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RHO archives : Topics : Men and Reproductive Health

IGWG Theme Statement: Dual Protection (from a Gender Perspective)

Individuals and couples have the right to enjoy healthy sexual lives free of unplanned pregnancy and sexually transmitted infections (STIs), including HIV. Dual protection, one means through which this goal can be achieved, is defined as simultaneous protection from both pregnancy and HIV/STIs.

In the ideal world, sexual partners would jointly and equitably decide on whether and when to engage in sexual intercourse, and whether and how to protect themselves from pregnancy and STIs. Today, however, a growing number of individuals face the risk of both unwanted pregnancy and of HIV and other STIs. Reducing the risk of both of these adverse events requires greatly enhanced efforts to promote widespread acceptance of dual protection strategies.

Ideally, individuals and couples would have access to means of protection from unwanted pregnancy and from all STIs. Currently, however, no means exist that have been proven to effectively prevent transmission of all STIs other than abstinence or mutual monogamy among uninfected partners. However, many people, most particularly women and adolescent girls, have little control over whether these practices can be implemented. Moreover, previous infection may leave currently monogamous couples at risk.

Dual protection against pregnancy, HIV and other STIs can be achieved either through the use of a condom alone or the use of a condom in combination with another contraceptive method (dual method use). When used consistently and correctly with every act of sexual intercourse, male latex condoms have proven to be a highly effective means of preventing pregnancy, HIV, and some other STIs. Female condoms also are becoming more widely available in various country programs and have been shown to be acceptable to many women and men in some settings. However, more data are needed to further determine both their acceptability and effectiveness for STI and pregnancy prevention on a broader scale. Dual protection also can be achieved through the avoidance of all types of penetrative sex and through mutual monogamy between uninfected partners using a method of contraception, practices that for many people may be impractical.

In spite of the potential for reducing both unwanted pregnancy and STIs, several factors lessen the acceptability and consistency of use of both male and female condoms. These include the need to use and to negotiate condom use with every act of sexual intercourse; the perception, particularly on the part of many men, that the use of condoms will dramatically reduce sexual spontaneity and pleasure; and, the association of condoms with illicit sex. The stigmatization of condoms and the people who use them has arisen, in part, as a response to programs targeting condoms largely to sex workers and "at risk" populations. Promoting condoms for pregnancy prevention can help to reduce this stigmatization.

Since men retain primary control over the use of condoms, women and adolescent girls are urgently in need of means of achieving dual protection, such as microbicides. Complications of unintended pregnancy and unsafe abortion are leading causes of reproductive mortality and morbidity among reproductive age females worldwide. In addition, women and girls are biologically, socially and economically more vulnerable than are their male partners to HIV and other STIs.

Because of existing gender disparities, men are more likely to decide on the timing and conditions of sex, and on the means of preventing infection, if any, and women often are unable to negotiate condom use with their partners. For example:

  • The socialization of girls and women often curtails their autonomy and undermines their ability to negotiate with men. It limits their knowledge of sex and reproductive functioning, and it discourages them from challenging male partners on many issues including sexual relations. Women who take the initiative to have condoms on hand may risk appearing "too ready for sex." On the other hand, girls and women in other settings are socialized to display sexual availability and yet are still limited from protecting themselves.
  • In suggesting condom use when they suspect or know their partners to be infected women may risk physical abuse or accusations of infidelity.
  • For some women, a pregnancy prevention rationale is essential for encouraging their partners to use condoms. However, many women are unable to negotiate condom use on this basis because they are already using another method of contraception, such as sterilization, IUDs, oral contraceptives, implants or injectables. In cases where a male partner is aware of ongoing contraception or the woman is already pregnant, other strategies are needed to negotiate condom use.

Stigmas surrounding sex, sexuality and condom use undermine the acceptability of condom use in other ways. For example:

  • In many settings throughout the world, risk-taking behavior is often a defining characteristic of male identity. For example, boys and men are socialized to initiate sexual activity at an early age and to have multiple sexual partners.
  • Some men fear that condoms may reduce their own sexual pleasure and/or reduce their ability to "perform."
  • The potential inconvenience and embarrassment of obtaining condoms, especially among women and youth, may constrain access and use.
  • Family planning service programs and providers often are biased in ways that reflect cultural norms and previous training. They may favor pregnancy prevention over disease prevention and they are more likely to encourage women to use longer-term methods than to recommend condom use. Further, family planning programs, for the most part, do not see men as their clients and are not prepared to serve them.

Unwanted pregnancy and HIV/STIs pose a growing social and health burden that must be addressed. The integration of dual protection strategies into family planning programs is, therefore, increasingly urgent. To meet this challenge, programs must find creative ways to:

  • Promote positive and equitable power relations between men and women, in part through efforts to increase couple communication and to challenge the prevailing norms and stereotypes that underlie risky behaviors;
  • Educate males and females of all ages about healthy sexual behavior, reproductive functioning and health, the risks of unprotected sex and the means of pregnancy and HIV/STI prevention, including condom use and all forms of non-penetrative sex;
  • Contribute to making physical and sexual coercion and gender-based violence unacceptable, and encourage men to question their own risk-taking behaviors in an effort to protect themselves, their partners and their families; and
  • Make the importance of dual protection strategies known to health workers and reward them for encouraging such strategies among their clients.

Innovative strategies are needed to ensure that dual protection becomes a routine feature of family planning and HIV/AIDS prevention programs. This may require working with individuals, couples and communities to build new social norms for sexual behavior that promote mutuality in sexual and productive decision-making.

USAID Inter-Agency Gender Working Group, Subcommittee on Men and Reproductive Health, 06/01/01

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