Football and condoms are a winning combination in Brazil. A new line of condoms depicting the logos of the most popular Brazilian teams went on sale in February 2002 and has already become a commercial success. Television advertisements in which supporters wear condom-shaped caps in their team's colours help to promote the condoms as well [1]. Behavioural change associated with condom promotion is a powerful tool for fighting AIDS among youth. However, social marketing strategies must be demand driven. Current condom social marketing projects are developed based on supply side strategies of price subsidies and retail sales. Lacking the involvement of youth, they result in limited impact for continuous condom use. John Snow/PROMUNDO initiated a condom social marketing plan for promotion of sexual behavioral change and use of condoms among youth in communities of Rio de Janeiro, developed with a national condom manufacturer. Youth provided useful insights during field-testing and these were incorporated into all phases of the project. Sixteen young men were trained as promoters to engage their peers on issues of gender-based violence and sexual health, and to sell condoms at places where young people meet (e.g. funk parties and local bars). The price was set based on willingness to pay at US$0.33 for three condoms. The condoms are sold with a magazine produced with the input of young people and sales are income-generating for the promoters [2]. Misconceptions about condom safety and effectiveness, availability, cost, and fear of censure may limit condom use among adolescents and youth. Community condom provision by youth may address these issues, but presents challenges for logistical support, supervision and sustainability. In March 2000, in rural Mwanza, Tanzania, 210 youths aged 16-25 years, of whom 24 were girls, were selected by other youth in their village to act as condom promoters and distributors. They received a two-day training course, which included a description of correct condom use, addressed misconceptions about condoms, and explained social marketing and record-keeping. Promoters paid 425 Tsh (US$0.50) to purchase their initial stock of condoms and 28 were selected from among the promoters and health workers in the community to act as central distributors of new supplies. Quarterly supervisory visits have been conducted to ensure condom availability, restocking and data collection. In the first 18 months of this initiative, 7,641 people bought 28,550 condoms from the promoters. Of these, 22% were 30 years old or over, 40% were aged 20-29, 23% were under 20 and 15% were school pupils. Overall 15% were female. However 30% of trained promoters were lost because of relocation or other change in circumstances and the level of promotion activity varied markedly between the villages. Promoters cited narrow profit margins, scarcity of capital funds, persistent misconceptions about and stigmatisation of condoms, and cultural resistance to condom use as their major difficulties. While community-based peer condom promotion and distribution are feasible and acceptable for increasing condom uptake, particularly among adolescents and young adults, in order to be sustainable, they must be complemented by additional strategies for increasing demand, decreasing misconceptions in the wider community, and maintaining stocks at local centres [3]. Widespread unprotected sex among young people, low levels of awareness of the risk of contracting HIV and other STDs, and the proactive opposition of churches, conservative media and politicians, facilitate the ongoing and increasing spread of HIV infection. The absence of proactive campaigns promoting sustained and appropriate use of condoms fuels the HIV and STI epidemics. Condomovil is a the only project of its kind in Mexico: it has a small vehicle which travels throughout the country promoting greater visibility of condoms, carrying out outreach activities in public places, universities, market places, bars and discos, addressed to sexually active young men and women. Educational interactive events, social marketing and free distribution of condoms and lubricants, public presentations in relevant fora, media presentations and advocacy among government officials, NGO and community leaders in cities and villages are some of the key components that have made Condomovil a model of condom promotion activities. Young beneficiaries have been able to discuss difficult issues related to HIV and STDs uninhibitedly and to have direct access to condoms. Swift responses to opposition and attacks from conservative groups have given Condomovil an added value and credibility in the cities it visits. As a unique form of outreach, with advantages of mobility and low cost, Condomovil should be replicated at state and local level. The project has already been replicated in Venezuela [4].
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