Assessing nurses' knowledge and attitudes towards promoting female condom use in South African primary healthcare clinics.

BACKGROUND: Female condoms protect against unplanned pregnancies and sexually transmitted infections (STIs) including HIV; however, their uptake is very low in South Africa. Nurses are frontline healthcare workers and are uniquely positioned to promote their use to their clients. This study assesses nurses' knowledge of, attitudes to, and practices regarding the promotion of female condoms at selected primary healthcare facilities in the King Sabata Dalindyebo sub-district of the Eastern Cape, South Africa. METHODS: A descriptive cross-sectional study was conducted from April to May 2021 at five community health centres in the King Sabata Dalindyebo sub-district, South Africa. A total of 139 nurses completed a self-administered questionnaire. Data were analysed using simple descriptive statistics. RESULTS: The majority of the participants (82.7%) were knowledgeable about the female condom. Some participants did not have a good attitude and willingness to promote female condom use to their clients. Junior nurses (enrolled nursing assistants and newly qualified professional nurses) were less knowledgeable about the female condom than more qualified and older nurses. There was no significant association between level of knowledge and attitude or willingness to promote the use of the female condom. CONCLUSION: This study found good knowledge of the female condom among the nurses; however, the knowledge did not translate into a willingness to promote the device at their health facilities. Capacity building of the junior nurses will fill the knowledge gaps identified. Studies exploring the sociocultural issues around the female condom are needed in the region.

A qualitative study on the clinical safety and user experiences of female condoms for anal intercourse among men who have sex with men in Shanghai, China.

Objective: This qualitative study aimed to understand the clinical safety, efficacy, and receptiveness of using the female condom (FC) during anal intercourse among men who have sex with men (MSM). Methods: Subjects for this study were recruited from a two-group crossover trial among MSM in Shanghai. The trial consisted of two phases, each including the use of condoms (FC vs. male condom), questionnaires, and in-depth one-on-one interviews. The two phases were separated by a washout period of 4 weeks. The minimum sample size for this study was determined in accordance with the principle of "information saturation." The qualitative data were organized and analyzed using ATLAS.ti version 7. Results: A total of 26 participants from the MSM population were recruited for this study, with 10 assuming the insertive role (i.e., "1"), 8 assuming the receptive role (i.e., "0"), and 8 being versatile (i.e., "0.5"). Each participant completed the crossover trial comprising two phases. The cumulative usage of FCs and male condoms (MCs) amounted to 115 and 127 times, respectively. During the reported sexual encounters, no participants reported incidents of condom rupture, slippage, or other malfunctions. A few participants reported experiencing slight chafing pain, primarily put forward by "0" participants. Apart from those reports, no instances of bleeding, swelling, or allergic reactions were reported. The efficiency of FC in disease prevention, the sexual partner's willingness to use FC, the freshness of FC, and positive sexual experiences were the main reasons for the consistent use of FC for anal sex. Discomfort and pain during sexual activity, the loose design and thick material of FCs, and difficulties in placing FCs were the major obstacles to FC use among MSM. The elements referring to the forehead exhibited varied in importance among "1,", "0," and "0.5" participants. Regarding the willingness to use the FC in the future anal intercourse, 61.54% of participants expressed a positive inclination, 23.08% were uncertain, and 15.38% stated that they would not. "A better sense of security during anal sex" was the main factor affecting willingness among "0" participants and "the sexual pleasure that the FC brought" among "1" participants. Improving the design and technology of FCs and increasing the frequency of use and practice might improve the use skills, which will favor the willingness to use FCs among the MSM population. Conclusion: FCs received positive user feedback from study participants, but distinctions were found in individuals in different sexual roles. Large-scale quantitative studies are needed to evaluate the clinical safety of the FC and its effectiveness in preventing the transmission of STDs during anal intercourse.

8 perguntas sobre o Preservativo Feminino

O Programa Municipal de DST/Aids responde oito perguntas sobre o preservativo feminino! Será que pode usar a camisinha feminina e a masculina ao mesmo tempo? Como é que coloca? Assista e confira!

A systematic study of the interplay between guest molecule structure and intermolecular interactions in crystalline sponges.

Utilization of the crystalline sponge {[(ZnI2)3(tpt)2·x(solvent)]n} method has enabled characterization of a novel family of synthetic organic oils. The systematic structural differences and diversity of functional groups offered by 13 related molecular adsorbates provide a detailed quantitative understanding of the relationship between the guest structure, its conformation, and the type of intermolecular interactions adopted with neighbouring guests and the host framework. This analysis is extended to assess the connection of these factors to the resulting quality indicators for a particular molecular structure elucidation.

Functional performance of the Wondaleaf condom: A crossover, noninferiority, randomized clinical trial.

BACKGROUND: New female condom (FC) products wishing to apply for United Nations Population Fund/World Health Organisation (UNFPA/WHO) prequalification are required to conduct a randomized, controlled clinical investigation comparing the new FC to the marketed FC, in order to comply with UNFPA/WHO and International Organization for Standardization (ISO) specifications. We aimed to assess the functional performance, acceptability and safety of the Wondaleaf female condom compared to the control FC2 female condom. METHODS: This randomized clinical trial enrolled 220 women in one South African site. The primary outcome of the study was the rate of female condom (FC) failure. Participants were asked to use five of each FC type and to collect information on use in a condom diary at home, and were interviewed after use of each FC type. RESULTS: Noninferiority was demonstrated for the Wondaleaf with respect to the reference FC2 for all condom functions. The Wondaleaf was found to be superior to the FC2 reference condom for invagination (p > .000), misdirection (p > .000) and clinical failure (p > .000). Acceptability ratings for a range of features were similar between the two FCs. Few safety events were reported for either device. CONCLUSION: The Wondaleaf performs as well as the FC2, and is equally acceptable. Results from this study will inform further refinement of this FC design. Trial registrations: ClinicalTrials.gov Identifier: NCT04076774 https://clinicaltrials.gov/. South African National Clinical Trials Database (SANCTR) number DOH-27-0319-6020.

Sexually transmitted infection (STI): A malady with skewed marital unfaithfulness, the Nigerian experience

Marital unfaithfulness is a major contributor to sexually transmitted infections in both sexes; however, societal view of the menace seems to use various lenses for the different sexes. Globally, evidence suggests that marital infidelity has existed in history. In Africa, as well as in Western society, infidelity is a problem facing many families and accounts for high incidence of divorce. This narrative review described and synthesized literature on marital infidelity and its association with sexually transmitted infections. We conducted informal interviews with married women on their experiences with marital infidelity in Nigeria. Associated physical, social and psychological cultured imposed consequences were experienced by women in Nigeria. The recurrent themes felt helplessness, enduring physical, emotional and psychological torture, accepting fate with reservation and being strangers in marital union. This narrative review could initiate critical thoughts and discussions on the factors in skewed marital unfaithful and the contribution to reproductive health and family life.

Examining the place of the female condom in india's family planning program aqualitative investigation of the attitudes, opinions of key stakeholders in Pune, India.

BACKGROUND: With overpopulation contributing to the depletion of planetary resources, the high rates of unintended pregnancies in India are a cause for concern. Despite the free supply of contraception options within India's national family planning initiatives, women are generally offered hormonal options as temporary spacing methods. However, female condoms, a much neglected but potent woman initiated, non-hormonal multipurpose prevention device, are yet to be considered for inclusion in India's contraceptive cafeteria. Thus, we aim to examine the place of female condoms among the contraceptive options, by analysing the perceptions of key stakeholders regarding its advantages and disadvantages, along with their opinions on how female condoms should be promoted. METHODS: We used purposive sampling to recruit and interview potential users and dispensers of the female condom. The interview participants visited or worked at family planning clinics in Pune at Smt. Kashibai Navale Medical College and General Hospital (SKNMC-GH), its urban and rural outreach clinics, and at Saheli (a non-governmental organisation for female sex workers). We conducted semi-structured interviews and coded our data inductively. RESULTS: We interviewed 5 rural women, 20 urban women (including 10 female sex workers), 5 male partners of female sex workers, and 5 family planning healthcare providers. Nearly half (12/25) of the women we interviewed, said that they were eager to use female condoms in the future. Many participants perceived female condoms to be an instrument to empower women to be in control of their sexual and reproductive lives (15/35), and that it provided user comfort and confidence (4/35). Their perceived disadvantages are that they are relatively more expensive (6/35), users have limited experience (9/35), and women who buy or use them may be stigmatised and feel embarrassed (4/35). Yet, nearly three-quarters of potential users (21/30) and most healthcare providers (4/5), were confident that female condoms could become popular following extensive promotional campaigns, interventions to improve availability and access, and initiatives to enhance the knowledge of female users. CONCLUSIONS: Female condoms have garnered support from both users and dispensers and have the potential to be widely adopted in India if family planning initiatives which increase awareness, knowledge, and access are systematically undertaken as with other contraceptive options.

Determinants of female condom use among female tertiary students in the Hohoe Municipality of Ghana using the Health Belief Model.

Background: Besides abstinence, the condom has proven to be the only effective method of preventing sexually transmitted infections (STIs), including HIV/AIDS. This study investigated the determinants of female condom (FC) use among female tertiary students in the Hohoe Municipality, Ghana using the Health Belief Model (HBM). METHODS: A cross-sectional design was adopted. Data were collected using a structured questionnaire in January 2019 and analysed using STATA version 14.0. Logistic regression was used to measure the strength of associations between the dependent and independent variables. A p-value <0.05 was considered statistically significant. RESULTS: The overall utilisation of the FC was 35.0%. Among the constructs of the HBM, it was perceived self-efficacy for FC use that was significantly associated with FC use: respondents who had the confidence to convince their partners to use the FC were 2 times more likely to use it than respondents who did not [AOR =2.15(CI: 1.26, 3.71); p= 0.005]. CONCLUSION: Female students in the current study exhibited poor utilization of the FC. Health promotion interventions should, therefore, focus on increasing their self-efficacy for FC use.

Dicas em saúde: Camisinha feminina

Orientações sobre Camisinha feminina: Informação.

Conocimiento y mitos del preservativo interno en población de 15 a 25 años, Región Metropolitana / Knowledge and myths of the internal condom in the population aged 15 to 25, Metropolitan Region

INTRODUCCIÓN: El preservativo interno, de vagina o femenino, es un método de barrera fabricado principalmente de poliuretano, que tiene una longitud de la funda de 17 cm y un diámetro de 7,8 cm. Se usa para tener prácticas sexuales seguras, ya que, al igual que el condón de pene, evita la gestación y disminuye el riesgo de adquirir una infección de transmisión sexual. OBJETIVO: Analizar conocimientos y mitos sobre el preservativo interno en personas de 15 a 25 años de las provincias de Santiago, Melipilla y Talagante, de la Región Metropolitana, Chile, en 2021. MÉTODO: Se realizó un estudio de tipo cuantitativo descriptivo transversal con una muestra de cinco mujeres y cinco hombres, con un total de 110 participantes. RESULTADOS: Se obtuvo como resultado que tan solo un 5% de los encuestados (6/110) ha utilizado el preservativo interno; en contraste, el de pene ha sido utilizado por el 79% de las personas participantes (87/110). Respecto a los mitos, un 55% de la población (60/110) afirma que al usar ambos preservativos aumenta su efectividad. CONCLUSIONES: Es posible concluir que factores como la edad y el nivel de educación sexual influyen en los conocimientos y mitos que giran alrededor del preservativo interno.

INTRODUCTION: The internal, vaginal or female condom is a barrier method made mainly of polyurethane, which has a sheath length of 17 cm and a diameter of 7.8 cm. It is used to have safe sexual practices, since, like the penis condom, they prevent pregnancy and reduce the risk of acquiring a sexually transmitted infection. OBJECTIVE: To analyze knowledge and myths about the internal condom in people between 15 and 25 years of age in the provinces of Santiago, Melipilla and Talagante of the Metropolitan Region, Chile, in 2021. METHOD: A cross-sectional descriptive quantitative study was carried out with a sample of 5 females and 5 males, with a total of 110 participants. RESULTS: It was obtained as a result that only 5% of the respondents (6/110) have used the internal condom; in contrast, the penis condom has been used by 79% of the participants (87/110). Regarding myths, 55% of the population (60/110) affirm that using both condoms increases their effectiveness. CONCLUSIONS: It is possible to conclude that factors such as age and level of sexual education influence the knowledge and myths that revolve around the internal condom.

Barriers and Facilitators to Acceptability of the Female Condom in Low- and Middle-Income Countries: A Systematic Review.

Background: Sexually transmitted infections, including HIV, remain a significant public health challenge for low- and middle-income countries, and about 111 million unintended pregnancies occur in these countries annually. The female condom is the only commonly available method that affords women and girls more control in protecting themselves from sexually transmitted infections, as well as unintended pregnancies. Yet, the female condom only accounts for 1.6% of total condom distribution worldwide. Objectives: To help fill the gaps in an understanding of what works for improved acceptability and use of the female condom in low- and middle-income countries, we conducted a systematic review of the literature that focuses on acceptability of the FC, as examined in the specific settings of intervention programs or research in low- and middle-income countries. Methods: We conducted a preliminary search of two purposively selected databases (PubMed and POPLINE) for English language articles from 2009 to 2019 with the keyword "female condom." PubMed yielded 145 articles, while POPLINE yielded 164 articles. Included studies involve a purposive, interventional deployment of the female condom; have occurred in a low- or middle-income country, as defined by the World Bank; and have focused on acceptability of the female condom. Upon review of duplicates and abstracts, a total of 14 articles made the final selection. Findings: The included articles represent seven different countries: the Dominican Republic, El Salvador, China, Malaysia, Nicaragua, South Africa, and Uganda. We identified four key barriers to FC acceptability, including partner acceptability, functionality, aesthetics, and access. We identified four key facilitators to FC acceptability, including repeated use, supportive attitudes, protection confidence, and reproductive control. Conclusion: Effective promotion and uptake of the female condom in low- and middle-income countries can be realized if novel strategies and approaches are implemented to tackle persistent barriers to acceptability.

The female condom: What do Australian women say?

BACKGROUND: The female condom is a barrier method for the prevention of sexually transmissible infections and unintended pregnancy. Uptake of this method remains low in Australia, although little research has been undertaken to explore this. METHODS: An interventional cross-sectional study was undertaken in 2019 to explore the views and experiences of women in New South Wales. After trying the female condom, they were invited to complete an online survey and/or structured interview. Training in the use of the female condom was not provided. This paper reports on qualitative findings from open-ended survey responses and interviews. RESULTS: In total, 284 participants completed the survey and 20 participated in an interview. Most were aware of the female condom prior to participating in the study, but few had used it previously. Four broad themes were identified from the data: (i) accessibility of the female condom, including cost and availability, (ii) supporting choice in different circumstances, (iii) aspects of empowerment and control and (iv) use of gendered language. CONCLUSIONS: The female condom may be an acceptable option for many women in Australia. To support the choice of method and promote uptake, it will be important to increase the accessibility of the female condom by raising awareness and addressing the issues of cost and availability. Further exploration of issues regarding inclusive language and messaging in health promotion campaigns and marketing is warranted to ensure that this product is accessible for all people who may wish to use it, regardless of gender or sexuality. Similar research could be undertaken with men/partners and members of the LGBTQ+ community to explore their perspectives of the female condom. SO WHAT?: To support contraceptive choice and promote the uptake of the female condom for those who desire this method, it will be important to address the issues of cost and availability. Accessibility will also be enhanced through the consideration of inclusive language and messaging in health promotion campaigns and marketing of the female condom.

Condom use and risk factors of inconsistent or low use of the condoms during heterosexual anal intercourse in sub-Saharan Africa: a scoping review

Anal intercourse (AI) has been reported to be the riskiest among other sexual intercourses in spreading human immunodeficiency virus (HIV) and the risk could be minimized by the use of condoms. Whilst AI is believed to be practiced mainly by men who have sex with men, AI has also been reported to occur in heterosexual relationships. However, data on condom use during heterosexual AI are inadequate in sub-Saharan Africa. Method: A scoping review of English language published articles on condom use during heterosexual anal sex, whose studies were conducted in Sub-Saharan Africa from January 2010 to May 2020 was conducted. Articles were searched systematically on PubMed and Google Scholar electronic databases. Heterosexual AI was defined as penile penetrative anal sex between a man and a woman regardless of the sexual orientation of the 2 parties involved in the act of heterosexual AI. Findings: A total of 21 studies were eligible for analysis. Most of the studies (17 out of 21) reported females to be involved in heterosexual AI whilst 9 out of 21 studies reported males to be involved in heterosexual AI. The lifetime prevalence estimates of condom use during heterosexual AI ranged from 29%-97.5%. Other prevalence estimates of condom use during heterosexual anal intercourse were reported over various recall periods which were: 12 months' recall period with prevalence estimates ranging from 2.9%-59%; prevalence estimates for the past 3 months which ranged from 50%-94.4%; 1 month's recall period with prevalence estimates ranging from 5%-96% and prevalence estimates for the last intercourse experienced ranging from 1%-55%. Condom use during heterosexual AI was generally low and/or inconsistent among female sex workers (FSWs), men who have sex with men and women (MSMW) and some women in the general population. There were no risk factors identified in the study for the inconsistent or low use of condoms during heterosexual AI. Conclusion: Evidence from this study suggests condom use during heterosexual AI could be fairly low especially among groups such as FSWs, MSMW and some women in the general population. Risk factors for using condoms inconsistently or using condoms less during heterosexual AI are not clear. Heterosexual anal intercourse and condom use during the AI practice is generally an under-studied subject in Sub-Saharan Africa. Future studies need to explore on heterosexual AI and condom use practices during AI comprehensively so that there can be concrete evidence on the subject which will inform targeted interventions aimed at reducing HIV among heterosexual populations in SSA

Lineamientos técnicos para la provisión de condones masculinos, femeninos y lubricantes a base de agua en el Sistema Nacional Integrado de Salud / Technical guidelines for the provision of condoms male, female and water-based lubricants in the National Integrated Health System

Los presentes lineamientos técnicos han sido elaborados en función de garantizar la cobertura y el acceso universal en salud. Sin embargo, la prevención de ITS/VIH, en particular en los grupos de población clave y vulnerable, se ve impactada por el estigma y discriminación, desigualdad en materia de género, violencia, falta de poder de decisión de las comunidades y vulneraciones de los derechos humanos, derechos sexuales y derechos reproductivos. Es debido a lo anterior, que se han identificado acciones necesarias plasmadas en este documento, para superar dichas barreras de acceso en estos grupos de población

These technical guidelines have been prepared in order to guarantee the coverage and universal access in health. However, STI/HIV prevention, particularly in groups of key and vulnerable population, is impacted by stigma and discrimination, inequality in of gender, violence, lack of decision-making power of the communities and violations of the rights human rights, sexual rights and reproductive rights. It is due to the above, that they have been identified necessary actions embodied in this document, to overcome these barriers of access in these population groups

Views and experiences of the female condom in Australia: An exploratory cross-sectional survey of cisgender women.

BACKGROUND: The female condom is the only female-initiated form of protection against unintended pregnancy and sexually transmissible infections (STIs). However, use of this method in Australia is low. To better understand women's views and experiences of the female condom, we conducted an interventional cross-sectional study. METHODS: Cisgender women ≥16 years, heterosexually active and living in New South Wales were recruited through social media advertisements and email invitations to clients of a family planning service. Eligible participants were provided with three female condoms and invited to complete a follow-up survey. Survey responses for women who attempted to use at least one female condom were summarised using counts and proportions. RESULTS: We recruited 556 women; few (30/556) had used the female condom before the study. There were 284 women who used, or attempted to use, a female condom during the study and completed the follow-up survey. Fifty-one percent (104/205) reported experiencing some difficulty in insertion, although only 46% (130/284) had seen an instructional demonstration. Approximately half (105/204) of women rated the sensation and comfort of the female condom as the same or better than the male condom, and 66% (137/204) reported that it provided the same or better lubrication. Approximately half of women said they would consider using the female condom again for STI prevention (51% (133/260)) or contraception (40% (103/260)), or would recommend to others (43% (112/260)). CONCLUSION: Findings highlight the need for increased health promotion and education regarding use of the female condom. To increase access it will be important to address method cost and availability in Australia. Future research should explore other perspectives of this method, including among the LGBTIQ+ community.

Systematic review and meta-analysis assessing the knowledge and use of the female condom among Nigerians.

BACKGROUND: The female condom (FC) is a critical component in a comprehensive and sustainable approach to prevent HIV, other sexually transmitted infections and unintended pregnancies. OBJECTIVES: This review provides comprehensive information about Nigerian's knowledge and use of FC. METHODS: We screened search output, evaluated study eligibility, and extracted data in duplicate. Data from similar studies were combined in a meta-analysis. RESULTS: There was a significantly (p < 0.0001) high-level of awareness amongst the respondents. However, the use of the FC was very low at 5.5% among female respondents. There was a significant (p < 0.0001) difference between FC awareness and use. The main reasons for FC use were prevention of unintended pregnancy (55%) and STIs/HIV (31%). We observed a significant difference between reasons of non-use of the FC [F (5, 13) = 5.195, P = 0.0077]. Furthermore, there were significant differences between the sources of information on FC [F (3, 8) = 32.89, P < 0.0001]. CONCLUSION: Despite the high levels of awareness, especially among the female respondents, the use of the FC has remained extremely low even among the young, educated undergraduate students. There is aneed for robust and consistent advocacy to make the FC available and affordable.

Percepções de profissionais e usuários da Atenção Básica sobre o preservativo feminino/interno / Perceptions of professionals and users of Primary Care about the female/internal condom

Este artigo apresenta o levantamento realizado com serviços da Atenção Básica da Prefeitura de São Paulo durante a entrega de dispensers e folhetos de preservativos femininos pós-licitação no ano de 2019. Profissionais responsáveis pela enfermagem e/ou pelo planejamento reprodutivo relataram os principais espaços e situações de promoção do método contraceptivo no serviço e os comentários espontâneos, positivos e negativos, feitos por colegas de trabalho e pelo público. Também tipificaram a demanda do público, revelando aumento tanto da procura ­ principalmente por mulheres adultas jovens, mas também por adolescentes ­ em grupos, consultas de enfermagem e durante a coleta de papanicolau quanto da retirada por demanda espontânea, além da inserção da oferta do preservativo feminino para pessoas pós-menopausa, idosas e, inclusive, homens.

Lessons from the evaluation of the South African National Female Condom Programme.

BACKGROUND: Understanding of the facilitators and challenges to female condom (FC) uptake has been limited due to lack of evaluation of national FC programmes. SETTING: The FC has been an integral component of South Africa's (SA) HIV prevention programme for 20 years and is the largest government-funded FC programme worldwide. METHODS: The national FC evaluation used a mixed-methods approach and consisted of key informant interviews and a telephone survey in a national sample of public and non-public sites. A sub-sample of sites participated in client and provider interviews, and a self-administered client survey. A review of distribution statistics from South Africa's District Health Information System was also conducted. RESULTS: All 256 public-sector and 28 non-public-sector facilities reported having ever distributed FCs. Less than 5% of these facilities reported stock-outs and less than 3% reported they had a supply of expired female condoms. Systems for male condom (MC) and FC distribution were complementary, with similar ordering, delivery and reporting processes. FC promotion by providers (n = 278) varied with regard to FC training, whether attitudes about FCs influenced providers offer of FCs, and how they counselled clients about FCs. Of the 4442 self-administered client surveys in 133 facilities, similar proportions of women (15.4%) and men (15.2%) had ever used FCs. Although FCs were available at almost all sites surveyed, only two-thirds of clients were aware of their availability. CONCLUSION: Data highlight the role of providers as gatekeepers to FC access in public and non-public sectors and provide support for further FC programme expansion in SA and globally.

Perceived male partner attitudes toward the female condom predict female university students' use of the female condom.

Female and male condoms are the only methods that prevent both sexually transmitted infections (STIs), including HIV, and unintended pregnancy. Despite continuing high STI rates, few studies investigate factors predicting whether women initiating female condom (FC) use sustain use. Using data from a randomized trial, we examined predictors of sustained FC use at five-month follow-up (FU2) among female university students in South Africa who participated in either a one-session, information-only, group-delivered Minimal Intervention or a two-session, group-delivered Enhanced Intervention. In the final multiple logistic regression model, believing one's partner holds positive attitudes toward the FC (aOR = 1.40; p = 0.028), and greater FC use for vaginal sex at previous assessment (aOR) = 1.19; p = 0.008) were associated with greater odds of FC use at FU2. Excluding number of FC-protected occasions at FU1 from the analysis, discussing FC use with partner (aOR = 2.89; p = 0.071) and believing one's partner holds positive attitudes toward the FC (aOR = 1.63; p < 0.001) were associated with greater odds of use at FU2. The FC empowers women to protect themselves from both STIs and unintended pregnancy, but targeted interventions are needed to address men's negative attitudes toward the device. Engaging men as FC champions to support and promote FC use, along with marketing campaigns targeted to men, may expand FC coverage and enhance uptake.