Condom Social Marketing: Selected Case Studies

Condom Social Marketing:
Selected Case Studies
Joint United Nations Programme on HIV/AIDS
UNICEF • UNDP • UNFPA • UNDCP
UNESCO • WHO • WORLD BANK

---

Acknowledgements
These case studies were prepared by Michael P. Fox, Consul-
tant, for the Department of Policy, Strategy and Research (PSR),
UNAIDS, Geneva, with significant contributions of time, in-
formation, data and materials from the head offices and na-
tional project offices of Population Services International, The
Futures Group Europe, International Family Health, as well
as from the Asociación Colombiana Pro-bienestar de la
Familia (PROFAMILIA) and Johns Hopkins University /Center
for Communication Programs. In addition, valuable inputs
were given by Mitchell Warren and the AIDSMark project.
The case studies project was initiated and coordinated by
Bunmi Makinwa, Communications Adviser, PSR, UNAIDS.
UNAIDS/00.37E (English original, November 2000)
ISBN 92-9173-018-1
© Joint United Nations Programme on HIV/AIDS
The designations employed and the presentation of the
(UNAIDS) 2000. This document is not a formal pub-
material in this work do not imply the expression of any
lication of UNAIDS and WHO and all rights are re-
opinion whatsoever on the part of UNAIDS concerning
served by these bodies.
the legal status of any country, territory, city or area or
The document may, however, be freely reviewed,
of its authorities, or concerning the delimitation of its
quoted, reproduced or translated, in part or in full,
frontiers and boundaries.
provided the source is acknowledged. The document
The mention of specific companies or of certain manu-
may not be sold or used in conjunction with com-
facturers’ products does not imply that they are endorsed
mercial purposes without prior written approval from
or recommended by UNAIDS in preference to others of
UNAIDS (contact: UNAIDS Information Centre).
a similar nature that are not mentioned. Errors and omis-
The views expressed in documents by named au-
sions excepted, the names of proprietary products are
thors are solely the responsibility of those authors.
distinguished by initial capital letters.
UNAIDS - 20 avenue Appia - 1211 Geneva 27 - Switzerland
Telephone: (+41 22) 791 46 51 - Fax: (+41 22) 791 41 87
E-mail: unaids@unaids.org - Internet: http://www.unaids.org

---

U N A I D S
B E S T P R A C T I C E C O L L E C T I O N
Condom Social Marketing:
Selected Case Studies
Joint United Nations Programme on HIV/AIDS
Geneva, Switzerland
UNICEF • UNDP • UNFPA • UNDCP
UNESCO • WHO • WORLD BANK
November 2000

---

Condom Social Marketing
Table of Contents
1.
Introduction
5
2.
What is social marketing?
6
Condom social marketing
7
The role of UNAIDS in social marketing
7
3.
Different approaches to social marketing
9
4.
Case studies
12
Community-based distribution in Haiti and Mozambique
12
-
Haiti
13
-
Mozambique
19
Community-based social marketing in India
24
Social marketing based on targeted service delivery in Cameroon
29
Social marketing with existing commercial brands in Kenya
35
A local private sector initiative in social marketing in Colombia
39
5.
Key lessons
47
6.
Selected bibliography (principal sources)
49
3

---

UNAIDS
Acronyms
AIDS
Acquired immunodeficiency syndrome
CA
Community agent
CBD
Community-based distributor
CBO
Community-based organization
CBSM
Community-based social marketing
CSM
Condom social marketing
DHMT
District health management team
DKT
DKT International
FGE
The Futures Group Europe
FP
Family planning
FPAK
Family Planning Association of Kenya
GTZ
Deutsche Gesellschaft für Technische Zusammenarbeit
HIV
Human immunodeficiency virus
IEC
Information, education and communication
IFH
International Family Health
IICH
Indian Institute of Community Health
IPPF
International Planned Parenthood Federation
KAP
Knowledge, attitude and practice
MCH
Maternal and child health
NACP
National AIDS Control Programme
NGO
Nongovernmental organization
PMSC
Programme de Marketing Social au Cameroun
PROFAMILIA
Asociación Colombiana Pro-bienestar de la Familia
PSI
Population Services International
SM
Social Marketing
STD
Sexually transmitted disease
TFGI
The Futures Group International
UK /DFID
United Kingdom /Department for International Development
UNAIDS
Joint United Nations Programme on HIV/AIDS
UNDP
United Nations Development Programme
UNFPA
United Nations Population Fund
UNICEF
United Nations Children’s Fund
USAID
United States Agency for International Development
WHO
World Health Organization
4

---

Condom Social Marketing
1. Introduction
Since its establishment in 1996, UNAIDS has promoted and supported social
marketing, and especially the social marketing of condoms, as a key strategy in the fight
against the spread of HIV/AIDS and STDs. Social marketing projects and programmes
exist in dozens of developing countries but, at the same time, there are still many more
countries with the potential to adopt or expand similar activities.
This document is the fourth in a series on social marketing produced by UNAIDS
to provide basic information on this activity and how its concepts and techniques may be
applied in response to the spread of HIV/AIDS, particularly in developing countries.
Previous documents were “Social Marketing: An Effective Tool in the Global Response to
HIV/AIDS”, as an introduction to social marketing which describes its main concepts and
techniques; “Social Marketing: Expanding Access to Essential Products and Services”,
which highlights lessons learned from three examples of social marketing applied to male
and female condom promotion in developing countries; and “A Global Directory of Con-
dom Social Marketing Projects and Programmes”, as a compendium of existing condom
social marketing projects in 1999.
“Condom Social Marketing: Selected Case Studies” presents six applications of
different social marketing techniques drawn from among on-going projects in developing
countries in the field of reproductive health and prevention of HIV/AIDS and STDs. Indi-
vidually they illustrate different, real-life approaches to condom promotion through so-
cial marketing in response to particular challenges and needs. All describe activities from
which significant lessons may be learned. In addition, they demonstrate the flexibility of
social marketing and how the technique can be adapted to deal with differing situations
and constraints.
The booklet is intended mainly for distribution to individuals and organizations,
from both the public and private sectors, who are interested in learning more about social
marketing, and how its concepts and techniques can be applied in response to the spread
of HIV/AIDS and STDs, particularly in developing countries. It is also intended to provide
basic information, as an aid to training, programme planning and related activities.
5

---

UNAIDS
2. What is social marketing?
“Social marketing” may be defined as the adaptation of commercial marketing
and sales concepts and techniques to the attainment of social goals. It seeks to make
health-related information, products and services easily available and affordable to low-
income populations and those at risk while at the same time promoting the adoption of
healthier behaviour. In fact, it may be said that the ultimate goal of social marketing is to
effect healthy and sustainable behaviour change.
Making quality products and services affordable and available is just
one part of the social marketing equation. Encouraging their use repre-
sents the other. Market research and a strong communications compo-
nent are essential to the success of a social marketing programme.
Social marketing has become increasingly popular among governments and do-
nors as an efficient and effective means of addressing serious health issues in developing
countries. It has its roots in family planning but the concept is now applied across many
fields in public life and health, in both developed and developing countries, including
such areas as protection of the environment, campaigns against smoking and alcohol
abuse, and the prevention and care of malaria, leprosy and tuberculosis. However, the use
of social marketing in response to the challenge of improving the sexual and reproductive
health of women and men in developing countries has attracted particular attention.
Social marketing complements, and does not replace (or even seek to replace),
free access to health services and products. It therefore does not compete with the public
health system and in fact supports existing systems. By making low-cost products avail-
able outside the health system, social marketing programmes alleviate the pressure on
existing services and thus allow the health system to use limited resources more effi-
ciently.
In addition, and particularly in the case of condoms, social marketing can be an
alternative source of products and information for people who may be unable or unwill-
ing to access locations where privacy is too often impaired. For instance, through social
marketing condoms are widely available in places where people routinely go, as opposed
to reproductive health clinics, which tend to be much less frequented by men and young
people. The possibility of anonymity in a commercial transaction then becomes attrac-
tive, particularly to women and sexually active young people.
Government support, then, is key to the success of social marketing programmes
and these are often developed in close collaboration with host country governments in
line with national priorities and needs. Many governments recognize the significant con-
tributions of social marketing to improving the sexual and reproductive health of their
low-income populations and extend important financial and political support to the activ-
ity. In many countries, for example, socially marketed products, frequently condoms, are
allowed tax exemptions or may be directly subsidized by local or national government in
order to reduce costs and prices; other examples include the use of IEC materials devel-
oped by social marketing in public schools and clinics, or the relaxation of restrictions on
6

---

Condom Social Marketing
the use of mass media for educational communications on sexual and reproductive health
issues. Condoms are a case in point, where only a few years ago it was very rare to find
a country where advertising this product was permitted in the mass media channels,
something that has now become quite common.
Condom social marketing
In the mid-1980s, condom social marketing (CSM) emerged as an effective tool in
combating the spread of HIV/AIDS. Through social marketing programmes and projects
in many countries affected by the epidemic condoms have become more easily available,
affordable and acceptable to sexually active men, women and young people in general as
well as to those in high-risk groups. Although the programmes have generally focused on
the product, concomitant communications and IEC activities have significantly contrib-
uted to raised awareness of the risks of infection and the means of prevention, reaching
people, governments and institutions in all sectors of public and private life.
Condom social marketing programmes have made condoms more ac-
cessible, affordable and acceptable in many of the world’s poorest coun-
tries. In 1997 these distributed about 900 million male and female
condoms. By 1999, at least 71 different social marketing programmes
for male and female condoms were active in 59 developing countries.
It has been said that in the case of condoms social marketing has acted as a
“normalizer” of the product, reducing the stigmas popularly attached to it. Until recently
in many developing countries, public access to condoms was difficult as the product was
often available only in pharmacies and health clinics and generally thought to be more
appropriate for use by and with commercial sex workers. Now, thanks to years of persis-
tent social marketing activities, condoms in many countries are widely available from a
variety of outlets, openly discussed in public and in the media, and are seen by many,
including many of those at high risk of HIV infection, to be common household items.
The “destigmatization” of condoms in many countries illustrates how
social marketing can help populations to overcome social and cultural
resistance to practising effective prevention of STDs and HIV/AIDS.
The role of UNAIDS in social marketing
The Joint United Nations Programme on HIV/AIDS (UNAIDS) is the leading advo-
cate for global action on HIV/AIDS. UNAIDS leads, strengthens and supports an ex-
panded response aimed at preventing the transmission of HIV, providing care and sup-
port, reducing the vulnerability of individuals and communities, and alleviating the im-
pact of the epidemic. Since its establishment in 1996, UNAIDS has promoted and sup-
ported social marketing, and particularly the social marketing of condoms, as a key strat-
egy in the fight against the spread of HIV and AIDS.
7

---

UNAIDS
As a cosponsored programme, UNAIDS plays a unique and important role in
garnering support for social marketing programmes. At the national level, UNAIDS en-
courages governments and NGOs to support, develop and implement HIV/AIDS preven-
tion social marketing initiatives within their countries. This may include advocating for
the inclusion of social marketing in national plans, the allocation of resources to social
marketing programmes from multilateral and bilateral donors, and the facilitation of a
positive legislative environment for social marketing. The exchange of experiences be-
tween organizations and countries is also encouraged.
In countries where social marketing programmes are being launched, UNAIDS
takes an active role as fundraiser and, more recently, as a potential provider of technical
assistance in collaboration with leading social marketing organizations, such as Popula-
tion Services International (PSI) and suppliers of products, such as with The Female Health
Company, sole manufacturer of female condoms. In addition, through its regional and
country network of programme advisers, Theme Groups and cosponsors, UNAIDS offers
an excellent means of disseminating information, experiences, best practices and lessons
learned in social marketing.
UNAIDS stimulates social marketing in the field:
H Myanmar, the Russian Federation, Haiti, Cuba and Ghana
H Female condoms
H Application of social marketing to other HIV/AIDS-related products
and services
UNAIDS promotes expanded interest in social marketing:
H UNAIDS website
H Social marketing assessments in Bulgaria, Cuba, Guyana, Liberia,
the former Yugoslav Republic of Macedonia, and Turkey
H Regional Marketing Training Exchange with projects in Albania and
Romania
H Forum 2000 on Social Marketing (in development)
UNAIDS provides key resources such as best practice materials and case
studies, including:
H “Social Marketing: An Effective Tool in the Global Response to
HIV/AIDS”
H “Three Key Lessons Learned in Condom Social Marketing”
H “A Global Directory of Condom Social Marketing Projects and
Programmes”
8

---

Condom Social Marketing
3. Different approaches to
social marketing
Social marketing programmes generally use the existing commercial infrastruc-
tures in countries to develop and distribute specifically branded products such as condoms.
This “traditional” approach, also known as the “own brand model”, is the most common
amongst social marketing programmes in developing countries and is closely associated
with Population Services International (PSI) and DKT International, organizations that
pioneered international social marketing in the 1970s and 1980s. It applies standard
commercial marketing and sales techniques for promotion and distribution through whole-
sale and retail sales points to the mass market. The social marketing organization may
receive unbranded products from international or national donors, or may directly pro-
cure quality products from manufacturers, and develops its own brands and packaging
for distribution. This entails the establishment of a professional in-country sales force and
management structure, frequently involving a local partner organization.
However, the ability to operate as effectively as possible in a wide variety of
contexts is a key element in any social marketing programme. In most developing coun-
tries low-income populations form the great majority and within it there is a frequent
need to target specific, often difficult to access, population groups with particular needs.
In addition to working through traditional sales networks involving wholesalers and exist-
ing retail outlets for consumer goods, social marketing programmes must frequently seek
to develop non-traditional outlets and informal distribution systems to meet the needs of
specific groups, and even communities, within the population.
The potential use of alternative distribution systems is an essential as-
pect of social marketing. Today, in many developing countries, socially
marketed condoms are to be found in both traditional retail outlets such
as pharmacies and drugstores and non-traditional points such as bars,
coffee shops, brothels, beauty parlours, workplaces, gas stations, and
bus and truck terminals.
Therefore, other ways of social marketing of products have been developed and
are also common. These approaches are not mutually exclusive although one or more
may be applied exclusively by a programme or project, or also as parts of a project for
strengthening and improvement of an existing “traditional” approach.
These models, or possible approaches to social marketing, include:
H
Community-based systems of product promotion and distribution (“community-
based distribution” /CBD) where non-professional sales agents are recruited from
among particular groups within the general population. The individuals receive
basic training in IEC and sales and are usually rewarded financially from small
margins on their sales. This approach is increasingly chosen as a means of reach-
ing geographical areas and socio-cultural groups that are difficult to access. Many
9

---