There is a pervasive pattern of stockouts of condoms, both male and female condoms, in African countries confronting HIV/AIDS, according to Carolyn Ryan, M.D., M.P.H, the Director of Technical Leadership at the Office of the Global AIDS Coordinator.
She called the condom gap “really quite disturbing,” given that condoms are a crucial tool for HIV prevention. While HIV incidence has fallen in recent years, in 2009 there were an estimated 2.6 million people newly infected with HIV, meaning that about 7000 people are acquiring the infection each day.
She made her comments at the January 6-7, 2011 meeting of PEPFAR’s Scientific Advisory Board. Many of the slides delivered at this meeting have now been made public on the PEPFAR website, including the presentation by Dr. Ryan on prevention and one by Dr. Charles Holmes on care and treatment, including PMTCT.
Dr. Ryan said that OGAC surveyed a number of high HIV prevalence African countries and found that in 9 out of 10 there were persistent, sector-wide stock-outs of condoms during 2008-2010 and that it was common for these stock-outs to last more than 2 months.
She said the median availability of male condoms is only 9.65 condoms per man per year, with large variations from country to country. In 2008 Ethiopia, Cote d’Ivoire and Zambia received the fewest condoms per man from donors among the countries surveyed.
Uganda has had a history of such stockouts, and Ryan’s presentation shows that in 2008 donors shipped only 7.9 condoms per man. A news report from last month indicates that in some northern districts in Uganda, health facilities have no condoms in stock for free distribution. HIV prevalence in the northern-central region of the country is about 8.2 percent, compared with the national average of 6.4 percent.
OGAC is working to understand the complex reasons behind the stockouts, and in a forthcoming report the agency will address how the US intends to respond. Ryan listed a number of factors leading to the shortages:
* Insufficient donor support for both condom provision and demand creation
* Ineffective funding mechanisms, such as ineffective basket funding
* Confusion over the US Government position on condoms
* Lack of prioritization of condoms by host governments
* Weak public sector supply chain systems
* Unfavorable regulatory policies – including import taxes and unnecessary post?shipment testing
Ryan also noted that similar issues led to insufficient supplies of female condoms. The Center for Health and Gender Equity states that the U.S. has dramatically increased its distribution of female condoms in recent years, with shipments growing from 1.1 million in 2003 to 14.6 million in 2009. However, the Center notes that female condoms still represented just 3.2 percent of total U.S. condom shipments in 2009 and that “U.S. government investment in female condom procurement falls short.” In addition, the Center, which will be releasing a new report on access to female condoms, states that the US is “not investing enough in programming to see the product really succeed.”
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