA has found that an emphasis on HIV prevention, rather than unintended pregnancy, is a more powerful motivating factor in encouraging women to use the female condom. And, as in other countries, convincing men of its benefits is crucial. Towards this end, the Nigerian Ministry of Health is developing a series of sensitization and awareness-raising workshops that will be held in bars, car repair shops, truck stops and vocational training centres – places where men tend to congregate.

“Our job is to increase people’s options—especially those of women and girls, who often feel powerless in the face of AIDS,” says Bidia Deperthes, who directs UNFPA’s efforts in comprehensive condom programming. “But to do so, we must find a way to enter a culture, to open people’s minds. Often, that is half the battle.”