CONTENTS
- The Condom Gap: A Health Crisis
- Sexual Behavior and Condoms
- Knowledge of Condoms and AIDS
- How Effective Are Condoms?
- New Condoms for the New Millennium
- Improving Access
- Promoting Condoms
- Policies for Condom Use
HIGHLIGHTS
- HIV/AIDS still spreading fast
- Changing the image of condoms
- Behavior change to avoid AIDS
- Ensuring condom quality
- Protecting young people
- Is the female condom promising?
- Sales marketing sales grow
- Condoms: a good investment
April, 1999
Series H, Number 9
Condom Promotion Works
Examples from Thailand, Uganda, and Nepal demonstrate how condom promotion can work.
Thailand. Thailand's 100 Percent Condom Program has been one of the world's most successful condom promotion campaigns (308). The program goal was to make condom use universal among CSWs. If a client refused to use a condom, the CSW was supposed to refuse sex and to return the money. The government closed brothels that did not abide by the program (226, 304, 308, 456).
From 1989 to 1994 condom use in commercial sex establishments increased from about 25% of all sex acts to more than 90%. STI rates among CSWs decreased by more than 85% (226, 456). Also, surveys among new army recruits in 1991, when the campaign began, and two years later showed that the more recent recruits not only were much more likely to have used condoms than the earlier group but also made fewer visits to brothels (100, 308).
While AIDS is still a problem in Thailand, the promotion of condoms and other prevention activities have been credited with a decline in the overall prevalence of HIV and other STIs (321) (see Figure 2). A strong mass-media campaign and free condom distribution have slowed the AIDS epidemic (157). Says a UNAIDS official, "Thailand is a good example that if you do something right, you can actually make a significant impact on the way the AIDS epidemic unfolds" (308).
Uganda. At one time Uganda had the highest AIDS infection rate in the world (133). While mostother developing countries have since seen increases in HIV/AIDS, Uganda has seen a decrease of up to 25% in the HIV infection rate compared with the rate in the 1980s. Uganda is the only country in sub-Saharan Africa where the incidence of AIDS has decreased (330, 603).
 Uganda Ministry of Health SID/AIDS Control Progamme |
In Uganda condom use increased and HIV prevalence decreased following a national AIDS prevention and condom promotion effort. |
Yoweri Museveni, Uganda's president since 1986, has been an activist and strong supporter of AIDS prevention programs (133). The Ugandan National Task Force on AIDS was set up in 1990 (32). In 1991 a multi-sectoral program began, including condom distribution and promotion involving popular songs and drama groups, counseling, and support services (2). In 1995 a nationwide promotion campaign started—with songs and soap operas, drama, posters, and other approaches promoting safe sex, abstinence, fewer sex partners, and condom use among young people (286).
There was a subsequent rise in age at first sexual intercourse and in monogamy and a decrease in HIV prevalence, especially among young people (147, 270). The percentage of pregnant women with HIV has dropped since 1991, based on blood tests at five sites (2, 270, 338). The use of condoms has increased substantially among young people. Among men ages 15 to 19, the percentage who had ever used condoms rose from 20% in 1989 to about 60% in 1995 (270).
Nepal. In Nepal a promotion campaign focused on CSWs and their truck-driver clients. Truck drivers are an important audience because they often travel long distances and visit CSWs when they are away from home for a long time (382, 453, 493, 587). Providing condoms and information along truck routes helped cut the risky behavior of both CSWs and truck drivers. Between 1994 and 1996 condom use by CSWs along the routes almost doubled, to 61%. In contrast, condom use fell among a comparison group of CSWs who did not receive information and condoms (269).
