title: Condom social marketing in sub-Saharan Africa and the Total Market Approach.
abstract: BACKGROUND
  Social marketing interventions are important in developing nations. Both increasing use and shifting users from receiving subsidised condoms need to be pursued using a Total Market Approach (TMA). This paper reviews the performance of social marketing through a cross-country comparison of condom use, equity and market share, plus a case study illustrating how TMA can be applied.
  
  
  METHODS
  Demographic and Health Survey data (1998-2007) provide condom use trends, concentration indices and sources of supply by gender for 11 African countries. Service delivery information and market research provide market share data for the same period. For the case study, two-yearly surveys (2001-09) are the source of condom trends, and retail audit data (2007-09) provide sustainability data.
  
  
  RESULTS
  Among women, condom use with a non-marital, non-cohabiting partner increased significantly in 7 of 11 countries. For men, 5 of 11 countries showed an increase in condom use. Equity improved for men in five countries and was achieved in two; for women, equity improved in three. Most obtained condoms from shops and pharmacies; social marketing was the dominant source of supply. Data from Kenya were informative for TMA, showing improvements in condom use over time, but sustainability results were mixed and equity was not measured. Overall market value and number of brands increased; however, subsidies increased over time.
  
  
  CONCLUSIONS
  Condom social marketing interventions have advanced and achieved the goals of improving use and making condoms available in the private sector. It is time to manage interventions and influence markets to improve equity and sustainability.
authors.affiliation: Population Services International, 1120 19th Street, NW #600, Washington, DC 20036, USA. schapman@psi.org
authors.forename: Steven
authors.initials: S
authors.lastname: Chapman
authors.forename: Krishna
authors.initials: K
authors.lastname: Jafa
authors.forename: Kim
authors.initials: K
authors.lastname: Longfield
authors.forename: Nadja
authors.initials: N
authors.lastname: Vielot
authors.forename: Justin
authors.initials: J
authors.lastname: Buszin
authors.forename: Lek
authors.initials: L
authors.lastname: Ngamkitpaiboon
authors.forename: Megan
authors.initials: M
authors.lastname: Kays
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D040241:Social Marketing; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000706:statistics & numerical data; D055815:Young Adult