title: A total market approach for condoms in Myanmar: the need for the private, public and socially marketed sectors to work together for a sustainable condom market for HIV prevention.
abstract: BACKGROUND
  Concerns about appropriate pricing strategies and the high market share of subsidized condoms prompted Population Services International (PSI)/Myanmar to adopt a total market approach (TMA). This article presents data on the size and composition of the Myanmar condom market, identifies inefficiencies and recommends methods for better targeting public subsidy.
  
  
  METHODS
  Data on condom need and condom use came from PSI/Myanmar's (PSI/M's) behavioural surveys; data for key populations' socioeconomic status profiles came from the same surveys and the National Tuberculosis Prevalence Survey. Data on market share, volumes, value and number of condoms were from PSI/M's quarterly retail audits and Joint United Nations Programme on HIV/AIDS (UNAIDS).
  
  
  RESULTS
  Between 2008 and 2010, the universal need for condoms decreased from 112.9 to 98.2 million while condom use increased from 32 to 46%. Free and socially marketed condoms dominated the market (94%) in 2009-11 with an increase in the proportion of free condoms over time. The retail price of socially marketed condoms was artificially low at 44 kyats ($0.05 USD) in 2011 while the price for commercial condoms was 119-399 kyats ($0.15-$0.49 USD). Equity analyses demonstrated an equal distribution of female sex workers across national wealth quintiles, but 54% of men who have sex with men and 55% of male clients were in the highest two quintiles. Donor subsidies for condoms increased over time; from $434,000 USD in 2009 to $577,000 USD in 2011.
  
  
  CONCLUSIONS
  The market for male condoms was stagnant in Myanmar due to: limited demand for condoms among key populations, the dominance of free and socially marketed condoms on the market and a neglected commercial sector. Subsidies for socially marketed and free condoms have prevented the growth of the private sector, an unintended consequence. A TMA is needed to grow and sustain the condom market in Myanmar, which requires close co-ordination between the public, socially marketed and commercial sectors.
authors.affiliation: Population Services International Myanmar, Director, Social Marketing, Population Services International, Director, Research and Metrics, Population Services International, Senior Regional Researcher, Asia/Eastern Europe, Population Services International Myanmar, Research Manager, Strategic Information and University of California, San Francisco, Associate Professor, Global Health Sciences hwhtat@psimyanmar.org.
authors.forename: Han Win
authors.initials: HW
authors.lastname: Htat
authors.affiliation: Population Services International Myanmar, Director, Social Marketing, Population Services International, Director, Research and Metrics, Population Services International, Senior Regional Researcher, Asia/Eastern Europe, Population Services International Myanmar, Research Manager, Strategic Information and University of California, San Francisco, Associate Professor, Global Health Sciences.
authors.forename: Kim
authors.initials: K
authors.lastname: Longfield
authors.affiliation: Population Services International Myanmar, Director, Social Marketing, Population Services International, Director, Research and Metrics, Population Services International, Senior Regional Researcher, Asia/Eastern Europe, Population Services International Myanmar, Research Manager, Strategic Information and University of California, San Francisco, Associate Professor, Global Health Sciences.
authors.forename: Gary
authors.initials: G
authors.lastname: Mundy
authors.affiliation: Population Services International Myanmar, Director, Social Marketing, Population Services International, Director, Research and Metrics, Population Services International, Senior Regional Researcher, Asia/Eastern Europe, Population Services International Myanmar, Research Manager, Strategic Information and University of California, San Francisco, Associate Professor, Global Health Sciences.
authors.forename: Zaw
authors.initials: Z
authors.lastname: Win
authors.affiliation: Population Services International Myanmar, Director, Social Marketing, Population Services International, Director, Research and Metrics, Population Services International, Senior Regional Researcher, Asia/Eastern Europe, Population Services International Myanmar, Research Manager, Strategic Information and University of California, San Francisco, Associate Professor, Global Health Sciences.
authors.forename: Dominic
authors.initials: D
authors.lastname: Montagu
mesh_terms: D003132:Commerce / Q000706:statistics & numerical data*; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D015438:Health Behavior; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D008297:Male; D002052:Myanmar; D017149:Private Sector / Q000706:statistics & numerical data*; D017150:Public Sector / Q000706:statistics & numerical data*; D040241:Social Marketing; D014480:United Nations
keywords: Condoms; commercial sector; equity; free condoms; health markets; public sector; social marketing; subsidy; sustainability; total market approach; universe of need