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Over the last 25 years, the single most effective technology in preventing AIDS has been the latex condom - short of giving up sex or sticking with one partner who's infection-free, there is not anything else.
In developing countries, social marketers have been trying to get more people to use condoms. And where they've been successful, HIV rates are coming down.
NPR's Brenda Wilson reports.
BRENDA WILSON: The billboards were huge, planted at major traffic stops in Addis Ababa. Huge pictures of a chunk of chocolate or fruit, like one large strawberry, off which tinted highlights waked it up, suggesting the scent of something delectable.
Mr. ANDY PILLER (Manager, DKT International, Ethiopia): We have strawberry, banana and chocolate-scented condoms. And since we're in Ethiopia, I've already had discussions with this manufacturer about having coffee-scented condoms produced.
WILSON: Andy Piller manages HIV prevention and family planning programs in Ethiopia for DKT International, a social marketing organization started by public health workers in India in the late 1960s.
Mr. PILLER: Our inventory right now is about 50 million condoms. And those will last us about a year.
WILSON: In a warehouse on the outskirts of Addis, about 40 women are seated at tables surrounded by stacks of boxes that run the length of the warehouse. They take condoms out of boxes and repack them three to a small box that may feature a couple embracing each other or a silver heart with DKT's logo.
Last year, U.S. researchers found that rates of HIV infection in Ethiopia dropped from 4.4 percent to less than 3 percent. Part of that had to do with how cases of HIV are counted, but Miller says some of the decline is real.
Mr. PILLER: When we first got here in 1991, the total number of condoms being brought into the country was probably around 250,000 pieces. And now, there's around 75 or 80 million condoms a year being used in the country, and our project represents about 75 percent of that amount.
WILSON: Even so, researchers say, just five percent of Ethiopians say they use condoms.
Another social marketing group, Population Services International, is now the largest condom distributor in the world, and like DKT, it's non-profit. Sally Cole, a senior vice president, says that making people buy into what you're selling is a very important aspect of social marketing.
Ms. SALLY COLE (Senior Vice President, Population Services International): We sell things and not give them away. We think if you buy it, you're much more likely to use it.
WILSON: She says they go to great lengths to enhance the value of the product.
Ms. COLE: We never want to be vulgar, but we certainly do want to sometimes be explicit. And we want to promote a product because we know that only preaching or only gloom and doom or only your gym teacher saying to you you got to wear socks or you'll get athletes foot is not always the best way to attract a young, sexually active person to take responsibility for his own heath or her own health and to use a condom.
WILSON: In countries like Haiti, Botswana and Kenya where PSI operates, rates of HIV are coming down and condom use is going up. Journalist Anne Waithera describes one of the television ads that is popular among young people in Kenya.
(Soundbite of TV commercial)
(Soundbite of music)
(Soundbite of train engine)
Unidentified Woman: (Singing) You will always be my...
Ms. ANNE WAITHERA (Journalist, Citizen Radio, Kenya): Okay, this two young girls, you know, sitting at a regular station. They see this handsome man coming their way, and he goes in - starts washing his hands under this tap and takes off his shirt and you see his incredible chest. And the young girls start salivating, and really, you know, admiring this man. And one of them has some mineral water. She drops the bottle, and this man comes over and he comes really close. He gets a pack of Trust condoms from his pocket because the bottle is broken, so he puts a condom on the bottle.
WILSON: There were several ads in the campaign, all using condoms in rather inventive ways - to repair busted car radiators, as umbrella covers.
Ms. WAITHERA: You know, Trust is the cheapest condom in Kenya. So people would sort dismiss it and want to buy a more expensive condom. But because they saw all this handsome young men and all this beautiful young girls being associated with the condom, then it became normal for someone to ask for a pack of a Trust condoms, which a teenager can afford.
WILSON: In 2005, 13 billion condoms were distributed worldwide. But the United Nations Development Program says that adds up to about 10 condoms a year for every man in Africa, and is not enough.
Terri Bartlett of Population Action International says it shouldn't be hard to increase the supply.
Ms. TERRI BARTLETT (Vice President for Public Policy & Strategic Initiatives, Population Action International): You know, we travel around the world, and at the end of every dirt road, there's bottled water, a Coca-Cola, and a pack of Marlboros. Why can't we have a condom there, too?
WILSON: And for want of a condom or the will to use one, there were seven million new infections of HIV last year.
Brenda Wilson, NPR News.
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