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Facilitator Notes: Given that we have so many effective HIV prevention options at our disposal, why do we need new ones?
Some of the most effective tools currently at our disposal have important limitations for many people most at risk of HIV.
Developing HIV prevention tools that would allow conception while still reducing the risk of HIV infection, that would be more within the control of the receptive partner, and that would enhance sexual pleasure without forming a physical barrier, would provide critical new options that are largely missing from current interventions. Many people do not know that globally, sex with a primary partner is the biggest source of HIV infection.
Of course, if both partners are HIV-negative or both HIV-positive, and they are monogamous, this may not be a problem in terms of HIV transmission. In the Canadian context, a recent survey of Canadians over the age of 15 showed that reasons for not using condoms vary quite a bit. Some new HIV prevention options, such as microbicides or PrEP, could help overcome many of these barriers. Facilitator Notes: This graph shows the percentage of women from various countries who used a condom in their last sex act.
Condoms continue to be a viable option for many people, and should be made readily available. Efficacy is the ability of a product to produce a desired clinical effect, such as protection against a specific infection, at the optimal dosage and schedule in a given population - in other words, how well an intervention works under controlled situations, such as in a clinical trial. Effectiveness refers to how well an intervention works in real-life settings, taking into account the likelihood that people will adhere to it, use it properly, the tolerability or ease of use.
Let’s try to see how this difference between efficacy and effectiveness might look visually. Facilitator Notes: When considering the potential introduction of new HIV prevention tools, people often compare them to condoms. However, we must carefully examine efficacy and effectiveness, through the relationship between rates of efficacy and rates of use.
Let’s start off by assuming that condoms reduce the risk of HIV infection by 90%, and a hypothetical microbicide reduces the risk by 60%. Facilitator Notes: However, at those same efficacy rates, you will have the same amount of protection if condoms are only used 20% of the time, than if you used microbicides 30% of the time.
Facilitator Notes: And if you use microbicides 75% of the time, you will get better protection than using condoms 20% of the time. So we can see that we must consider the likelihood of people using a product, not only its inherent efficacy.
Ask the following questions as a discussion or debate allowing the participants to break up into groups again and discuss. Update: Currently, I use protection as soon as my period is done, as time has gone by, my personal cycle has shortened somewhat, and I've had to make adjustments to compensate for that.
I've used different colors to represent different things, red for notes on menstruation, green representing fertility and any sex occurring on these days is likely to result in pregnancy. The main key to success when using fertility awareness methods is having enough safe days before ovulation.

It is important not to rely on mucus signals alone when first learning about your cycle, mucus can often be very confusing, very little of it may appear during the cycle.
Note: Do not check consistency of cervical fluids when you are sexually aroused, your natural juices can obscure the true mucus reading. It is important not to use the calender alone as your sole means of identifying when not to have unprotected sex.
Its really not that hard to determine when you are fertile, all it takes is a little information and education, once you know what to look for and have found which tools work for you.
This calender example will work for women who cycle regularly between 27 and 30 days (length of normal menstrual cycle) for cycles which fall outside this range the days will need to be adjusted. Women who have irregular cycles will need to focus more on identifying when they are fertile, if your cycle varies widely, you may want to look into herbs which can help bring your cycle into balance and encourage some regularity. When learning to chart your cycle, and learning about your cycle it is important to keep notes, and use as many tools available as you can. As we will see, there are several reasons why existing prevention options may have limitations and are not always appropriate for many individuals and populations at risk. The experience of contraception shows us that the more options you provide to people, the more sex acts are protected since people are more likely to find an option that best suits their environment, needs and preferences. In fact, it is true all over the world and across populations that once trust and love enter a relationship, condoms usually exit. However, many people are unaware of their status, and in many couples, one or both partners have sex outside of the relationship. In the Unites States, the rate of reported condom use with a husband or boyfriend was just greater than 15%.
The authors of this graph noted that surveys of women in 13 countries found that fewer than 7% reported condom use in the last sex act with their regular partner. These two terms are often used interchangeably, but they express distinctly different concepts. People often assume that since condoms have a high rate of efficacy, and new HIV prevention tools are usually thought to have lower rates of efficacy, then the introduction of new HIV prevention technologies must necessarily be a bad thing since people will potentially replace highly effective tools with less effective ones. Light purple represents my notes on cervical mucus, and dark purple represents sexual activity, with notes on whether or not contraception (birth control) was used. The most difficult aspect to using fertility awareness methods is identifying when ovulation will happen. Check cervical mucus when you go to the bathroom, check the toilet paper every time you wipe, just get into the habit of it. Combined with mucus observation, Cervical changes, basal thermometer, or fertility testers. For women who cycle regularly, the calender can be very effective as a guide, but needs to be combined with another method to allow you to know when fertility has passed for this cycle. Experimenting with different methods of fertility awareness, gives you the opportunity to learn a great deal about your body, and see which methods work best for you.
It is not uncommon for mucus present to be considerably less than what was described above on the calender.

With proper condom promotion programmes, we can help people increase their use of condoms for casual or commercial sex. Providing HIV prevention options that can reduce risk while simultaneously allowing for intimacy, conception and sexual pleasure could help bridge a prevention gap that condoms simply cannot cross. By providing options that more people are more likely to use, new HIV prevention technologies could fill an important prevention gap.
Please keep in mind it is your responsibility to practice safe sex, to protect yourselves from diseases. As the a woman's monthly cycle unfolds it is difficult for most women to pin point when ovulation occurs exactly. In the days preceding the arrival fertile mucus I experienced a very dry sensation, uncomfortably dry in fact. I've notices in you squeeze you muscles you can help to expel some of the mucus from the vagina, try blowing your nose, the same muscles you use when you blow your nose, or poop are the ones that can push out the cervical mucus, check for mucus following these activities. One of my most informational and educational tools was a plastic speculum to view my cervix.
There are some months where I notice only a small amount of fertile mucus, the clear, stretchy kind, there have been cycles, where I would only see a little bit of stretchy mucus, just once.
If you are not in a long-term committed relationship or married, then you should use condoms every time regardless of whether it is a non-fertile day, diseases are transmitted with one sexual contact -- it is important to use condoms every time. The only way to pinpoint ovulation to the day is by using a basal thermometer or if you feel, as some women do, a twinge at mid-cycle which is ovulation occurring, this is something most women do not feel happening.
Signs can be subtle, and easily missed, especially when your not sure what you are looking for. Even with intense condom promotion efforts, consistent condom use amongst regular partners is difficult to achieve, unless, of course, the couple knows that one of them is infected and one is not. When ovulation occurs can vary each month, thus changing the days of your cycle that your likely to be fertile. This is why it is so important to realize relying on mucus signals alone, especially for the inexperienced puts you at great risk for pregnancy. A really good book, in addition to the information found on the web site, which can help teach you what you need to know about your cycle.
Also, many people are unable or unwilling to use condoms; they do not like to use them, they may not find them pleasurable, they may have difficulties maintaining an erection, they may be allergic to latex, they may be tired of condom messaging and want alternatives to reducing risk, and they may see them as a barrier to intimacy. Using a calender alone, is called the Rhythem method, and has a high failure rate due to this reason. Even though I felt very dry, with no traces of any mucus, I realized that I had not ovulated yet and that I would soon, and sure enough the fertile mucus arrived on schedule. If I had unprotected sex on either of the dry days, particularly Day 11, I would be setting myself up to conceive.

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