Stigma and branding as Catalysts OR deterrents in the use of preventive prophylactics for at-risk populations: Lessons for New Prevention Technologies (NPTs).

Published: September 22, 2011

BACKGROUND: Stigma and nomenclature of Preventive prophylactics can influence risky sexual behaviours. 20 settings in Uganda were identified to describe this association from July 2010 to August 2011.

OBJECTIVE: To show effect of branding/ nomenclature on use of prophylactics, their demand and provision.

DESIGN: Literature review on branding of prophylactics, Qualitative information using a short structured questionnaire and focus group discussions inquiring into stigma, needs of male sex-workers, where they get condoms/lubricants and what the unique characteristics attributed to anal sex were, formed our design.

SETTING: This covered 3 suburbs of Kampala (Nansana, Kawaala and Kabalagala) chosen for the big number of male sex-work as opposed to just MSM Liaisons where reluctant responses to answering the three questions would be experienced; 1 ward in Mbale; 1 ward in Mpondwe and; 5 major pharmacies/shops that stock KY jelly, female condoms and Same sex sexual reproductive health commodities.

RESPONDENTS: The respondents included 74 male sex-workers (17 years to 32 years), 4 male pimps/escorts (2 were 25/33 years: 2 were 42/52 years) 10 gay-friendly organisation heads, 5 substance users (20; 24; 33; 35; 35 years), 5 pharmacists, and 3 regular clients of male sex-workers ( 27,42, 47 years) as key informants.

INTERVENTION: All discussions and conversations were conducted in safe spaces and confidentiality was assured for all. Names of respondents except for venues were struck off all lists.

MAIN OUTCOME MEASUREMENT: The extent and scale of stigma that male sex-workers/sexual minorities face may be a deterrent in accessing SRH commodities. Other deterrents included the regard of providers, the price and branding of SRH materials. RESULTS: Anal sex was chosen as the topic and 6 names for imaginary anal sex prophylactics were provided to discussion groups: An-dom; hygiene-dam; hyg-dam; hyg-dom; ano-dom and; hygandom. 101 (100%) respondents did approve of some form of protective; all expressed no fear on ordering a male condom from a familiar pharmacy or shop. They agreed a male condom is used by the insertive partner and the receptive partner may not have equal negotiation powers. 80 (80%) respondents agreed that a prophylactic provided by the receptive partner was a powerful decision tool to prevent HIV/STIs. 10 (10%) had improvised latex gloves to use in protecting themselves during anal sex and had had same sex anal intercourse a week ago. 3 (3%) clients who also had same sex insertive sex expressed no loss of pleasure in situations of use of the improvised latex glove protection because the tightness around penis increased enjoyment all the times they used it. 3 (3%) pharmacists expressed fear in importing anything to do with “gay things”. However, when asked whether branding such as “male condom” was okay they felt it would be ambiguous. Branding such as “anal-condom” was repulsive. All said that the name “An-dom” reminded them of a mosquito repellant. 20 (27%) male sex-workers agreed the name “hygiene dams” (borrowed from dental dams) whereas appealing had a “political” connotation of the valley dam saga. The pharmacists remarked on its being too long to pronounce. They suggested “hyg-dom”. MSM-friendly condoms (Mfc) as a term (this was to compare with the letters fc2 on a packet that was shown around for comparison) was also agreed on by 1 (1%) of the pharmacists as a brand name. On deciding which name to pick finally, 90 (90%) respondents picked the name “Hygandom” as a good brand name. When probed further it was realised this short name carried within it an urge for hygiene, would be used as a condom and that it would improve the sense of cleanliness and esteem. The term “anal-wipes” was dropped by all (100%) for bringing images of cleaning after a long call. The 10 (10%) leaders of gay friendly organisations pointed out that this name was not stigmatizing and would improve on its demand.
In depth interviews revealed: “Branding and social marketing are crucial, we do have KY-Jelly and all our clients order for it without finger biting because of the multiple uses it has. “Hygandom” would have an equally catchy name and an attribution that they are used for hygiene purposes. ” – Pharmacist in Wandegeya

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