In the developing world, excluding China, the prevalence of condom and vasectomy use among married couples averages just 4% and 3%, respectively. Use is slight partly because men do not know enough about these methods and may believe rumors. Men need clear, factual information from reliable, trusted sources.

Condoms. Condom promotion and sales have increased in response to the HIV/AIDS epidemic, but use of condoms falls far short of the need for them (81, 139, 144). For sexually active people with multiple partners, using condoms is the only way to protect against HIV/AIDS. Many men do not like condoms, however, because they interrupt sex and diminish pleasure. Others do not trust condoms. Many men and women think mistakenly that condoms often break or that tiny, invisible holes allow sperm and HIV to pass through (77).

In many countries social marketing helps to make condoms widely available. Worldwide, social marketing programs sold 937 million condoms in 1997, 20% more than the year before (299). Social marketing programs promote condoms both for family planning and for STD prevention (81, 144, 197). In Vietnam, for example, social marketing has focused on condoms for family planning (94). Cambodia's Condom Social Marketing Program has helped to promote safer sexual behavior as well as to increase demand for condoms for family planning. Before Population Services International (PSI) started a social marketing program in 1993, condom sales in Cambodia averaged about 2 to 3 million annually. In 1997 sales were estimated at 10.5 million (197).

In addition to more promotion and better availability, another approach to increasing condom use is developing new condoms that allow more sexual pleasure and convenience (263). A new, looser condom has been launched in Europe to appeal to men who are skeptical of condoms. The condom is designed to be more comfortable and easier to put on. It is made of polyurethane, not the usual latex, and is about half as thick as a conventional condom (184).

Vasectomy. While many men do not choose vasectomy because they desire more children, others shun vasectomy because they believe incorrectly that it will lower sex drive, cause impotence, and be inconvenient. Several communication campaigns have used the mass media to get facts to men about the safety and ease of vasectomy. For example, a 1994 vasectomy promotion project in Kenya aired spots on a private television station to improve men's attitudes toward vasectomy. Advertisements in newspapers motivated men to request more information about vasectomy and told men about clinics that perform vasectomies (122). As a result, 835 men in the Nairobi area requested information about vasectomy, more than double pre-campaign requests. After six months of the campaign, the number of vasectomies had increased by 125% (134).

An IEC campaign in Dar es Salaam, Tanzania, sought to dispel rumors about vasectomy and to promote its benefits. During 1995 and 1996 the Vasectomy Promotion Project used radio, newspapers, and satisfied client testimonials to give men and women the facts about vasectomy and to provide information about available services. Addressing a common misperception of men, the campaign stressed that vasectomy differs from castration. It sought to allay men's fears of side effects such as loss of sex drive, obesity, and impotence. The campaign, which reached more than 60% of its intended audience, concluded that men are willing to choose vasectomy if providers educate them and inform them of its availability (173).

In Brazil a multimedia campaign promoted vasectomy as "an act of love." The central image of the campaign was a cartoon of two hearts, one male and one female, who playfully depicted the advantages of vasectomy. The animated cartoon aired on television, and the hearts were featured in pamphlets, magazine advertisements, and billboards. During and after the campaign, requests to clinics for information about vasectomies increased substantially (122, 134). Years after the campaign, family planning clients still referred to the two hearts (63).

Potential family planning clients consider information from friends and relatives to be reliable and trustworthy. Thus satisfied vasectomy clients often can recruit new clients (13, 266, 282). The Family Planning Association of Pakistan, for instance, asks its clients in Faisalabad who have had vasectomies to recommend the procedure to friends and relatives interested in permanent contraception. Also in Brazil, Colombia, and Mexico, vasectomized men have been especially influential in helping other men decide to have vasectomies (266).

In Colombia Profamilia opened its first clinics for men in 1985, performing 1,241 vasectomies that year. Its male clientele has increased steadily since then. A decade later Profamilia performed 6,825 vasectomies in a year (14).