Using Men as Community-based Distributors of Condoms

Many managers of reproductive health programs are weighing the benefits of adding more men to community-based distribution (CBD) programs in order to reach more men inthe community and distribute more condoms, thus providing dual protection against sexually transmitted infections(STIs, including HIV/AIDS) and pregnancy.CBD programs have traditionally used female agents to target female clients. Relatively few studies have addressed men's effectiveness as CBD agents or as providers of condoms. This Summary highlights the key findings of some 20 reports from 13 countries that discuss the effectiveness of male agents. The reports address a variety of questions, including community acceptance of male agents, productivity of male versus female agents, and program issues related to use of male agents. Only three controlled operations research studies, conducted in Congo (formerly Zaire), Kenya, and Peru, specifically compare male and female CBD agents and control for confounding factors such as the agent's geographic location, length of time in the program, marital status, and education; these are cited where their findings apply.

1. Most communities accept men as CBD agents. Studies in Cameroon, Ghana, Kenya, Mali, Pakistan, and Tanzania found that clients and communities accept men as CBD agents and welcome the information and services that they provide. Overall, almost all the evidence suggests that communities accept male agents.

2. Male agents distribute more condoms than female agents do. Two of the three controlled studies compared male and female condom sales. In the Kenya study, male volunteers distributed almost three times more condoms than did female volunteers. The eru study showed that condom sales by male distributors were significantly higher than those by female distributors.

3. Male agents serve more male clients than female agents do. In the Peru study - the only study that related agent gender to client gender - male CBD distributors in two cities served more male clients, while the female distributors served more female clients.

4. In most settings, men and women are equally productive asCBD distributors. The three quasi-experimental studies in Congo, Kenya and Peru - as well as an uncontrolled study in Kenya and another in Paraguay - found that male agents pro-vided as many or more couple years of protection (CYP) as female agents.

5. Adding male distributors entails only minor adjustments in program operations.In some settings, program directors should be prepared to address the reluctance of managers and supervisors to recruit male agents in what they regard asa "women's program."

Program managers may need to adapt their recruitment strategies to accommodate men's schedules.

Men and women can be trained together. The timing of training courses may require adjustment to fit varied work schedules.

Evidence suggests that adding male agents to CBD programs can enhance efforts to provide dual protection against STIs and pregnancy. Male agents are acceptable to communities; they are at least as productive as women as distributors of condoms; and they can be included in programs with minimal adjustments. The inclusion of male distributors in CBD programs should be considered an element of best practices.