Post offices throughout Tanzania are selling a controversial new set of four stamps whose purpose is to promote HIV/AIDS prevention. One focuses on the growing population of AIDS orphans that the epidemic has created, while another encourages national solidarity in the response to the epidemic. A third points out that everyone is vulnerable in its message, "AIDS has no barrier."
But it's the fourth stamp that has captured the most notice. It pictures a Salama condom — the brand promoted by TAP — and carries the message, "Condoms prevent transmission of HIV." Although some conservative and religious groups have objected to the stamps, the Post Office and the National AIDS Control Program, whose support TAP recruited as the stamps were developed, have stood firmly behind the campaign.
Bold and creative initiatives such as this are a hallmark of TAP's Social Marketing Unit (SMU), which is directed by an AIDSCAP partner, the U.S.-based, nonprofit Population Services International (PSI). PSI is a global leader in social marketing, which uses commercial marketing techniques to promote and expand interest in and use of socially beneficial products such as condoms. Through advertising, public service notices, product launches, use of media outlets, special events promotion and expansion of distribution networks — all standard product marketing methods used in the business world — social marketing has raised public awareness about using condoms to prevent HIV infection and greatly increased the numbers of condoms sold in developing countries throughout the world. In many places, social marketing's promotional efforts have turned around negative public attitudes about condoms, enhancing their desirability not only for health and contraceptive reasons but as symbols of sophistication or a sign of emotional commitment to a partner.
Making Condoms Desirable — and Affordable
The point of marketing products is to increase sales, and the concept is no different for social marketing of condoms. While hundreds of millions of condoms have been distributed free of charge throughout the developing world since the HIV/AIDS epidemic began, social marketing is built upon the concept of promoting the value — and thus increasing the use — of products such as condoms by charging a price for them. Customers are making an investment in their health when they buy condoms and are much more likely to use a product that they've paid for.
In countries as impoverished as Tanzania, though, a key strategy is to set condom prices that even low-income people can afford to pay. Salama condoms cost only $.03 apiece, about a fifth the price of the next lowest socially marketed brand and a tiny fraction of the cost of some imported commercial condoms with price tags of $1.00 to $3.00 each. This level of pricing, which is possible because all of the condoms are given to the project by international donors, allows most adults convinced through promotion of the value of condom use to purchase them consistently.
And many Tanzanians have indeed been convinced. From December 1993 to the end of its original contract in June 1997, TAP's SMU has overseen sales of 30 million condoms — far exceeding the original project goal of 6 million. Salama now claims more than 90 percent of the country's market share. Health surveys also reveal that, since the start-up of Salama sales, a significant percentage of Tanzanian adults have come to understand the importance of condom use in HIV prevention and have heard of the Salama brand name, evidence of the impact of Salama advertising and promotional activities.
Making the Pitch
In fact, it is the advertising and promotional aspects of social marketing that can have the broadest impact on how society responds to the epidemic, since the prevention messages they convey reach everyone, not just those prepared to buy condoms. Pitching a brand name is only part of the process; convincing the public that HIV/AIDS threatens their lives and that they must act to protect themselves is what drives promotional efforts. TAP's SMU thus invests considerable time and effort in planning promotional activities because of their importance as behavior change communication tools.
One particularly valuable promotion strategy has been the use of mobile video vans in each of four vast regional sales zones. These 3.5-ton vans — built to negotiate rutted rural roads — contain complete mobile video units. In coordination with local health officials who organize and announce the vans' arrival, sales teams set up a huge screen in a soccer field or town square to present videos on behavior change and condom use. After each video showing they lead audience discussions, distribute promotional materials and tell viewers where they can buy condoms in their communities. In a nation where only a tiny minority of the population have television sets and entertainment opportunities are few, the vans often attract audiences in the thousands. In 1994, more than 2 million people attended 457 video showings throughout the country.
Another major promotional success was the popular "Je?" poster and newspaper advertisement series — Tanzania's first advertising campaign dealing with HIV/AIDS — which ran throughout the entire second year of the project. Designed for the general population, the ads and posters portrayed a single hapless character in comic but dangerous situations: putting his head in a crocodile's jaws, teasing a lion, dancing in front of a commuter bus with no brakes, sleeping on railway tracks. The messages throughout the campaign compared such activities to the dangers of having unprotected sex and promoted the use of Salama condoms.
"The 'Je?' campaign was a huge success," said Tim Manchester, PSI Tanzania project manager. "Everything that people had seen about AIDS before this had been a speech or a sermon or a newspaper story that was all gloom and doom. We made the character a bit comical so you'd remember him, and kept the story coming so we could build anticipation about what he would do next. To this day [two years later], people are still talking about his exploits."
Other poster campaigns targeted urban women, portraying them as taking charge of their lives by warning their partners that without Salama condoms there would be no sex. The "Je?" character was also portrayed in a poster series promoting the ABCs of safe sex (Abstinence, Be faithful, or use a Condom). More than 46,000 posters, 95,000 promotional calendars and tens of thousands of other materials such as T-shirts and stickers have been distributed since the beginning of the project.
The SMU produced four popular TV commercials for Salama, including a remake of a clever ad that originated in South Africa showing a karate superstar coming out of a movie screen to give a Salama condom to a passionate couple in the back row of the theater. For radio, the project created a series of public service announcements using the Salama theme song in the background and a voiceover with HIV/AIDS prevention messages.
The SMU has also promoted Salama by sponsoring 418 public events such as sports competitions, concerts and beauty pageants. During half time at soccer matches and breaks in other events, staff reach a captive audience with educational presentations and roving condom salespeople. Sometimes theater groups present prevention dramas.
Such promotional activities are key to increasing demand for condoms. And this demand has helped SMU expand sales outlets throughout many regions of the country, making condoms available in places where they had never been sold before.
Getting Condoms to Customers
Getting Salama to market has not been a simple task. Tanzania is the largest country in East Africa-about the same size as Texas and New Mexico put together-and it remains fractured geographically by an inadequate transportation infrastructure and underdeveloped commercial distribution networks. The nation's limited telephone and other communications systems also make it difficult to build the kind of commercial network that would allow sustained growth in condom distribution.
Despite these logistical constraints, TAP's SMU has been able to dramatically improve access to condoms throughout its sales zones, which cover nearly all of the country's 20 regions and include more than half of the national population. Four of those zones are operated directly by SMU and include a network of nearly a thousand retail sales points. In addition to the more traditional outlets such as pharmacies and over-the-counter drugstores, these venues include grocery stores, bars, night clubs, guesthouses, hair salons, photo studios and gas stations — enabling people seeking protection from HIV/AIDS to buy condoms where they live, work and seek entertainment, during many more hours of the day.
The nine TAP clusters also incorporate Salama condom sales and promotion into many of their own prevention activities, including training of peer educators. The Tabora cluster, for example, has developed a particularly successful social marketing component. The cluster has trained hundreds of community-based educators and independent vendors as sales promoters and retail agents and has opened eight new wholesale outlets and 126 retail outlets throughout the region.
A fifth zone — which includes Dar es Salaam — is covered by a commercial distributor, Kay's Hygiene. In addition, 10 pharmaceutical wholesalers and 38 consumer goods wholesalers are now marketing Salama. The project has worked hard to encourage the growing participation of the commercial sector in Salama's distribution, which it sees as a sign of sustainability.
"This is good news," said Tim Manchester, PSI Tanzania project manager. "It means that a substantial quantity of the product is now moving through commercial distribution channels without the project's direct involvement."
