It Takes a Market to get Men to Use Condoms in Africa. Here's How.

What can be done to increase the use of condoms by men in African countries? PSI and the United Nations Population Fund (UNFPA) teamed up over the past year to study and report on the state of play in six African countries. The results are out in six new case studies that will be presented during a consultative meeting on the Total Market Approach that PSI and UNFPA are hosting, today and tomorrow.

During the meeting, participants will discuss the findings from the six case studies conducted in African countries. Then, representatives from ten organizations will discuss how they can work together to support the development and implementation of the Total Market Approach in national markets for male condoms and other family planning supplies.

The UNFPA sponsored case studies were carried out in the past 12 months with support from two independent researchers in Botswana, Lesotho, Mali, South Africa, Swaziland, and Uganda. All of the countries have large condom social marketing programs, are affected by HIV, and have high maternal morbidity and mortality relative to their economic development.

Content for the case studies was based on a review of the literature, seven key TMA metrics calculated from national-level data, and interviews with stakeholders. All case studies were subject to review by stakeholders, including Ministries of Health and non-governmental organizations in all six countries, UNFPA’s local and regional offices, UNFPA headquarters in New York City, PSI country and regional offices, and PSI’s headquarters in Washington DC.

Each case study describe the market for male condoms in each of the countries, and the roles of the public, social marketing, and commercial sectors in those markets.

The cases illustrate the universe of need for condoms, levels of use, socioeconomic equity among users, and the market presence of condoms for reproductive health and HIV prevention (dual protection).

They also propose a set of recommendations for improving the effectiveness, efficiency, and sustainability of condom markets.

The studies aim to inform the development of appropriate, evidence-based decisions to increase condom use equitably and sustainably through actions undertaken in the public, socially marketed, and commercial sectors.

Here is what we found:

Botswana

Botswana Cover Photo © Corbis

The prevalence of HIV in Botswana is among the highest in the world, with nearly one-fifth of the population infected.

Although large-scale HIV prevention efforts have resulted in a decrease in new infections over the past two decades, consistent condom use remains critical for preventing new infections.

In Botswana, the number of condoms needed to protect all sexual acts from HIV infection and unplanned pregnancy (universe of need) is higher than the actual number of condoms on the market (volume).

Inequity remains an issue and there is evidence to suggest that condom use is concentrated among wealthier segments of the population.

Efforts should focus on those most in need, including the poor and those living in rural areas.

Read the study: Botswana

Lesotho

Lesotho Cover Photo © Anthony Kambi Masha, Courtesy of Photoshare

The prevalence of HIV in Lesotho is among the highest in the world, with almost one-quarter of the adult population infected.

Although large-scale HIV prevention efforts have resulted in a 16% decrease in new infections, risky sexual behavior and insufficient levels of condom use continue to drive the HIV epidemic.

Demand for condoms has increased over the years, including among those with higher risk behavior.

In 2012, 61% of men and 46% of women reported using a condom the last time they had sex, more than double the percentage in 2004 and more than 25% higher than in 2009.

Equity in condom use has also improved. According to recent data, approximately one-third of condom users fall into the bottom two wealth quintiles.

To meet increasing demand, all market sectors must address chronic shortages in supply, especially for free condoms.

Read the Study: Lesotho

Mali

Mali Cover Photo © Eliasaph Diassana

Male condoms are an important part of Mali’s national strategy for HIV prevention, and the dual protection offered by condoms is a key component of reproductive health programs, especially for youth who may not ordinarily seek medical advice or other contraceptive methods before becoming sexually active.

In 2006, only 8.9% of males and 1.9% of females reported using a condom the last time they had sex, and individuals in the wealthiest quintile are more likely to use condoms than those in poorer quintiles.

While rates of use are higher among youth and individuals with multiple or casual partners than reported in previous years, condom use is still low.

Approximately 98 percent of condoms on the market were totally or partially subsidized. However, as it stands, wealthier classes are the ones benefitting from free and socially marketed condoms.

Increasing informed demand and promoting higher rates of condom use among Malians – especially for HIV prevention – is crucial.

Read the study: Mali

South Africa

South Africa Cover Photo © Panos / David Larsen / Amo

South Africa has the greatest number of people living with HIV in the world, with an estimated 16.9% of the adult population infected.

Although large-scale HIV prevention efforts have resulted in a decrease in new infections, risky sexual behavior and insufficient levels of condom use continue to drive the HIV epidemic.

In South Africa, the number of condoms needed to protect all sexual acts from HIV and unplanned pregnancy (universe of need) is much higher than the actual number of condoms on the market (volume).

Currently, lengthy condom procurement processes, an unreliable condom supply, and lack of government funds for warehousing and distribution cause inefficiencies in public sector distribution, which result in shortages throughout the country.

Accessible, high quality data are needed to guide decisions by all market stakeholders.

Read the study: South Africa

Swaziland

Swaziland has the highest HIV prevalence of any country in the world, with more than one-quarter of the adult population infected.

Although large-scale HIV prevention efforts have resulted in a decline in incidence since 1998, risky sexual behavior and insufficient condom use continue to drive the epidemic.

In 2012, approximately two-thirds of men and women reported using a condom the last time they had sex, compared to fewer than half in 2006.

Rates of condom use have also increased among unmarried youth, but are lower than rates in the general population.

Condom use is also no longer concentrated among just the wealthy: nearly 40% of condom users fell into the bottom two wealth quintiles in 2012, compared to less than 25% in 2006.

Limited coordination between the public sector and implementing partners, including non-governmental organizations (NGOs), results in overstocks of free condoms in some places while other sites are severely under-stocked.

Read the study: Swaziland

Uganda

From 1992 to 2002, Uganda successfully reduced the prevalence of HIV/AIDS from 18% to approximately 6%; however, some concerning trends are emerging and HIV prevalence has increased with an estimated 7.3% of adults currently infected.

Condom use among the general population has increased, but overall demand still remains low, which helps explain why volumes are also low.

Rates of use are higher among youth, but have decreased within some groups, including males with casual partners and females with multiple partners.

The total market approach provides an opportunity for improved efficiency, equity, and sustainability in Uganda’s market for male condoms.

Enhanced reporting systems could improve commodity projections and forecasting, which would help identify market needs as well as gaps in supply.

Read the study: Uganda