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The Power of the Provider to Promote Female Condoms.

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Presentation on theme: "The Power of the Provider to Promote Female Condoms."— Presentation transcript:

1 The Power of the Provider to Promote Female Condoms

2 What we are going to cover  The field of female condoms  Why female condoms matter  How to use female condoms  Effective promotion strategies  The provider’s role  Hands-on practice and role plays  About the Chicago Female Condom Campaign  Next steps  Resources

3 But first, let’s talk ground rules  We’re all here to learn  Listen actively and respect others when talking  Participate to the fullest of our abilities  Speak from own experiences with “I” statements  Sit by someone you don’t know!  Promise that what is said here, stays here  Ask questions  Anything else?

4 A word about language  People who are not female-identified may be turned off by the name “female condom”  Other names for FCs include… Internal condom Receptive partner condom Bottom condom Insertive condom Manhole cover Catcher’s mitt What other terms have you heard?

5 A word about language and gender  Best practice to affirm & respect clients’ gender expression & identity  Don’t make assumptions about a person’s gender  Ask their preferred pronoun such as: she/her, he/him, ze/hir, they/them, etc  Don’t be afraid to ask! Just be respectful  Tell them yours too!

6 Pre-test  Help us assess what you know and think about FCs before the training  Take post-test after completing training  Show you AND us what you learned today

7 Let’s get to know each other!  Your name, agency, role, & preferred gender pronoun 1=Never heard of FCs 2=Heard of FCs, but haven’t talked at length about them 3=Feel pretty confident talking about FCs, but have more to learn 4=Very knowledgeable & comfortable w/ FCs 5=Know tons about FCs; talk about them with everyone I meet!

8 Your thoughts on FCs  What do YOU think about FCs?  What do you think when you see them?  Do you think FCs are effective prevention tools?  What do you say when they are mentioned?  Do you think they enhance pleasure?

9 Renewed energy & interest in condoms  CDC prioritization of condom distribution  Gates recent RFP for “Next Generation Condom”  Several female condom products on the market today, and additional products in development  Promotion of FC2 for receptive partners of all genders  Folding silicone male condom in clinical trials  First RAI condom in acceptability trials

10 The field of female condoms  Female Health Company’s FC2 Nitrile (synthetic latex) Pre-lubricated with silicone-based lubricant Does not contain spermicide Most widely distributed FC around the world Only FC available in U.S.

11 About the FC2  FDA approved FC2 early 2009  What’s different between FC1 and FC2? Non-allergenic for people with latex allergies Softer Seamless Quieter More affordable Warms to body temperature

12 Anatomy of the FC2  6.5 inches long  Has 2 flexible rings— inner and outer  Inner ring stays inside of FC when used for vaginal sex  Inner ring enables insertion into vagina and up to cervix where it locks into place  Outer ring at FC opening lays outside of vagina against the vulva or outside of the anus  Outer ring helps acts as guide for penetration, which prevents bunching

13 The field of female condoms  The Woman’s Condom Polyurethane with capsule applicator Capsule dissolves upon insertion Foam shapes hold it in place Commercially available in China

14 The field of female condoms  Cupid Latex Sponge assists with insertion Outer ring helps keep it in place during sex Available EU, Brazil, Portugal, and South Africa Pre-qualified by WHO

15 The field of female condoms  Panty Condom Polyethylene sheath pre-lubricated w/ Vaseline Limited distribution in Colombia, under review for WHO pre-qualification  Phoenurse Polyurethane, silicone lubricated Insertion tool Limited availability in China & Brazil, under review for WHO pre-qualification

16  What FC is available in the U.S.?  Are all FCs made out of the same material?  Of what material is the FC2 made?  What is the function and purpose of the inner ring?  What is the outer ring’s function & purpose?  Can you take inner ring out for vaginal sex? Pop quiz!

17  Women and men need options  Prevention and protection  Empowerment  Pleasure Why promote female condoms

18 Female condoms are for:  Women  Men  Youth  Transgender people  Queer people  Straight people  Pregnant women  Pre or post-menopausal  People living with HIV  People who are HIV—  People who have had a hysterectomy

19  People need variety of tools for different times and situations  Non-hormonal contraception is limited  No side effects  Offer post-menopausal women solution to vaginal dryness  No biomedical combination contraceptive and HIV prevention tool yet exists Why promote FCs—more options

20  Only tool that offers women dual protection against pregnancy, STIs, & HIV  Comparable to male condoms in reducing risk of STIs, pregnancy, HIV  External genitalia coverage reduces skin-to-skin STIs  Hopkins economic analysis showed DC’s FC program prevented 22 HIV infections in first year, saving $8m in future medical costs Why promote FCs—prevention & protection

21  Receptive partners of all genders need array of tools to take active role in their own health  Women need tools to help control if/when they have children  Provides additional option when male condom negotiation is not possible or safe Why promote FCs—empowerment

22 Why promote FCs—pleasure  FC feels more “natural”, allows for increased sensation and heat  Receptive partners can take charge of own health  FC2’s rings double partners’ pleasure  Enables spontaneity because FC isn’t reliant on erect penis  Don’t have to pull out right away  FCs can be used in sexual play

23 Most importantly  Protected sex acts INCREASE when FCs are offered alongside male condoms  Consistent condom users often switch between methods when both male and female condoms are available

24 Pop quiz!  Why should providers talk with their clients about pleasure?  How can FCs enhance intimacy?  Are FCs comparable in protection to male condoms?

25 Giving people the right tools  Essential to provide education along with FCs to ensure client comfort and confidence  Study showed intensive training increased FC use and decreased unprotected sex overall by 10-25% among U.S. women  NYS study found that intent to use FCs among clients was significantly associated with provide FC knowledge, FC attitudes, and self-efficacy for FC promotion

26 The power of the provider  Health care providers are trusted info sources  People who learn about FCs from providers or clinics are more likely to use them  Provider perspective translates to client Critical provider feels comfortable & confident with FC Negative provider bias=reduced client intent to use

27 Critical components of FC education  Use positive and affirming language to introduce FCs  Highlight pleasurable aspects  Help clients/patients become familiar with FCs Take the FC out of the package Explain FC construction and purpose Inform them that practice makes perfect

28 Critical components of FC education  Talk through vaginal & rectal anatomy, using model or pictures  Demonstrate insertion  Have client demonstrate back to: Make sure comfort with insertion Correct mistakes Create space for questions  Compare to learning something new--tampons, contacts, etc.

29 External female anatomy  Mons pubis  Pubic bone  Clitoris  Urethra  Vaginal opening  Labias (Lips)  Anus 

30 Internal female anatomy  Ovaries  Fallopian tubes  Uterus  Cervix  Vaginal canal

31 Penis anatomy

32 Anal anatomy  Anus  Rectum Female Male

33 Use FCs to…  Alternate who wears the condom  Enhance intimacy by having partner stay inside after climax  Have safe sex even when a partner refuses to wear a condom  Keep the spontaneity going  Take care of self and partner

34 When not to use female condoms  When using a NuvaRing  When using a diaphragm  When using male condom  With a pessary – a device to hold a pro-lapsed uterus’s in place  If it feels uncomfortable or hurts

35 Female condoms for vaginal sex  MUST keep inner ring inside for vaginal sex  Enables FC to stay in place by locking behind pubic bone  DO NOT remove inner ring when using FC for vaginal sex  Can be inserted prior to sex

36 A note about FCs and anal sex  Anal sex, it’s not just for gay men!  Women have anal sex, it’s usually unprotected  FCs can open important dialogue on anal sex  FC2 is NOT FDA approved for anal sex ( neither are MCs)  Inconclusive safety and NO efficacy data on FCs for anal sex  Campaign promotes FCs for anal sex as risk reduction strategy

37 How to insert FCs for vaginal sex 1.Squeeze inner ring between thumb and middle finger. 2.Insert inner ring into vagina and use index finger to guide inside. 3.Put finger inside FC and gently push into vaginal canal. Inner ring will fit behind the pubic bone, over the cervix.

38 How to insert FCs for anal sex  FCs for anal sex is a risk reduction strategy  Insert at time of sex act  Options for use: Insert FC into anus like similar to vaginal use Remove inner ring, place FC on penis or dildo  Use lots of lube and enter the anus slowly 1 2 3

39 After FC insertion  Make sure FC is not twisted  FC should be smooth against walls of vagina or anus  Outer ring must be outside vagina or anus, covering external genitalia/anus  Add lube for increased pleasure and easy movement  Hold FC in place; guide penis into FC so as not to push FC to the side  If FC gets twisted, comes out, or bunches, use a new one!

40 A note about lube  FC2s pre-lubricated w/ silicone-based lubricant  Nitrile, like polyurethane, tolerates oil-based lubricant  Important to be careful about messaging to ensure client doesn’t think oil-based lube can be used with all condoms  Oil-based lube DESTROYS latex condoms  If clients prefer oil-based lube, FC2s may be a good option for them

41 When finished  To remove FC, twist outer ring to keep the semen inside  Gently pull FC out, and throw away  Use a new FC with every sex act  NEVER use a male condom and a FC at the same time

42 Troubleshooting with the FC  What should you do if the FC is pushed inside the vagina?  What should you do if the FC sticks to the penis?  What should you do if the penis slips between the FC and the vaginal wall?

43 Down and dirty of FCs  FCs reduce risk of HIV, STIs, and unintended pregnancy.  Just one gets it done. Never use FC & MC at same time.  Inner ring must remain inside for vaginal use.  FC must be inserted for anal sex at point of the sex act.  Outer ring lies over lips of the vagina or anal opening.  Put lube inside FC to increase pleasure and make sure FC doesn’t stick to penis.  FCs can increase pleasure for both partners.  Practice makes perfect.

44 Make your FC pitch!  Take 5 to 7 minutes to draft your own pitch about female condoms  Think about the main points that MUST be made and what information to include to increase a person’s intent to use the female condoms  We will regroup to share pitches

45 Pop quiz!  What are the essential components of FC education?  How are female condoms used for vaginal sex?  Can female condoms be used with male condoms?  Can female condoms be used for anal sex?  When must a person start with a new female condom?  What about lube is important to talk about with clients?

46 How to use model correctly  Must be right side up  Cover cut out with hand  NO adjusting through cutout  Use vaginal opening to insert FC

47 Full demonstration: vaginal and anal  Let’s put it all together!  Full Demonstration: Talk your partner/group through a FC demonstration for vaginal and anal use from expiration date to removal as if they have never seen one before.

48 Demonstration feedback  How’d it go?  How was it for you to practice inserting the FC?  What challenges did you encounter?  What additional information do you need to coach a client to correctly insert the FC?  What additional resources might you need?

49 Role plays  Role plays: We’ll read through sample scenarios provide suggestions for what a provider should/could say to the clients.

50 Where to get FCs  FHC FC2 finder Text“findFC2” to 877877  Individuals can buy FCs at select Walgreens Visit stores near that stock Order them online  Agencies, clinics, Chicago businesses, & others who participate in the Chicago Community Condom Project s/svcs/get_free_condomsatoneofourstispecialtyclinics.html s/svcs/get_free_condomsatoneofourstispecialtyclinics.html

51 Insurance coverage of FCs  Private health insurance and Illinois Medicaid cover female condoms  HOWEVER, commercial availability is woefully limited  Select Walgreens stores stock FC2s  Does your organization have a clinic or pharmacy? If so, does it stock FC2s?

52 Getting FCs for your community  IDPH-go through lead agent  Chicago Community Condom Project Run by CDPH Access MCs and FCs for free! Contact Marguerite Harrold at to learn how your organization can participate!

53 Chicago Female Condom Campaign  Mission: Increase awareness, access, and use of FCs  Broad-based coalition including HIV, reproductive health and justice, harm reduction, domestic violence, LGBT, women’s health, youth, and others!  Achieve mission through provider trainings, resources, media, & advocacy  Trained 400 providers on effective FC promotion  Part of a national movement

54 The FC movement is growing  Chicago is one of 7 cities with an FC program and is leading advocacy and education efforts Atlanta Houston Los Angeles New York San Francisco Washington, DC

55 Chicago Female Condom Campaign  Available resources: Trainers Brochures Palmcards Tips for providers PowerPoint Facebook & Twitter

56 When you return to your agency  Assess how your agency makes FCs available  See how visible FCs are  Ask your colleagues how they talk about FCs  Determine if staff near the FC bin know FC basics  Pair information gathered with what you learned today to create a pro-FC culture at your agency

57 Create pro-FC culture at your agency/clinic  Make FCs visible  Include FCs in prevention conversations  Make FC materials available  Share what you learned with colleagues;  Encourage participation in FC trainings  Global Female Condom Day!  What will you do with what you learned today?

58 Next steps  What next step do you commit to taking when YOU return to your agency?  How will you share what you learned today?  Complete training evaluation  Pick up materials  Endorse the campaign!  Be a part of Global Female Condom Day!

59 Post-test  Let’s see what you learned today!  Write your same number at the top of the test.

60 Post-test 1.The female condom is a barrier method that reduces a person’s risk of unplanned pregnancy and sexually transmitted infections (STIs), including HIV.  TRUE 2.The FC2 female condom is latex-free and pre-lubricated with a silicone-based lubricant.  TRUE 3.The female condom can be used together with the male condom.  FALSE

61 Post-test 4.The FC2 female condom can be used safely for vaginal sex without the inner ring.  FALSE 5. The female condom is Food and Drug Administration (FDA) for both vaginal and anal sex.  FALSE 6.The U.S. Food and Drug Administration (FDA) approved using the FC2 female condom more than once.  FALSE

62 Post-test 7. Understanding the female reproductive system and the location of the cervix helps women properly insert a female condom.  TRUE 8. The FC2 female condom is inserted properly into the vaginal opening by squeezing the inner ring with your thumb and middle finger or twisting he outer ring into a figure 8.  TRUE 9. The FC2 is currently the only female condom available in the U.S.  TRUE

63 What do you think of FCs now?

64 Thank you! Jessica Terlikowski AIDS Foundation of Chicago Sara Semelka AIDS Foundation of Chicago

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