There is no such thing as a free… condom: social marketing to prevent HIV/AIDS in Vietnam

In the early 1990s, selling condoms was highly controversial in Vietnam. For so long, condoms had been distributed to each household throughout the country for free for family planning use only. Condoms were not used for promoting safe sex. It was extremely difficult to convince the media to advertise condoms, very hard to convince the government that it was possible to generate revenue from selling condoms. People found it embarrassing to buy condoms in shops or drugs stores.
 

At that time, I worked with a US-based NGO named DKT International to develop and implement the first social marketing program to sell condoms and oral contraceptives in Vietnam. The fundamental principle of social marketing is to use marketing techniques to achieve social objectives with the primary goal of promoting social good. The program was a big success, and condoms and pills were branded and became available in the market.

In 2005, when I started working on the Vietnam HIV/AIDS Prevention Project, condoms were still a sensitive topic but many people then understood the importance of using them properly. I decided to apply social marketing in this World Bank-supported project. In 2010, with additional financing from the United Kingdom’s Department of International Development (DFID), the project was expanded from 20 to 32 provinces in Vietnam, which covered two thirds of its 90 million people.

I would attribute the success of this project to three key factors:

• The use of social marketing;
• A favorable market for private companies to invest in; and
• A strong network of peer educators.

 Using social marketing, the VIP Plus condoms distributed under the project have been sold through non-traditional channels such as guesthouses and entertainment venues where sexual activity often occurs.

“In the past, we distributed condoms for free, but we didn’t know if people did use them or not,” Nguyen Thi Hoa, a peer educator in Thanh Hoa Province recently told me. “Now we sell condoms at a low price and we know they would use them. Otherwise, they wouldn’t buy.”

Unlike 1992, Vietnam now already has a pool of private companies who are interested in bidding to get contracts for condom social marketing. The government’s new policies and strong political commitment on fighting HIV transmission clearly stated that innovative methods were strongly supported.

When we started the social marketing program under the project, that favorable environment created a solid foundation for VIP Plus condoms to be born. The slogan and the images were designed, the prices were identified and the distribution agencies were selected following the World Bank’s procurement guidelines. The coordination among different players at central and provincial level was smooth.

This social marketing program is also a good test on how a public-private partnership works on the ground. Interestingly, seven private companies won the bids which created a competition on condoms sales. In the past 14 months, 42 million condoms were sold and 60 percent of them were distributed at guesthouses and entertainment venues. If an additional amount of 32 million VIP Plus condoms are sold by the end of this year, then for the first time ever, the government will earn $1.2 million in revenues. This will be used for reinvesting in the harm reduction program after the project closes in December 2013.

The success of the VIP Plus condom social marketing program helps increase the availability of condoms and the accessibility to quality condoms for high-risk groups.

The project would not have been able to run without a strong network of peer educators, such as drug users, sex workers and MSM (men who have sex with men). In the past eight years, at least 2,000 peer educators have been involved in the project. They are the backbone for the project’s harm reduction intervention activities. They could approach the “hidden groups” in the society and share with them knowledge and information about HIV/AIDS prevention. They also helped distribute manuals, condoms and clean needles to their peers.

At the beginning, it was hard to reach them. The health staff started working with a few peer educators in each province who were confident to appear in public. Interaction between local authorities and peer educators was a turning point. They met up frequently at local government buildings, such as health institutions, and the people’s committee office.

A woman in Kien Giang Province gave me a hug and told me in tears: “Now I know how to ride the bicycle because I need to reach my peer who is not in my community. This is a big change in my life”.
Stigma and discrimination against people with HIV/AIDS has also significantly decreased.

“My wife is proud of my work,” a drug user in Thanh Hoa Province shared with me. “People in the village saw that health workers come to our house and talked about how to prevent HIV infection and gave me needles. Then, I told my drug-user friends not to share needles to keep them safe from the risk of HIV transmission. I also give needles to them.”

I am also very proud of the project because it has significantly contributed to keeping Vietnam’s HIV/AIDS prevalence rate below 0.3 per cent of its population.

What are effective approaches to prevent HIV/AIDS from spreading in your communities? Share with us!