Provider HIV and pregnancy prevention practices in southern Africa: The female condom

HIV prevalence is high in southern Africa, as is infection among young women. The female condom is currently the only female method for HIV/STI and pregnancy prevention, and this study assesses provider practices. We conducted national, probability surveys of physicians and nurses providing family planning and HIV/STI prevention services in South Africa and Zimbabwe (n = 1,452). We asked providers about their contraceptive and HIV/STI care. Virtually all providers surveyed care for low-income patients, adolescents, women needing contraception, at-risk and HIV-positive patients. Eighty percent usually discuss pregnancy and HIV/STI prevention at the same visit. Most (90%) offer their patients female condoms (99% for male condoms). Ninety-two percent consider the female condom to be an appropriate contraceptive for women at high risk of HIV, while very few consider the highly effective contraceptives (e.g. pill, IUD, implant), apart from injectible, as appropriate. Views were similar for HIV-positive women. Providers rate as high the need for female barrier methods, as well as methods that can be used discreetly by women. Results of trials on female barriers have been discouraging (i.e. microbicides, diaphragm), but a new, less expensive female condom, FC2, was recently approved for USAID distribution. The female condom leaves certain needs unaddressed, such as discreet use by women or coital-independence, but has advantages too: it is already recognized by providers and integrated into practices. Providers reported they would welcome an improved female barrier method. Distribution of supplies should quickly follow approval, to address HIV and pregnancy prevention needs.