Preventing HIV/AIDS with Condoms: Nine Tips You Can Use
The HIV/AIDS epidemic continues. In 2007 we can expect millions of new infections. Most will be transmitted through sexual intercourse. Condoms remain a key method of reducing these infections.
I have helped to increase condom use for HIV prevention in Ethiopia, Namibia, Vietnam, Indonesia, India, Bangladesh, Nepal, Azerbaijan and Yemen. In addition, I have helped to increase condom use for contraception in Pakistan, Sri Lanka and Bangladesh. From my experience I have learned many useful lessons. I have summarized key lessons in this Special Report. These Nine Tips are suitable for disease prevention programs and for contraceptive programs. They are suitable for public sector programs as well as private sector and NGO programs.
Tip 1: “Do what commercial marketers do”. A colleague of mine calls this “John’s Law” because I often recommend the use of commercial marketing principles to my clients. I recommend marketing principles because marketing is a very cost-effective way of changing behavior, even among poor, rural people, who are not easily reached by other systems, such as health clinics. And I have found a strong relationship between the level of success of a public health project and the level of use of commercial marketing principles. Marketing principles are the foundation for each of the following Tips.
Tip 2: “Know Your Customers”. This tried-and-true marketing principle is important. But I’ve been surprised again and again to see project planners in developing countries producing behavior change communications materials without a solid understanding of the knowledge, beliefs and behavior of their target groups. Then, after little or no pretesting of their materials, they spend a large proportion of their communication budgets on inappropriate logos, costly newspaper, radio and TV ads, while leaving their outreach staff without in-service training or adequate supervision. The results are disappointing because most of the target groups remain unreached. Instead, they should base their field activities on what each target group -- such as mothers, mothers-in law, fathers, and community leaders – believes about key topics. For example, in Yemen, the Social Marketing Project managed by Marie Stopes International formed behavior change communication plans with the help of studies of target groups by the Jordan-based PEER group. The PEER professionals trained local men and women to interview their peers about “what people like you” believe about specific topics, such as diseases that can be transmitted during sexual contact, awareness of methods of preventing sexually transmitted diseases, and the types of communication networks used by the women and the men. In India, the HIV/AIDS Project managed by the University of Manitoba, Canada, used focus group techniques to obtain detailed information about key topics surrounding HIV/AIDS from rural women who may be at risk of infection from husbands (see photo). Women like these may become distributors of project condoms, selling them to neighborhood women at affordable prices.
Tip 3: “Strengthen condom supply and demand”. This tip may appear obvious, but some planners put the lion’s share of their resources into building a condom supply chain, including nice packages and nice displays of the packages, especially in urban pharmacies, assuming that people who have never used condoms will become users when condoms are displayed in the pharmacies. The results are disappointing because most people in most developing countries rarely enter a pharmacy and may be unaware of condoms. And the opposite is also true: some communications experts will create demand for condoms by spending big on advertising, including TV and radio, as described in Tip #2, without expanding their supply chain to distribute condoms into rural areas where most of the people live. Here’s a tip to help you remember the goal of integrated supply and demand used by commercial marketers: to have the right product in the right place at the right price and with the right communication for each target group.
Tip 4: “Position condoms as ordinary household products”. While watching a recent TV documentary about the Cameroons, I saw a nun talking about the container of condoms in her health clinic. She said, “A condom is just a little bit of latex; there can’t be any harm in that.” This lovely example reminded me of a pioneering project in Sri Lanka managed by Population Services International in the 1970s that “took the shyness off” discussions about condoms by working with owners of small general stores and pharmacies in small towns. The project placed metal signs with just one word: Preethi (“Happiness”) on the outside of the shops, while inside, packets of Preethi condoms were displayed alongside other personal care products such as tooth paste and razor blades. Customers quietly purchased a pack by just saying “Preethi” to the clerk. Officials of government and donor agencies were surprised and delighted to discover there was no negative uproar; and the New York Times was impressed enough to publish an article and photo about Preethi. Later, in Nepal, the HIV prevention project managed by Family Health International greatly expanded condom access and sales by placing condom displays in many small shops such as tea shops, tobacco shops and snack shops, frequented by long-haul truckers away from home. The photo shows a shelf display of condoms in the upper left corner of a busy snack shop.
Tip 5: “Different condoms at different prices for different folks”. Market at least two brands of condoms: a low-priced brand that’s affordable to poor couples and a higher-priced brand for middle-class couples. Everybody will win: more customers will be satisfied; the risk of HIV infection will decline; and project revenues will increase, allowing profits from sales of the higher-priced brand to subsidize the costs of marketing the low-priced brand. Here’s a tip about pricing: if an official suggests that your condom prices should be raised to the level needed to cover all the related costs, you can explain your policy is to maximize sales by selling at least one brand that poor people can afford. And you can diplomatically mention that all countries subsidize their public health programs for poor people; it’s a fact that most listeners accept.
Tip 6: “Get intimate with condoms in the privacy of the workplace”. This Tip is so easy to implement, so inexpensive and so effective (because it is intimate). The workplace concept worked beautifully in Sri Lanka in the 1970s. A fieldworker employed by Populations Services International met with groups of 20-30 workers such as policemen, school teachers, and female tea pluckers, in their workplaces. To “get the shyness off” he gave each person a free sample of Preethi condoms, then he opened a sample, removed the condom and unrolled it while discussing its correct use. After a few moments of self-conscious giggling, people started to talk. They said they had never heard of a condom, and they asked questions about the most intimate aspects of condom use. In Namibia, where HIV prevalence is very high, business owners were quick to invite the social marketing project, managed by Marie Stopes International, to visit workplaces, such as road construction sites, where they could educate workers about HIV prevention and hand out free condom samples. And the project managed by Family Health International in Nepal contracted with local NGOs to train male outreach workers to inform long-haul truckers and their helpers about unprotected sex at drop-in centers (see photo). Meanwhile, trained female outreach workers met with small groups of female sex workers in their workplaces: tiny restaurants on the fringe of truck stops on the highways.
Tip 7: “Entertainment reaches and teaches poor people faster and better”. All projects that aim to help poor women should consider entertainment as a vehicle because it is so powerful. And cost-effective! Call it Edutainment or Enter-Educate or Socio-Drama or whatever you wish, but do try it – you’ll like it. The grand-daddy of successful large-scale contraceptive edutainment for birth spacing is the 16 mm. feature-length movie, “I Was a Fool” by Population Services International in Bangladesh in 1983, which has been viewed by millions of men and women in fields and playgrounds after dark. Johns Hopkins Center for Communications created a nonprofit enterprise in Bangladesh that proliferated Enter-Educate campaigns on various topics through various media, including radio dramas for women. And in Pakistan, in 1992 Johns Hopkins created a ground-breaking weekly TV serial drama, “Ahaat” (“A Small Sound”) that was eagerly followed by millions of home viewers; evaluation showed that the serial reversed the behavior of millions of ordinary adults from silence to open discussion about delicate social issues including contraception and domestic violence. Edutainment now includes radio dramas, street dramas and sidewalk theatre in many developing countries, for example, PSI/India’s traveling theatre group that teaches contraception to villagers in some of northern India’s poorest areas (see photo). Although these initiatives require substantial budgets, the investment pays off in very substantial improvements in knowledge and behavior change of women and men who are beyond the reach of mass media. And here’s another useful tip: costs of Edutainment can be lowered by selling advertising time to multinational companies that market beneficial, affordable health products such as soap for hand-washing, oral rehydration salts for babies, and vitamin-mineral tablets for women. Click here for examples of Edutainment by the Communication Initiative.
Tip 8: “Reach poor women by Local Marketing”. Some condom behavior change campaigns have little success because they depend too much on reaching men. And condom ads are often weak because they are limited by laws or government policy. But it’s important to reach women directly, because women have a very strong interest in guarding their own health and the health of their children, specially when they know that the AIDS virus can infect them through sexual transmission. Local marketing can be exceptionally cost-effective, partly because most women are comfortable learning from another woman. It is specially effective in cultures where women are restricted to their own household and neighborhood. Not convinced that local marketing works? Here’s a tip: consider the huge success of Avon Calling and Tupperware Parties that use Local Marketing techniques to sell their products through neighborhood women in Western countries. A well-trained woman can create many more new users when she is close-up and personal, like the mother pictured here, explaining birth spacing methods to her neighbors in a small town in India. (Photo courtesy of PSI/India)
Tip 9: “Advocate for support from policy-makers”. We need to do much more of this because some VIPs and stakeholders remain uncomfortable with discussions of HIV/AIDS or condoms. Consider advocacy as behavior change communication aimed not at potential condom users but at influencers whose support will help ensure continuation and expansion of your work. I observed an excellent example when I lived in Pakistan in the mid-90s: Marie Stopes International used a short conference to showcase its fieldworkers and successful activities to influential public servants and donor officials, followed by a presentation of action plans for the next year; this was followed by lunch where all participants could interact informally. Or try this: invite a photo-journalist to produce a short article for publication, as mentioned in the New York Times example in Tip #4. And you can try this simple, strong advocacy method: create a short video (10-15 minutes) aimed at changing a specific policy, and show it on your notebook computer in very small meetings of VIP influencials. In Indonesia, we called them “Little Tea Meetings”; and they succeeded. But that’s another story.
Can I Assist You?
I hope these Nine Tips will help you and your colleagues. If you need assistance with HIV prevention, I can help you. And, as shown in my complete resumé/CV, I have experience in additional mother-and-child health topics. To contact me, email firstname.lastname@example.org.
Do you need more details of my condom-related experience?
I have useful experience in many countries with condom programs aimed at HIV prevention and also programs aimed at contraception. Click here for my Achievements With Condoms.
Do You Need My Resumé/CV?
My complete resumé/CV contains a summary of my specialties, my approaches to my work, plus a chronology of my education and achievements. Click here for my complete resumé/CV.