Answers to Your Questions on Condoms Dispelling Myths and Misperceptions UN Cares: The UN system-wide workplace programme on HIV www.uncares.org 2 Answers to Your Questions on Condoms Condoms Are Back! Historically, condoms were a very popular method of contraception and were used for prevention of sexually transmitted infections (STI). When hormonal and other more technologically advanced contraceptives emerged, condoms became less popular except in Europe and Japan. With the emergence of HIV as a threat to health all over the world, condoms have regained their important role in the prevention of infection and pregnancy. Why should the UN provide information on condoms to its employees? It’s simple, makes sense, and is a good investment to ensure UN employees have evidence-based factual information; to encourage them to share this information with partners, family and friends; and to encourage them to use condoms to prevent HIV transmission and unwanted pregnancy. After all, condoms are the best method available to protect against HIV for sexually active people. Why should I be interested in using condoms (and what are they anyway)? Providing information about condoms is simple, makes sense, and is a good investment to ensure UN employees have evidence-based factual information. Proper use of condoms prevents HIV, many other sexually transmitted infections (STI), and unintended pregnancy. HIV is transmitted primarily through unprotected vaginal or anal intercourse with an infected partner. Worldwide, sexual intercourse is the leading mode of HIV transmission. Thus condoms provide “dual protection” against diseases and unintended pregnancy. Male condoms are sheaths, usually of latex/rubber, that are designed to cover the erect penis and stay firmly in place during sexual intercourse. They are sometimes made of polyurethane. Some condoms are made of synthetic material or animal tissue, but while these may prevent pregnancy, they do not protect against HIV transmission. Female condoms (FC) made of polyurethane and the FC2 made of nitrile, also offer “dual protection” (see p. 9) Who needs condoms? Anyone who fits even one of the following groups: • Men and women who have or have had more than one sexual partner (of the opposite or same sex) and are not sure that they or their partner(s) are HIV negative. • Couples who would like to delay or prevent a pregnancy. • Couples who are not certain about their mutual commitment to having only one uninfected partner. • Men and women who have not been tested for HIV and do not know their HIV status. • HIV positive men and women who would be protecting an uninfected partner and protecting themselves from additional infections. Remember, even if you have had only one partner in your entire life, you can become infected with HIV if your partner has had other sexual partners. 1 Note: This publication is based on Myths, Misperceptions and Fears on Condom Use, UNFPA, NY, 2007. Dispelling Myths and Misperceptions 3 Male Condoms What features of condoms should I know about – lubrication, shapes, ribs, colours, flavours? Lubrication: Condoms are packaged with a water-based lubricant, or are used with the application of an additional water based lubricant such as silicone or K-Y Jelly. Lubrication makes sexual intercourse easier and prevents condom breakage. Oil based lubricants such as Vaseline, hand lotion, baby oil, or edible oil should never be used as they weaken latex and may cause condoms to break. You can find additional lubrication, in pharmacies and in some specialty shops that sell condoms. Always read the label to make sure that the lubrication you buy is indeed water-based. Shape: Condoms come in a variety of shapes. Most have a reservoir tip although some have a plain tip. Condoms may be regular shaped (with straight sides), firm fit (indented below the head of the penis), or they may be flared (wider over the head of the penis). Shape does not really matter as far as protection from HIV is concerned. It is a personal preference. Ribs: Ribbed condoms are textured with ribs or bumps, which can increase sensation for both partners. Again, this is a matter of personal preference. Colours: Condoms also come in a variety of colours. Some people find this adds to the fun and makes use of condoms easier to discuss. Flavour: Some condoms are flavoured to make oral sex more enjoyable. They are also safe to use for vaginal or anal intercourse. What about condom size? Condoms are made in different lengths and widths, and different manufacturers produce varying sizes. There is no standard length for condoms, though those made from natural rubber will always stretch if necessary to fit the length of the man’s erect penis. The width of a condom can also vary. Some condoms have a slightly smaller width to give a “closer” fit, whereas others will be slightly larger. Research has shown that if the condom is too large it can slip off during intercourse. The best condom is the one that fits the best, not necessarily the largest. How do my partner and I choose which condom is best for us? Experiment! All of the differences are designed to suit different personal preferences and enhance pleasure. It is important to communicate with your partner to be sure that you are using condoms that satisfy both of you. In a global study comparing latex with polyurethane condoms, latex condoms were perceived to fit better and are more effective while polyurethane condoms were believed to be better for sensitivity, smell better and have better lubrication. Many UN offices are presently supplying all employees with excellent quality, latex, lubricated condoms either at no cost or at a very low cost. Condoms with different features are available at pharmacies and other local distribution points at generally reasonable prices and high quality. It makes sense to start with the condoms offered at your UN office. If you or your partner is not fully happy with those, you can try other types. There is no particular best brand of condom. A higher price does not necessarily mean higher quality! All condoms provided by the UN system, ministries of health, and reliable pharmacies should be high quality. Experiment! All of the differences are designed to suit different personal preferences and enhance pleasure. 4 Answers to Your Questions on Condoms Using Male Condoms to Provide Pleasure and Protection How do condoms work? Correct use of condoms prevents the mingling of sexual fluids between partners. These fluids (ejaculate or pre-ejaculate from the male, or lubricating mucous in the female, or blood) may contain viruses, bacteria, or other organisms that cause sexually transmitted infections. They may also contain the man’s sperm, which can lead to a pregnancy How do my partner and I use a male condom correctly? • First, always check the expiry date on the package. Don’t use an expired condom. • Handle condoms gently. Open the package carefully, but never use a scissors or a knife! • Remove the condom from the packet, being particularly careful if you are wearing rings and/or have long or jagged fingernails so as not to rip the condom. • Check that you have the condom with the correct side facing up, so that it can easily be rolled down. If you accidently put the condom on upside down, you need to throw it away and use a new one to avoid transferring any pre-ejaculatory fluid (semen) to your partner. • Pinch the air from the tip of the condom (this makes room for the semen and is key to avoiding breakage) and place the condom on the end of the penis. Some people like to put one or two drops of water-based lubricant inside the tip of the condom to increase sensitivity. • Carefully roll the condom down over the ERECT penis until it is completely unrolled and/or the entire penis is covered. Ensure that there is no air in the condom (the tip of the condom should be ‘slack’ or ‘empty-looking’). If additional lubrication is desired, lubricate the outside of the condom using a water-based lubricant. • Put on the condom BEFORE any penile contact is made with the vagina or anus. (As far as infection is concerned, any unprotected penetration increases risk.) • Wear the condom from the beginning of penetration to the climax, and withdrawal after sexual relations, while the penis is still hard. • Once the sexual act has ended, remove the condom by holding the base of the condom and sliding it off, being very careful not to allow the semen onto your hands. • Wrap the used condom and dispose of it in an appropriate manner – for example, in a rubbish bin. Never flush a condom down the toilet, as it will block the plumbing system! Think of the ‘3 Bs’: bin, burn or bury. • Always use one condom per act. What is the most common mistake in using condoms? The number one mistake is not using them consistently and correctly! What are some other common mistakes in using condoms? Common mistakes include: • Use of a condom beyond its expiration date. • Failure to use a (new) condom with every act of sexual intercourse. Dispelling Myths and Misperceptions 5 • Not storing condoms in a cool, dry place. Long exposure to air, heat, and light makes them more breakable. • Stashing them for long periods in a back pocket or wallet. • Tearing the condom while opening the packaging with scissors, teeth or jagged fingernails. • Failure to leave space at the tip of the condom to collect semen. • Failure to ensure the condom remains lubricated. • Use of oil-based lubricant on latex condoms • Failure to put on a condom before any contact (foreplay) between the penis, and the vagina or anus takes place. • Poor withdrawal technique, like withdrawing after the penis is soft, or not holding it in place which may cause semen to spill. • Turning a condom inside out after a failed attempt to put it on, inadvertently transferring seminal fluid to the outside of the condom. • Using 2 male condoms at the same time instead of one – or using a male and female condom during the same sex act: this increases risk of breakage with increased friction. What should we do if a condom breaks? Show concern for your partner. Consider use of emergency contraception pills. If taken fewer than 72 hours after intercourse, they can prevent pregnancy. Talk about sexual histories and possible HIV status to help determine mutual risk of a Sexually Transmitted Infection (STI). If a partner is HIV positive, or does not know their HIV status, go immediately to a physician or to the person in the UN who may be able to determine if you could benefit from Post-Exposure Prophylaxis (PEP) -- the immediate use of antiretroviral drugs to prevent HIV sero- conversion after exposure to potentially HIV infected body fluids or blood. The woman may also wish to obtain Emergency Contraception (EC) to prevent a possible pregnancy. Remember, PEP and EC must be administered within 72 hours to be effective, and earlier treatment is better. Troubleshoot. Did you use an expired condom or an oil-based lubricant? Maybe you nicked the condom with a fingernail while putting it on. Whatever the cause, learn not to do it again. Research has shown that men who experienced a condom break or slip were twice as likely to do so again. So be careful! Will condom use reduce our sexual pleasure? Some people think that condoms reduce spontaneity, cause premature ejaculation, and can reduce sensation and pleasure. Some may even think condoms cause impotence, penile weakness, and loss of erection or vaginal dryness. However, experience of most couples and researchers suggests that most condoms are thin enough to provide nearly normal sensitivity when applied correctly. Condoms cannot cause vaginal dryness. If the vagina is dry, lubricated condoms can alleviate the problem or additional water-based lubricant can be added to the condom or directly to the vagina. Reasons for vaginal dryness could be the use of contraceptive pills, a vaginal infection, ageing or insufficient arousal. Loss of erection, penile weakness, and impotence are more likely due to issues other than condom use including medical, physical, or psychological reasons for the condition. With practice most people can learn to use condoms in ways to add to, not detract from, the sexual experience. Experimentation with different condoms can increase stimulation for both partners. Experience of most couples and researchers suggests that most condoms are thin enough to provide nearly normal sensitivity when applied correctly. 6 Answers to Your Questions on Condoms Can use of condoms increase sexual pleasure? Yes. Sexual stimulation can be enhanced when a man allows his partner to put the condom on him prior to sexual intercourse. Use of condoms can be a “fun” component of sex and promote intimacy between couples. Putting on the condom with the partner’s help can be integrated into sexual foreplay and add to sexual enjoyment. Some couples appreciate the fact that intercourse may last longer with use of condoms. Many women and men enjoy intercourse more knowing they are protected from possible disease and pregnancy. A condom which constricts the shaft of the penis at its base actually helps create a fuller, more rigid penis, increasing stimulation. Efficacy of Male Condoms for HIV Prevention and for Contraception How effective are condoms in preventing disease and unintended pregnancy? Laboratory studies have established that male latex condoms are impermeable to infectious agents contained in genital secretions, including HIV. Some people believe condoms are not effective because they have holes that allow viruses to pass through, are not reliable and leak, and they break or slip off easily. The facts are that every manufactured lot of high quality condoms of the type obtained by the UN undergo many rigorous performance tests by the manufacturers and by independent laboratories to ensure they have no holes, and will not easily break. They are visually inspected for defects, and tested for bursting volume and pressure. Conclusive evidence from extensive research among heterosexual couples, in which one partner is infected with HIV, shows that correct and consistent condom use significantly reduces the risk of HIV transmission from men to women and from women to men, as well as from men to men. How do we know that HIV and other viruses cannot pass through latex condoms? Laboratory studies have established that male latex condoms are impermeable to infectious agents contained in genital secretions, including HIV. They provide a highly effective barrier method when used consistently and correctly. Gonorrhoea, Chlamydia and Trichomoniasis are sexually transmitted infections and, like HIV, are transmitted by genital secretions amongst other ways. STIs are more easily transmitted than HIV and correct condom use can provide a barrier protecting the area of exposure to genital secretions in both sexes. Genital ulcer disease (such as genital herpes, syphilis and chancroid) and human papillomavirus (HPV), which is the main cause of cervical cancer, are transmitted primarily through contact with sores/ulcers or with infected skin. Research studies have shown that correct and consistent use of condoms can help reduce the risk of herpes and syphilis infection. However, condoms do not necessarily protect against these ulcerative diseases (especially if the condom does not cover the infected area or site of potential exposure). Dispelling Myths and Misperceptions 7 Are there other ways to prevent sexual transmission of HIV besides using condoms? Technically, the best way to avoid being exposed to HIV infection through sexual intercourse is to abstain from having sex. This can mean delaying the age of first intercourse or, once sexually active, refraining from having sex. Though oral sex is much less likely than vaginal or anal intercourse to result in the transmission of HIV, HIV can be transmitted via oral sex, though documented cases of transmission with oral sex are rare. However, the risk of HIV transmission increases if the person performing oral sex has cuts or sores around or in their mouth or throat; if the person receiving oral sex ejaculates in the mouth of the person performing oral sex; or if the person receiving oral sex has another sexually transmitted infection. Mutual masturbation is safe as long as genital secretions do not enter cuts or sores on the other person. HIV prevention may consist of an expressed agreement to remain absolutely faithful to each other – and then honouring that agreement. Some couples talk about letting each other know if they have broken the agreement so that they can return to using condoms for HIV protection. Such honesty may not always be easy since breaking trust is painful. For some people, this approach is not without risks. Many people, especially women, have become infected in relationships in which they loved and trusted a partner who has had sex outside the relationship, or who may have become infected in another way, such as through injection drug use. For other sexuallyactive individuals where absolute faithfulness, or HIV status of self or partner are not known, use of male or female condoms offers the most effective and accessible means of preventing HIV transmission. Condoms and Health Issues Can use of condoms harm our health? Some people believe that condoms cause any number of health problems. The facts are that condoms cannot cause bleeding, infertility, infection, disease, foetal damage, cancer, or back pain. However, vigorous sex may contribute to some of these problems. For instance, excessive rubbing of the penis against a dry vagina or anus can be painful for the receiving partner, and lead to bleeding. Vigorous thrusting or an uncomfortable sexual position may cause back pain. Male and female condoms can not get lodged inside the uterus or anus, nor do they have any harmful effects on a foetus if the woman is pregnant. The opening to the cervix is far too small to allow a condom to pass through. On the contrary, condoms protect both the foetus and the mother from HIV and many other STIs. As has been made clear earlier, condoms provide protection against many health risks, such as unintended pregnancy, HIV and most STIs, and infertility arising from untreated STIs. This latter issue is particularly relevant for women, over half of whom don’t show symptoms even if they have an STI. What do I need to know about condoms and allergies? Some men and women are allergic to latex or to chemicals added to latex and these people should not use latex condoms. Allergies could cause burning and itching and the development of rashes and sores on the genitals. This type of allergy Condoms provide protection against many health risks, such as unintended pregnancy, HIV and most STIs, and infertility arising from untreated STIs. 8 Answers to Your Questions on Condoms is categorized as Type 4 contact dermatitis. If a person is allergic to latex, they should use synthetic condoms such as polyurethane or nitrile female condoms or polyurethane male condoms. An individual may experience a reaction to condoms of one manufacturer and not another and thus should try various brands to see which works best for them. Is the deposit of sperm in the vagina good for women? In some countries, semen is thought to give strength and therefore should be ejaculated into the woman rather than collected in a condom. Sperm, transported into women by semen, has the potential to fertilize the female’s egg (ovum). It does not possess any health benefit to women. Deposit of sperm is good only if a woman wants to be pregnant and the “donor” is free of disease. Semen is the fluid that protects and carries the sperm to fertilize an egg (ovum) in human reproduction. All men inevitably “waste” billions of sperm and litres of semen during a lifetime. They are wasted in a condom, washed out of a woman’s vagina, or re-absorbed into the man’s body because he has not ejaculated. All this is normal and does not cause any harm to the man or the woman. Sex education influenced adolescents to delay sexual activity. When these adolescents finally became sexually active, they were much more likely to have protected sex. Morality Issues Does learning about condoms increase sexual activity in young people? Condoms are sometimes thought to be associated with illicit or casual sex. Some people also believe that providing information to young people on condom use for prevention of pregnancies and STIs, including HIV, will promote earlier first time sexual experiences and/or increased sexual activity. The myths and misperceptions on this subject include: sex education and condom availability promote early sexual activity and promiscuity; using condoms means you don’t trust your partner; male and female condoms are for use with sex workers and for casual sex; married and long-term partners don’t need protection against infection. The World Health Organization and UNAIDS reviewed scientific articles on sex education programmes in different countries and found two promising results. The first was that sex education influenced adolescents to delay sexual activity, and the second was that when these adolescents finally became sexually active, they were much more likely to have protected sex. Does it make sense to use condoms with your spouse? Being mutually faithful with a long-term partner does not remove the risk of infection unless both partners have a current negative HIV test and both refrain from behaviours that would place them at risk of future infection. People can have HIV infection for many years, 10 or more, before they have any physical signs or symptoms of AIDS. Some partners may not be honest about their sexual relationships with others, past or present. They might lie in order to avoid upsetting or angering a partner, and not reveal information about other partners. Abstinence and mutual monogamy of non-infected partners are the only 100% effective ways of avoiding sexually transmitted HIV and other sexually transmitted infections. Mutual monogamy, non-penetrative sexual practices, and other safe Dispelling Myths and Misperceptions 9 sexual practices, such as consistent and correct condom use, are valid alternatives to abstinence. We encourage all UN employees and their family members to go for Voluntary Counselling and Testing (VCT) for HIV. If you are in a long-term relationship and you and your partner are both negative, you may discuss whether you may need to use condoms or not. If you are in a relationship where one partner is HIV-positive – or if both are positive, a healthy sexual life is possible with consistent and correct condom use. Is suggesting use of a condom an insult? Using a condom is a caring, respectful, and responsible practice with those with whom you have a sexual relationship. Work to improve communication between sexual partners in order to overcome the difficulties people face in talking to others about sex and negotiating condom use. This may be especially difficult for women in some cultures. Condom use can be suggested for dual protection (to prevent unintended pregnancy and the transmission of HIV/STI). Young females as well as married women who do not want (more) children should find it easier to insist on condom use for prevention of pregnancy, rather than HIV/STI prevention, thus avoiding the issue of stigma, blame and distrust, while maintaining protected sex. Female Condoms 1. What are female condoms? The female condom is a relatively recent development. It is a loose-fitting sheath, made of either nitrile or polyurethane, with a flexible ring at either end that is positioned inside the vagina. Use of the female condom is increasing, with studies showing that the female condom is acceptable to both male and female partners. Like the male condom, the female condom prevents HIV transmission by helping avoid exposure to semen or vaginal fluids. It is currently more expensive than the male condom and is not as readily available in many parts of the world, although UN system agencies are encouraged to make them available to employees. With the creation of the FC2 made of nitrile, it is now cheaper to produce. What are some of the advantages of female condoms? • Women can have added control over their health with the use of the female condom by taking the initiative to wear the condom. • It does not depend on the erection of the penis for application. • It can be inserted into the vagina several hours before sex. Thus, it can be used without interrupting sexual spontaneity. • It does not need to be removed immediately after ejaculation. • Both oil-based and water-based lubricants can be used. • Because it is made from polyurethane, many men and women feel that warmth is better communicated and intercourse feels “more natural,” erotic and pleasurable than with latex products. • Because the outer ring partially covers the external genitalia, the female condom may provide more protection against ulcerative STIs, such as herpes and chancroid than does the male condom. Like the male condom, the female condom prevents HIV transmission by helping avoid exposure to semen or vaginal fluids. 10 Answers to Your Questions on Condoms • Some men and women prefer the female condom over the male condom because it has more space and feels less restrictive. Are there different kinds of female condoms? The Female Health Company produces two types of female condoms. The FC1 is made of polyurethane while the newer FC2 is made of a nitrile polymer. They are thin, soft, odourless, and strong. How effective is the female condom? outer ring inner ring The effectiveness of female condoms is comparable to that of male condoms. The polyurethane female condom produced by the Female Health Company has been extensively studied and the conclusion is that these female condoms are a safe and effective method of contraception and HIV/STI prevention. How to use a female condom • Always check the expiry date on the packet; if the date marked has passed, the condom should not be used. The female condom comes pre-lubricated with a non-spermicidal silicone based lubricant. While the female condom is still in the unopened packet, spread the lubrication around with your fingers to ensure even coverage. Tear open the packet carefully with clean hands, and avoid the use of sharp objects. • The female condom (pictured) has a ring at each end. Pinch the inner ring (at the closed end of the condom) with your thumb and middle finger so that it becomes long and narrow in order for you to insert it, a bit like one does with a diaphragm. • You should find a comfortable position for insertion, such as squatting or sitting with one leg raised or lying down. Next, insert the female condom into the vagina. The vaginal opening should be relaxed. • Then, place your finger inside the female condom and push the inner ring as far as it will go up into the vagina, ensuring that the pouch does not get twisted during insertion. The inner ring should be at the cervix, and the outer ring (at the open end of the condom) should remain on the outside of the vagina, covering part of the external genitalia. The female condom will line the inside of the vagina, whose natural shape, along with the inner ring which sits against the cervix when inserted properly, holds the condom in place. • It is now safe to have penetrative sex. Note that the man’s penis need not be fully erect for penetration with use of the female condom. Be sure that the penis goes inside the female condom in order that the surface of the genitals of the male and the female are protected. You are not protected if the penis goes between the outside of the female condom and the wall of the vagina. • After sexual intercourse, squeeze and twist the outer ring and gently pull the condom out to remove (you don’t have to remove it immediately after the act). Do this before standing up, to prevent ejaculate from leaking out. Like the male condom, the female condom is a one-time use product; it should not be reused. Dispose of it in a responsible and appropriate manner, remembering the ‘3 Bs’: bin, burn or bury. Never flush it down the toilet, as it will block the plumbing system. Dispelling Myths and Misperceptions 11 Because the female condom is a relatively recent development, it is advisable that women practice insertion and removal of the female condom prior to first time use for a sexual encounter. Before making any decisions about future use and/or in order to find the most comfortable position for insertion, it is recommended that women try it at least three times. What is the reputation of the female condom? The Female Condom has been subjected to many of the same myths and misperceptions held against male condoms. Also, although many couples are very happy using them, some people say that the female condom makes a lot of noise during vigorous sex, or the female condom is difficult to use. A few people have complained that the inner ring can cause pain to both the man and the woman. There is some evidence that the new and improved female condom (FC2) doesn’t make as much noise during vigorous sex. Some people are also noisy during sex, but to some people, various sounds can become part of the enjoyment of the experience. Like most things new, one has to become accustomed to its use. It is true that the female condom requires some practice before one can use it with ease. Since the female condom is a new method, it is recommended to try inserting it according to the instructions in the package several times before utilizing it in a sexual situation. The inner ring of the Female Condom should not cause any discomfort if inserted properly. Some people report that the inner ring actually adds sexual pleasure to both the man and the woman. And some men report a preference for the female condom, as intercourse feels more natural, as they are not wearing anything constrictive. Communicating About Condoms How can I negotiate condom use with my partner? Many people have difficulty insisting on condom use when the relationship with their partner or spouse is one of subservience or inequality. Until each of us is free of fear to demand or negotiate safer sex from our partners, we will continue to be in a vulnerable position. The Female Condom (FC) is highly recommended in situations where the woman is unable to have her partner use the male condom (MC) and she can more effectively negotiate FC use. It should also be recommended when one of the intended sexual partners has allergies to latex and they have access to polyurethane or synthetic nitrile polymer Female Condoms. Might this work for you? • “I’m going to enjoy it more if I feel safe and protected.” • “I would just feel better protected if you used a condom.” What can you think of that would be better? What are your friends’ experiences? It is time to talk and share solutions that work in your culture. A number of UN duty stations have initiated orientation sessions on HIV that include spouses and partners. If your duty station has such sessions, consider inviting your spouse or partner; if such sessions have not been held, you may want to raise this possibility with the UN Cares team, the Learning Facilitators, with your Since the female condom is a new method, it is recommended to try inserting it according to the instructions on the package several times before utilizing it in a sexual situation. 12 Answers to Your Questions on Condoms employee association or with your human resources officer. It may then make it easier to hold a meaningful discussion on condom use. Should I educate my children and friends on condom issues? Children and adolescents need accurate and comprehensive education about sexuality to practice healthy sexual behaviour as adults and to avoid unintended pregnancy and sexually transmitted infections. It is your responsibility to provide this education to your children. You can find helpful information on www.uncares.org. Answer their questions directly, with age-appropriate information, in a matter-of-fact way, without shame or embarrassment. Include condoms in your discussion. If your children’s school does not do so, you may want to consider demonstrating how to use them. A number of UN duty stations have initiated orientation sessions on HIV for children, including condom demonstrations for teens. If your duty station has such sessions, consider sending your children; if such sessions have not been held, you may want to raise this possibility with the UN Cares team, the Learning Facilitators, with your employees association or with your human resources officer. You can also be a source of valuable information for friends. Share this publication. Show leadership! What if I have further questions about condoms? You can also be a source of valuable information for friends. Share this publication. Show leadership! You can talk to UNAIDS or public health employees at your UN office. You can also send an email to [email protected]. The choice is up to you!
© Copyright 2024