Social marketing programs have adopted different approaches: some have put more emphasis on cost-recovery and so have priced products to generate more revenue, while other programs have kept prices low to maximize sales. A comparison of 24 social marketing programs in 1991 found, not surprisingly, that lower prices resulted in higher sales (231).

Social marketing programs have dramatically increased access to condoms in many countries. Social marketing has been perhaps the single most important contribution that the family planning field has made to prevention of HIV/AIDS and other STIs (608). In 1991 social marketing programs operated in 37 developing countries and sold about 575 million condoms (587). By the end of 1997 such programs operated in at least 55 countries, most of them assisted by Population Services International (PSI), DKT International, or SOMARC (Social Marketing for Change) with support from USAID and other donors such as UNFPA. Programs in 49 of these countries sold condoms, and total sales to retailers were about 900 million (143) (see Figure 1).

In some countries sales growth has been enormous. In Brazil, perhaps the best example, sales by DKT rose from 406,000 in 1991 to more than 33,000,000 in 1997 (143, 587).

The world's largest condom social marketing program is in India. The government buys condoms from local manufacturers at low bulk prices and then sells them to nonprofit social marketing organizations and private companies at 30% of the price the government paid. The private companies normally sell the condoms at a markup from that price (235, 527). The largest nongovernmental condom social marketing program is in Bangladesh, where in 1997 some 140 million condoms were sold, supported by USAID and the European Union (143). In addition, social marketing programs sell female condoms in at least seven countries under the auspices of PSI (143, 428).

On balance, do social marketing programs take customers away from commercial brands? Apparently not in large numbers, although some substitution effect is evident in countries where contraceptive use is widespread (12, 489). Surveys of social marketing customers suggest that many customers are new to condoms—and often new to any form of family planning (531). In Brazil, for example, where overall condom sales rose after the introduction of social marketing, most buyers of subsidized condoms were previously unserved lower-income people. Commercial condom brands continued to sell to middle- and upper-income groups (169).