With nearly 86 percent of HIV transmission through unsafe sex in India, the National AIDS Control Programme (NACP) has consistently been promoting condom use as a safe sex practice for prevention of Sexually Transmittednfections/ Reproductive Tract Infections (STI/RTI) and HIV and protection from unwanted pregnancy.
Condom promotion, through education, counselling and advertising, encourages the use of condoms while condom distribution makes condoms readily available to individuals either for free or at highly subsidized prices. Condom promotion campaigns, both at the generic and brand promotion level, have been undertaken in India with varying levels of efforts over the last few decades.
The specific Condom Promotion Objectives are:
- Increase demand for condoms among high risk, bridge and general population.
- Expanding social marketing programme to saturate coverage in high HIV prevalence and/or high family planning need districts and to increase the demand for condoms among high risk, bridge and general population.
- Maximize access of free condoms with most vulnerable groups – while minimizing wastage.
- Increase sales in rural areas and expand availability through condom sales through non-traditional outlets (stores not previously selling / that do not usually sell condoms).
- Introduce product mix and brand management innovations to promote consistent condom use.
- Increase the accessibility of condoms to make it available within 15 minutes of walking distance from any location.
NACO’s Condom Promotion strategy focuses on two aspects: ensuring availability and creating demand for condoms.
I. Salient Features:
The availability of condoms is addressed through two separate segments of Condom Promotion: Free Condoms and Socially Marketed (Paid-subsidized)
a. Free Condoms (Nirodh): Free Condoms are procured by Department of Health & Family Welfare, Ministry of Health & Family Welfare and distributed by NACO/ SACS to High Risk Group (HRGs) through TI NGOs/ICTC/ART centre for HIV/AIDS Prevention.
b. Socially Marketed Condoms: Socially marketed condoms are distributed by NACO through its Social Marketing Organizations (SMOs). The Programme focuses geographically on high prevalence and/or high fertility districts with additional emphasis on ensuring condom availability for HRG – Vulnerable population intensive areas. The Programme also focuses on expansion of condom availability of hitherto unserved/ underserved areas such as rural markets and increasing the numbers and types of outlets stocking and selling condoms to and make it a ubiquitous product. Hindustan Latex Family Planning Promotion Trust, Population Health Services (India), Pashupati Chemicals & Pharmaceutical Limited, HLL Lifecare Limited- a PSU, Parivar Seva Sanstha, Population Services International, Janani and DKT India are the same SMOs who work in India.
The salient features of the Targeted Condom Social Marketing Programme are as under:
• Ensure availability of subsidized condoms to consumers who cannot afford market priced (commercial) condoms especially in high priority districts.
• Focused on high priority districts for better impact.
• Districts are categorized in four category.
• Coverage of 100% high risk areas in the programme districts.
- Targeted Intervention sites
- Trucker halt point
- Migrant districts (source, transit and destination)
- Large construction sites
• Unique performance-based contracting with SMOs, against predefined targets for condom sales, outlet coverage, mid media contacts etc.
• SMO operations closely linked to programme objectives (e.g. rural sales, non-traditional outlet, etc.)
• Real time monitoring of programme implementation down to field-level ensures timely interventions and corrective actions if any required.
• Data validation through online Programme Monitoring Software and field visits.
• Specific focus on Deluxe Nirodh (GoI brand).
• Number of mid-media contacts for demand generation monitored.
• The payments of SMOs are released based on achieving milestones.
c. Female Condom Programme: The Female Condom Programme empowers FSWs to protect herself with Female Condom in non-negotiable environment.
The strategies that guide NACO in achieving its objective of increasing consistent use of condom to nearly 100% and creating easy accessibility of condoms are:
Increasing Retail Availability: By integrating social marketing with targeted interventions the NACO seeks to create better condom availability in rural and remote areas, integrating condom supply chain management with the networks of major cooperatives and Fast-moving Consumer Goods (FMCG) companies, and developing village level interfaces with self-help groups, post offices, rural banks, etc., besides skill building of health and link workers. The current Condom Social Marketing programme is focused on increasing condom accessibility in rural as well as high risk areas.
Condom - Behaviour Change Communication: While the initial focus was on condoms as a key family planning method, interpersonal communications are also putting emphasis on HIV prevention since the late 1980s and bringing in protection from STIs currently.
The current communication campaigns focus on enhancing risk perceptions to motivate the target group to use condoms and normalisation of condom use. Thus all channels of communication are being explored to promote condom use. The NACO and State AIDS Control Societies (SACS) in coordination with the district health authorities organise the supply of free condoms as a part of targeted interventions only.