'It depends on who is asking and why they will use it': Access to male condoms in Timor-Leste

PLOS Glob Public Health. 2023 Sep 29;3(9):e0002409. doi: 10.1371/journal.pgph.0002409. eCollection 2023.

Abstract

The uptake of male condoms remains markedly low in The Democratic Republic of Timor-Leste (Timor-Leste), an island nation in South-East Asia. To understand why, we conducted participatory and operational research about beliefs, understanding and access to male condoms from both a community and healthcare provider perspective. We held 14 participatory group discussions (PGDs) with 175 community participants (84 men, 91 women; aged 18-72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse) in 2019. We held individual in-depth interviews (IDIs) with 24 healthcare providers working in the same community catchment areas as the PGDs. Two counsellors, four doctors, fifteen midwives, and three nurses participated (16 women, 8 men; aged 25-56 years). Data were analysed using reflexive thematic analysis. PGD and IDI participant awareness, understanding and beliefs about male condoms were diverse. Male condoms were often discussed as something negative and taboo, and as something that is highly regulated and discouraged within society and the health system. However, many PGD and IDI participants also challenged this narrative by providing a more rights-based perspective about universal access to sexual and reproductive health information and services, including male condoms. Insights from our research have been used to inform programmatic decision-making in Timor-Leste, including health promotion and service delivery initiatives. Our findings can be further used to inform national health policy, healthcare provider training, and advocacy and communication work.

Grants and funding

Marie Stopes Timor-Leste (MSTL) received financial support from the Australian Department of Foreign Affairs and Trade (DFAT) to conduct this research. DFAT, through The Australian Embassy in Timor-Leste, were stakeholders in this research and provided inputs and feedback across different research stages, including study design and research communication. DFAT had no role in the analysis, decision to publish, or preparation of this manuscript. The five field research team members (HH, AS, MS, HSX and SM) were employed by MSTL at the time of research design and data collection. MSTL receives funding from The Australian Embassy in Timor-Leste. HH is supported by a Human Rights Scholarship, awarded through The University of Melbourne. MAB’s time is supported by an Australian Research Council Discovery Early Career Researcher Award (DE200100264) and a Dame Kate Campbell Fellowship.