The performance of social marketing in reaching the poor and vulnerable in AIDS control programmes

The article reviews evidence on the impact and effectiveness of condom social marketing programmes (CSMPs) in reaching the poor and vulnerable with information, services and products in the context of HIV/AIDS/STD prevention and control. Ideally, the success of CSMPs would be judged by whether they contribute to sustained improvements in sexual health outcomes at the population level. Given methodological and attribution difficulties, intermediary criteria are employed to assess effectiveness and impact, focusing on changes in behaviour (including condom use) among poor and vulnerable groups, and access by the poor and vulnerable to condoms, services and information. It remains difficult to reach definitive conclusions about the extent to which CSMPs meet the sexual health needs of the poor and vulnerable, due largely to reliance on sales data for CSMP monitoring and evaluation. CSMPs (like many health programme strategies) have traditionally collected little information on client profiles, health-seeking behaviour, condom use effectiveness, and supply-side issues. Recent data indicate that CSMPs are unlikely to be pro-poor in their early stages, in terms of the distribution of benefits, but as CSMPs mature, then inequities in access diminish, followed by reduced inequities in condom use. The paper assesses the extent to which social marketing is effective in improving access for the poor and vulnerable using a number of variables. In terms of economic access, it is evident that low-income groups are particularly sensitive to CSMP price increases, and that a cost-recovery focus excludes the poorest. Convenience is significantly improved for those who can afford to pay, and CSMPs appear to be addressing social and regulatory constraints to access. Conventional CSMP monitoring systems make it difficult to assess the effectiveness of behavioural change IEC strategies, although data on this dimension of the social marketing approach are beginning to emerge.