The National Condom Strategy 2018-2022
Swaziland has made significant progress over the last decade in battling the HIV epidemic. With the scale up of antiretroviral therapy (ART) and prevention programmes, such as those to prevent mother-to-child transmission of HIV. The country’s HIV prevalence has also remained relatively high, with 19% among population 2 years and older and 26% among 15-49 years’ age group, (SDHS, 2006/07) though a decline has been noted in the incidence. According to the 2016 Swaziland HIV Incidence Measurement Survey (SHIMS), HIV incidence has reduced by 50% from as high as 2.48% to 1.39% among adults 18-49 years. Unmet need for family planning including the condom is still high especially among women living with HIV which increases chances of maternal mortality and morbidity that can be avoided. Thus awareness and use of primary preventative methods is critical for the country to reduce the incidence of new HIV infections by 2022.
Through various health policies and strategies, including the Sexual and Reproductive Health Policy, condom use is an important biomedical intervention for HIV, Family Planning (FP) and Sexually Transmitted Infections (STIs) prevention. Though comprehensive knowledge of HIV infection is high, there are still many myths, misconceptions, and cultural barriers to condom use. Gender dynamics influence the ability for partners to negotiate condom use. Accessibility and availability of condoms is still an issues which then reduce the chances of it being used across all targeted populations. Female condoms could have great impact should they become available, well-known, and accepted by users. Key populations such as men who have sex with men, sex workers, their clients, and their partners have the highest incidence of HIV. Thus, a successful prevention programme for the country is crucial and must account for this unique HIV infection context.
The goal of the National Condom Strategy, 2018–2022 is to improve access to quality and affordable male and female condoms for all sexually active individuals to contribute to the prevention of HIV, other Sexually Transmitted Infections (STIs), and unintended pregnancies in Swaziland. The strategy provides a multisectoral framework for sustainable, coordinated, comprehensive condom programming (CCP) and outlines the roles and responsibilities of all stakeholders within the given five-year timeframe.
To achieve this goal, six strategic objectives have been developed through consultation with government, key stakeholders, and experts in condom programming aligned to the four CCP thematic areas namely, “Leadership and Coordination,” “Supply and Commodity Security”, "Demand, Access, and Utilization,” and “Programme Support”. A set of strategic priorities, outputs and activities has been developed in each of these thematic areas. This addresses the gaps and challenges faced in each thematic area. These activities reflect on the guiding principles: Equity of access of male and female condoms, sustainable financing for male and female condoms, Total market approach, multi-sectoral partnerships, engagement and involvement, and integration of HIV/STI prevention, SRH and family planning. having a special focus on mobile populations, sex workers, men who have sex with men and gender sensitivity.
Key roles for implementation of the strategy is highlighted with the Ministry of Health providing the key role including all partners especially commercial players. Monitoring of the strategy is a key element that has been included in collaborative quarterly meetings to address bottlenecks, annual strategy review meetings to share best practices, highlight progress made, and pinpoint areas in which strategy priorities need to be modified based on the continuously changing environment.