Expanding Access and Ensuring Availability

Condoms don’t always need to be free: Segmenting the condom market—with the private sector selling condoms and social marketing programs reaching the poor with free condoms—is cost-effective and can expand condom access

By limiting subsidized or free condoms to low-income consumers, market segmentation maximizes government and donor investments, freeing up funds for other strategies, such as programming to prevent commodity shortages. While some evidence shows that condoms freely distributed to the general public are less likely to be used than purchased condoms³¹¹ research still suggests that free condoms are most effective for vulnerable and marginalized populations.³¹² However, other studies suggest that free condoms are welcome and free condoms are needed in STD clinics, HIV treatment facilities, sex worker outreach organizations, and NGOs.³¹³ A study in South Africa that followed 384 male participants who received a total of 5,528 free condoms at 12 public health facilities found that, after five weeks, 44 percent of the condoms had been used, 22 percent had been given away, nine percent had been lost or discarded and 26 percent were still available for use. Wastage at five weeks was less than 10 percent.³¹⁴

Using a range of points of distribution can maximize the reach of prevention programs.

A variety of distribution outlets, including pharmacies, supermarkets, bars, restrooms, primary health care clinics, family planning clinics, and mobile units can serve population groups with different needs and levels of income. At the same time, distributing condoms and contraceptives across a range of networks can help to reduce costs of service delivery and promotion by maximizing the contribution of existing outlets and programs. Prevention messages can come from a range of voices, not just health providers, teachers and peer educators, but also hair stylists, taxi drivers, and many others. Making condoms available through such non-traditional outlets is likely to encourage use, especially by young people who may feel uncomfortable obtaining them in traditional locations, such as local shops. Research suggests that social marketing campaigns that have improved availability of condoms through the commercial sector can take much of the credit for the rise in use among young African women (Cleland and Ali, 2006).³¹⁷

The USAID-funded AIDSMARK Project³¹⁸ was successful in marketing male and female condoms to different groups using innovative distribution and promotion strategies. In Nigeria, pharmacies are the most efficient distribution point for condoms and comprise 90 percent of annual condom sales. However, pharmacies are not open late at night and are typically not located near brothels and bars frequented by sex workers. In response, Population Services International (PSI) worked to include a variety of nontraditional retail outlets—including street hawkers and small shops—in the distribution network of Gold Circle condoms. Between 2000 and 2004, sex workers reporting condom availability within 30 minutes of the brothel increased from 68 to 98 percent. Meanwhile, sex workers reported increased consistent condom use rising from 79 to 89 percent between 2002 and 2004.³¹⁹

In the Dominican Republic, PSI worked with sales teams from local NGOs to strengthen social marketing techniques for the Pante brand of male condoms. Alternative sales outlets were established in “hot zones” that stayed open late, including pay-by-the-hour motels and small corner stores called “colmados,” both convenient sites for sex workers. As of 2006, 72 percent of sex workers in the country reported they were able to find condoms within 100 meters of their workplace. ³²⁰

In Myanmar, teams of peer educators were trained to promote, demonstrate and sell female condoms at drop-in centers for sex workers. To counter stigma, the condoms were branded feel—a name shared with other local shampoo, soap and candy products. The project contributed to an increase in the number of sex workers who reported ever using the female condom—from 15.6 to 35.6 percent over a two-year period. A masculine brand of feel, was developed for the MSM community.³²¹ In Zimbabwe, the vast majority of women frequent hair salons at least once a month. Knowing this, PSI trained female hair stylists from more than 500 salons in low-income neighborhoods to promote the care female condom as a method of dual-protection. Between 1997 and 2006, annual sales of the care condom rose from 120,720 to 1.36 million with more than half of sales made at hair salons.³²²

Media campaigns can influence social norms and promote condom use

Media campaigns have been central to successful efforts to promote condom use. In Malawi, greater exposure to health and family planning radio programs is associated with a significantly higher likelihood of ever using condoms among both men and women³²³ [see Box 12: Successful Media Campaigns Promoting Condom Use]. Among South African adolescent girls, condom use was found to be positively correlated with mass media exposure.³²⁴

Box 12: Successful Media Campaigns Promoting Condom Use

In Cameroon, the 100% Jeune program targets 14 to 24 year old youth using a combination of mass media and interpersonal communication channels to motivate them to either use condoms consistently or not have sex. The program includes peer education sessions, a weekly radio call-in show, a monthly magazine, integrated television, radio and billboard campaigns, and a network of branded youth-friendly condom outlets. Surveys implemented at 18 month intervals between 2000 and 2003 found that condom use, including consistent use with regular partners among youth of both sexes, increased during the course of the program. Analysis of data on exposure to the program reveals the campaign was a significant determinant of these improved condom behaviors among young people.³¹⁵

Mass media campaigns have had similar successes in positively influencing condom norms among adolescent women in Brazil. In 2003, Brazil’s Ministry of Health launched a national campaign promoting the use of condoms among adolescents, called “The Carnival Campaign.” Survey data on the Carnival Campaign indicated that higher exposure to campaign messages from billboards and television had a positive and significant effect on young women’s perceptions that it is acceptable for women to purchase condoms.³¹⁶

Expansion of prevention programs, including condom and contraceptive distribution, to rural areas is vital, as HIV has almost everywhere spread into even the most remote regions

Despite industrialization and migration to urban areas, many developing countries still have large rural populations. However, due to limited resources and political priorities, public health facilities tend to be concentrated in urban areas. Evidence from Kenya shows that HIV interventions targeting sex workers need to be expanded in rural areas in order to prevent further generalization of the epidemic.³²⁵ Likewise, research from Angola shows a need to reach the less educated, peri-urban and unemployed young people.³²⁶

Please see the Appendix for this section's end notes.