Casting a Wider Net: Improving Access to Condoms

In a dusty marketplace in Port-au-Prince, an itinerant vendor arranges her wares on a small table: combs, soap, cigarettes -- and bright yellow packets of condoms.

In a tiny Kathmandu shop barely bigger than a phone booth, a merchant decorates the wall with colorful condom packets strung up like holiday lights.

And in downtown Nairobi, young people in blue uniforms gather before setting off on bicycles to sell condoms around the city.

A few years ago, such scenes didn't exist. In many developing countries, condoms were available only at family planning clinics and pharmacies, during limited hours, to a limited clientele.

The HIV/AIDS epidemic changed that forever. Because condoms remain the only proven method of preventing HIV transmission in sexually active populations, promoting condom use has become a central effort for prevention projects around the world. Successful promotion and mass marketing ventures have raised demand for condoms, making it critical to increase their accessibility wherever people live, work, shop and seek entertainment.

"The key to AIDS prevention is getting condoms to the people who need them," said Richard Frank, president of Population Services International (PSI), which works with the AIDS Control and Prevention (AIDSCAP) Project in social marketing of condoms for HIV/AIDS prevention in developing countries.

"The traditional method of selling condoms only through pharmacies and clinics greatly constricts distribution," said Frank. "It narrows the number of outlets dramatically and limits availability for many segments of the population."

Condoms are now appearing in places they've never been seen before: at a kiosk by a Brazilian beach, in the cloth rucksack of an itinerant Bangladeshi poet, or on board a small boat catering to riverbank dwellers in Zaire. Whether the outlets are stationary -- a tea shop in Phnom Penh -- or mobile -- a motorbike salesman in rural Haiti -- the result has been tens of millions of new condom sales worldwide and, it is hoped, many HIV infections averted.

In Haiti, for example, sales figures have risen some 200 percent since PSI introduced the Pantè condom in 1990, despite several years of social upheaval and an international fuel embargo that choked most commercial distribution throughout the country. More than 15 million Pantè condoms were sold between 1990 and 1995.

A wider variety of sales outlets for condoms also means more opportunities to teach people why and how to use them. Pamphlets and brochures are often available at sales points, and at some outlets -- such as the beach kiosks in São Paulo -- health educators demonstrate correct condom use and encourage safer sex behavior. Spontaneous discussions about condoms and HIV/AIDS prevention often break out among shoppers viewing a sales display. Even when no sale takes place, the increased public exposure is beneficial in itself.

"One important reason for broadening the number and kind of condom outlets is that individuals see the product and become sensitized to it," said Richard Frank of PSI. "Eventually, the message gets across that condoms are part of everyday life -- an everyday means of saving your own life."

-- Margaret J. Dadian