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Social marketing programmes in over 50 countries have made condoms available, affordable and acceptable to those who need them most. The continued support of condom social marketing programmes is crucial to slowing the spread of HIV/AIDS and preventing new infections.

What is Social Marketing?

"Social marketing" is the adaptation of commercial marketing techniques for social goals. Using traditional commercial marketing techniques, social marketing makes needed products available and affordable to low-income people, while encouraging the adoption of healthier behaviour.

Social marketing has become increasingly popular among governments and donors as a way of addressing serious health issues in developing countries. While social marketing has its roots in family planning, it has been the use of social marketing to respond to the AIDS epidemic that has attracted much of this attention.

Using commercial marketing techniques, social marketing makes the product available and affordable while linking it to a communications campaign geared to effect sustainable behavioural change.

In the mid-1980s, condom social marketing emerged as an effective tool in combating the spread of HIV/AIDS. Maintaining a product focus, social marketing programmes have adapted and continue to adapt distribution and communications techniques to meet the challenges posed by the epidemic. Social marketing programmes have made condoms available, affordable, and acceptable in countries affected by the epidemic and have used communications messages to raise awareness of the disease and reach people, governments and organizations.

In 1998, social marketing programmes distributed more than 783 million condoms in over 50 countries and conducted targeted communications campaigns in countries as economically and culturally diverse as Haiti, Myanmar, The Russian Federation, South Africa, Zambia and Zimbabwe.

Since its establishment in 1996, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has supported social marketing activities within the context of an expanded response to HIV and AIDS. In addition to expanding access to and stimulating use of condoms, social marketing has contributed to broad behavioural change in a range of contexts. This document highlights three key lessons that have been learned in encouraging and promoting condom social marketing.

· Seed money can effectively be used to leverage additional resources for major public health impact. · Social marketing can be applied to new products and services. · Social marketing can help create an enabling and supportive environment for behavioural change.

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Case Study: Myanmar

Seed money can effectively be used to leverage additional resources for major public health impact.

In mid-1995, with support from Myanmar's official National AIDS Programme (NAP) and UNICEF, Population Services International (PSI) conducted formative social marketing research. A condom brand name was developed - APHAW that means "trusted companion" in Burmese. Unfortunately, fundraising activities met with limited success, and PSI was only able to implement a small, pilot-project in 1996/97, with distribution averaging about 65,000 APHAW condoms per month,

Recognising the need for, and availability and accessibility of high quality condoms throughout a much wider area of Myanmar, UNAIDS provided a special grant to jump-start activities on a larger scale and catalyse interest among other donors to support on-going activities. With this support, the condom social marketing project increased availability and acceptability of condoms, especially amongst those groups that are particularly vulnerable to HIV/AIDS.

The project has:

· identified and researched a range of population groups that practise high-risk behaviours, including migrant workers, commercial sex workers, injecting drug users, and out-of-school youth;

· developed targeted marketing campaigns, including Information, Education & Communication (IEC) and outreach activities, promotion and advertising, and condom distribution;

· distributed over one million condoms in the first three months - triple the previous three months' distribution prior to UNAIDS support;

In addition, key components of the UNAIDS-supported project were to increase local capacity to prevent STDs and HIV/AIDS and to mobilize other donor resources for long-term project implementation. Here, too, the project achieved great success and has:

· trained local government authorities and health care officials in HIV/AIDS, social marketing, and behaviour change and prevention strategies. This training provided a unique opportunity to obtain support at the local level to carry out project activities;

· trained numerous local NGOs and community based organizations in social marketing and related activities to foster enhanced collaboration;

· trained retailers in social marketing, basic marketing theory, condom retailing and provided them with information on HIV/AIDS so that the retailers could provide some level of support in addition to APHAW condoms;

· with the demonstrated success of social marketing with UNAIDS support, PSI motivated the British Government's Joint Funding Scheme (JFS) to provide a grant of almost £500,000 for two additional years of expanded social marketing activities;

· secured additional funds to launch targeted social marketing campaigns along Myanmar's borders - high traffic areas for cross-border trade, transportation and HIV/AIDS.

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The importance of UNAIDS support to the Myanmar social marketing project was crucial to long-term HIV/AIDS prevention activities in the country. Without this unique support to jump-start activities and catalyse other donors, it is not clear what future social marketing and, therefore, a steady supply of quality condoms would have had in Myanmar. UNAIDS is now working closely with PSI to identify other countries and situations where this type of seed money can make all the difference. In addition to several social marketing assessments in various countries, UNAIDS has supplied seed money to PSI to start social marketing activities in Liberia and The Russian Federation.

Case Study: The Female Condom

Social marketing can be applied to new products and services.

The success of male condom social marketing in both family planning and HIV/AIDS prevention programmes has led to a natural progression to consider use of social marketing in creating interest and access to the female condom, a relatively new device that provides additional protection against STDs and HIV/ADS. The first large-scale social marketing launch of the female condom was the "care contraceptive sheath" in Zimbabwe in 1997. Female condom social marketing has now been tested and expanded in at least eight additional countries.

While social marketing uses commercial techniques and often works in close collaboration with government activities, social marketing programmes should not conflict with either normal private sector sales of products or the government's free distribution. In fact, all three mechanisms need to be complementary - each providing products to different audiences, thereby making the products more widely available to all. Where commercial marketing is competitive and profit-motivated, social marketing's primary objective is to improve health by expanding the market and use for specific products.

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Each of these sectors has a delivery system, a target audience (or audiences) and standard methods of operation The table below gives some examples of the different sectors' approaches to promotion and distribution of the female condom

	Public Sector	Social Marketing	Commercial
Product	Identical polyurethane sheath manufactured by The Female Health Company
Packaging	Bulk foil - the Female Condom.	Brand name and package developed for project - the care contraceptive sheath, Dominique.	International or regional brand from the manufacturer - Reality, Femidom.
Price	Free to the consumer.	Highly subsidised - retail price between 8 and 30 US cents per female condom.	Profit making - retail price in excess of $1 per female condom.
Distribution	Clinics, non-governmental organisations (NGOs) and community-based organisations (CBOs).	Traditional and non-traditional outlets - very wide accessibility when and where people need the product. Primarily in the developing world.	Mainly traditional outlets such as pharmacies and chain stores. Primarily in Europe and North America.
Target Audience	Poorest of the poor, outside the cash economy. Clinic attendees.	Lower income groups. Specific target audiences.	Middle and upper income groups.
Promotion	Posters, flip charts, peer education, health workers.	Brand advertising. Mass media, point-of-purchase, special events, in-store promotions.	Brand advertising. Limited mass media and point-of-purchase.

In addition to different distribution and pricing strategies - free in a clinic versus sold at a subsidized price in a liquor outlet, for example - the public sector and social marketing can develop different messages for their chosen audiences Again, collaborative development can prevent duplication and a misallocation of limited resources

UNAIDS, PSI and The Female Health Company, manufacturers of the female condom, collaborate on female condom social marketing programmes in several areas including development of resource materials, IEC tools and programming guides

Case Study: South Africa and Nigeria

Social marketing can help create an enabling and supportive environment for behavioural change.

Prevention of HIV is a sensitive issue requiring the support of all sectors of society, Social marketing has been extremely successful in creating environments in which behaviours can change. One way of influencing society has been in recruiting prominent individuals and groups to deliver and endorse safer sex messages, This approach has been successful with peer educators, sports and music figures, religious leaders and politicians.

Nobel Prize winner Archbishop Tutu has delivered an impassioned plea for South Africans to face the facts about HIV and AIDS in "The Rubber Revolution", a documentary produced by PSI's South African partner, the Society for Family Health (SFH). In the documentry produced in 1996 Tutu, along with Catholic and Muslim leaders and various national sports figures, discussed the importance of open discussions about sexuality and HIV/AIDS. The documentary, especially Tutu's participation, was so well received that at the end of 1996 SFH again met with Tutu to produce television and radio public service announcements (PSA). Filmed in his office in the South African Truth and Reconciliation Commission, Tutu said:

Fellow South Africans, I am Archbishop Desmond Tutu. Our great nation faces a terrible challenge with HIV and AIDS spreading so fast. We in the church believe that sex should only take place within marriage. However, for those of you who do practise sex outside of marriage, I encourage you to take the right precautions and practise safer sex. Please use condoms.

Archbishop Tutu's PSA along with two other messages from prominent South Africans first aired on World AIDS Day 1996. Prior to his involvement, the South African Broadcasting Corporation had not allowed the word "condom" to be used on prime time television. Archbishop Tutu's PSA helped SFH to open the airwaves and dramatically influence the media policy and the general environment and culture in which sexuality is discussed and, indeed, practised.

In an interview just after the premiere of the PSA, Tutu was asked about how he was able to reconcile condom use and safer sex with his religious beliefs and leadership. He said that the rapid spread of HIV and AIDS in South Africa made it impossible for anyone truly committed to the new South Africa NOT to take action. He said:

While we in the church believe in sex only within marriage, we have to face reality and give our young people reasonable alternatives. We simply cannot ignore what is happening.

The Society for Family Health in Nigeria launched its own high profile campaign with world-class football star, Sunday Oliseh, who is a prominent role model in Nigeria. SFH produced print, radio and television messages with Oliseh promoting condom use, safer sex and the social marketing brand, Cold Circle. The campaign was launched simultaneously with the 1998 World Cup Soccer tournament, in which Oliseh led the

Data on the reach of the Sunday Oliseh campaign confirmed that a very high percentage of survey respondents saw the advert during the World Cup and displayed very high recall of the key messages.

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What is UNAIDS Role in Social Marketing?

The Joint United Nations Programme on HIV/AIDS (UNAIDS) is the leading advocate for global action on HIV/AIDS, UNAIDS leads, strengthens and supports an expanded response aimed at preventing the transmission of HIV, providing care and support, reducing the vulnerability of individuals and communities, and alleviating the impact of the epidemic.

Population Services International (PSI) is the leading social marketing organization in the world, with projects in more than 50 countries on five continents. A nonprofit group based in Washington, D.C., it develops and implements programmes worldwide to encourage healthful behaviour and increase the availability of health products at prices low-income people can afford.

Since 1996, UNAIDS and PSI have collaborated to develop, implement and promote social marketing as a key strategy in the prevention of HIV/AIDS.

As a cosponsored programme, UNAIDS plays a unique and important role in garnering support for social marketing programmes. At the national level, UNAIDS encourages governments to support HIV/AIDS prevention 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. Social marketing is complimentary to, and does not replace, free distribution of condoms.

In countries where social marketing programmes are being launched, UNAIDS takes an active role as fundraiser. Finally, through its network of programme advisers, Theme Groups and Cosponsors UNAIDS offers an excellent means of disseminating best practices and lessons learned in social marketing.

Since 1996, UNAIDS and Population Services International (PSI) have collaborated to develop, implement and promote social marketing as a key strategy in the prevention of HIV and AIDS.

UNAIDS stimulates social marketing in the field

· Myanmar, The Russian Federation and Liberia
· Female Condom
· Application of social marketing to other HIV/AIDS-related products and services

UNAIDS promotes expanded interest in social marketing

· UNAIDS website
· Social marketing assessments in Bulgaria, Macedonia, and Turkey
· Regional Marketing Training Exchange with projects in Albania and Romania

UNAIDS provides key resources

Best practice materials and case studies, including

· "Social Marketing: An Effective Tool in the Global Response to HIV/AIDS"
· UNAIDS website
· A directory of social marketing projects (Currently under development)
· "Extending Choice: Challenges in Condom Social Marketing" (conference planned for 2000)

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Key social marketing resource materials

· "Social marketing: an effective tool in the global response to HIV/AIDS", UNAIDS Best Practice Collection, November 1998.

· The Female Condom: an information pack, WHO/UNAIDS, April 1997.

· The Male Latex Condom, January 1999.

For more information about social marketing, HIV/AIDS and the programmes described in this document, please contact: the UNAIDS Information Centre.

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20 avenue Appia
1211 Geneva 27
Switzerland
Tel: (41) 22 791 4651
Fax: (41) 22 791 4187
E-mail: [email protected]
Website: http://www.unaids.org

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1120 19th Street, NW
Suite 600
Washington, DC 20036, USA
Tel: 1-202-785-0072
Fax: 1-202-785-0120
E-mail: [email protected]
Website: http://www.psi.org

2000