Inter Press Service - October 31, 2004
Bayano Valy

Delegates to 'Countdown 2015: Sexual and Reproductive Health and Rights for All' (which took place at the beginning of September) heard that on average, men in sub-Saharan Africa only have access to about three condoms a year.

As condoms have long been acknowledged as a key part of efforts to contain the spread of AIDS, this limited supply of prophylactics would appear to have dire implications for Africa. In Mozambique - one of the poorest countries on the continent - an examination of condom availability offers cause for both hope and concern.

In 1998, a Washington-based non-governmental organisation (NGO) - Population Services International (PSI) - sold or distributed some 10 million condoms in Mozambique. This year, PSI hopes to push the figure to 16 million.

This group is one of the leading condom suppliers in the Southern African country. Other entities - NGOs, AIDS organisations and private firms - are also involved in this field, as it Mozambique's Ministry of Health, which distributes free condoms.

Mouzinho Saide, director of the National Programme to Combat AIDS, told IPS that in 2003 the ministry gave away slightly over 20 million of the prophylactics: "The level of condom demand increased, and that's due to improvement in public awareness that the HIV/AIDS problem is serious."

"We hope to distribute about 25 million condoms this year," adds Saide. This figure is likely to go up to 40 million next year, at a cost of 1.58 million dollars (1.32 million dollars are being spent by government on condoms this year).

PSI has used the theatre, radio plays and dance in order to educate the public about the importance of using condoms.

"We've got teams at the provincial and district levels. It's the provincial co-ordinator who's responsible for all issues related to logistics, sales and communications - and this is in co-ordination with the districts," Jose Alho, PSI marketing director, told IPS.

Usually, the teams arrange meetings with communities in which they discuss the benefits of condom usage.

People who attend the meetings take part in exercises where they learn how best to negotiate condom use; they also practise putting condoms onto wooden models of male genitalia to minimise the chances of incorrect use of the prophylactics.

At times, however, these efforts meet with resistance.

In early September, national television showed images of people throwing away condoms that activists had distributed during a rally by the governor of the southern Gaza province.

The activists were also told to stop acting disrespectfully. It seemed clear that many of those at the rally saw condom use as something that compromised decency rather than saving lives.

"There's a misconception about condom use, and it's not for lack of information that they (members of the public) are reluctant. It's more of a cultural element," says Alho, noting that PSI has met with similar resistance in the northernmost province of Niassa (which accounts for about 11 percent of AIDS cases) and the central province of Manica (which has 19 percent of AIDS cases - the second highest in the country).

According to the health ministry, 14.9 percent of people in Mozambique are HIV-positive (the country has a population of slightly over 18 million). HIV prevalence varies from region to region, however: in the central part of the country, prevalence is put at almost 17 percent, reaching 26.5 percent in Sofala province.

Some men associate condoms with prostitutes, and think they should only use the prophylactics when frequenting sex workers.

Even in these situations, higher prices may be paid for the right to have sex without a condom on the assumption that it lessens a man's pleasure. A man will argue that "he can't take a shower with an umbrella," observes Alho.

In other cases, a woman who asks for a condom to be used may be accused by her partner of not trusting him.

"Acceptance of something is a process of intensive work. Our levels of education limit people's views, and this is even more worrying in the rural areas where there are some who believe that condoms cause HIV/AIDS," says Saide. Almost 56 percent of Mozambicans are said to be illiterate - although this figure is likely to be higher in rural areas.

Victor Muchanga of the National AIDS Council says government wants to "improve and increase condom use among the population", and that it is currently working on a strategy to this effect.

The council sees Mozambicans as falling into either a "general" or a "high risk" category as far as HIV is concerned, the latter including sex workers, customs agents and highly mobile persons such as long- distance drivers and hawkers. Customs agents are often said to allow female hawkers through border posts with making them pay duties if the traders have sex with them.

Muchanga says authorities would like to increase condom use amongst the general population by 50 percent by 2007, and 80 percent by 2009. For persons in the high-risk category, the targets are 80 percent by 2007 - and 95 percent by 2009.

The money for purchasing condoms comes from, amongst others, the United States Agency for International Development. The United Nations Children's Fund, in its initiatives for AIDS prevention and care, informs people about how condoms can be used to prevent HIV transmission.

The "Jeito" brand of condoms, marketed throughout Mozambique, can sell for less than five cents for a packet of three - although unscrupulous vendors may charge ten times as much.

In a country where, according to the 2004 Human Development Report, about 38 percent of people live on less than a dollar a day, even small inflation in the price of condoms is cause for concern.

The development report is published by the UN Development Programme.

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