Condom Social Marketing in India Innovations to drive condom usage International AIDS Conference Washington July 2012

Background Condom Promotion historically associated with Family Planning. – Focus on high fertility states – govt. distribution : free supplies : public health system Communication limited to family planning Gap in availability and affordability; – Commercial condoms restricted to Urban India; – Limited or negligible interest of private sector in rural areas – High distribution cost barrier

Background…. Very few (4-5) social marketing organizations covering the entire country. – Only donor supported programs received adequate coverage – Independent activity in limited areas by different donors leading to disparate efforts Lack of technical and professional management of condom promotion. NACO recognized the need to a have single national program with a focussed approach to ensure availability of subsidized condoms to consumers in high priority districts.

Condom Market Segmentation Commercial Condoms Urban Affluent Population Socially Marketed Condoms Clients of FSWs, Migrants, Truckers, Males in rural India / lower income segments in urban India Subsidized by GoI ; distributed through retail network via social marketing organisations (SMOs) Free Condoms Marginalised communities Procurement cost borne by GoI distributed to Public Health System, NACO TIs. Government

Targeted Condom Promotion Availability and Accessibility: Expanding social marketing programs in the high priority (HP/HF) districts to ensure availability of subsidized condoms to consumers who cannot afford market priced (commercial) condoms Focused on increasing demand for condoms among high risk, bridge and general population Increasing consumer usage of paid condoms to ensure sustainability

Ensure condom availability (paid /free) in 100% high risk areas in – Targeted Intervention sites – Trucker halt points – Migrant districts (source, transit and destination) – Large construction sites Minimizing wastage in free supply of condoms while maximizing its access the most vulnerable groups Targeted Condom Promotion

Implementation Approach Comprehensive Targets to ensure program priorities – targets on sales, outlets, demand generation activities with specific focus on non traditional outlets, rural and mid media contacts, and government brand Performance based contracting : – Unique contracting with SMOs with payouts pro-rated to target achievements – Weightage given to key program priorities

Implementation Approach Real-time monitoring of program implementation – field-level information ensures timely interventions and corrective actions if any required. Experienced, professional implementers with strong marketing and sales experience

The Innovations Distribution through non traditional outlets – taking the condom to where the consumer is…. Demand Generation - – Mid-media – Using local theatre and folk culture for active social messaging and mass media

Mass media…message deepening …to enhancing Risk Perception …to Consistent use Condom normalization

Phase I Phase II Phase III Phase IV Phase V targets Sales111m322m525m439m772m Outlets0.3m0.57m0.8m0.63m1.2m Districts Massive scale up of NACOs Condom Social Marketing Programme

Impact Condom market growing at 15% YoY Ensuring sustainable condom usage thru increased use of paid condoms

Impact *BSS- Behavioral Surveillance Survey 2006 ** Condom Promotion Impact Survey 2010 Condom is easily accessible Mean time to access condom Consistent Condom Use can prevent HIV AIDS Consistent Condom Use can prevent HIV AIDS Condom use with non- regular/ casual partner Condom Use with FSWs 98%77% 89% 77% 30min 88%19min 81% 65% 58%

Other Innovations Female Condom Program – encourage condom use by empowering FSW in low negotiating situations. – FC programme implemented by NACO in 13 states Condom Vending Machines (CVM) Program 10,000 CVM installed across major towns in the country to provide 24x7 access to condoms CVMs integrated into CSMP as non-traditional outlets

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