PSI was the first organization to deploy the power of social marketing against the AIDS epidemic in a project started in 1988 in the Democratic Republic of Congo that was shown to have increased abstinence, mutual fidelity and consistent and correct condom use. PSI has continued to be an innovator in the field, introducing a range of products, services and communication strategies to confront the changing face of the epidemic in an increasingly targeted way.

Using a formula based upon the AVERT model, developed to account for a variety of interventions, PSI estimates that sales of its HIV/AIDS products and services in 2005 directly resulted in hundreds of thousands of infections being prevented.

PSI uses the best evidence available and its own marketing savvy to develop HIV/AIDS strategies that are balanced and targeted to the appropriate groups.

Balanced: PSI has strategies that are appropriate for different kinds of people at different stages of their lives. Abstinence and delay of sexual relations are promoted to young people not yet sexually active. Mutual fidelity and/or condom use are promoted to those sexually active but in stable relationships. Condoms are promoted to high-risk groups and members of the general population exhibiting high risk behavior. VCT is encouraged for everyone, and sometimes, as with truck drivers in India, for certain high-risk groups.

Targeted: In settings with low HIV prevalence, PSI is likely to target mainly high risk groups like commercial sex workers and migrant workers. In high-prevalence settings, where everyone is at risk, PSI is likely to focus on both high-risk groups and the general public. Communication channels are carefully selected in order to ensure reception by the particular groups targeted.

PSI HIV/AIDS prevention programs change behavioral norms mainly in four areas which are critical to slowing and reversing the HIV/AIDS pandemic:

• Voluntary Counseling and Testing (VCT): PSI was one of the first international NGOs to implement VCT social marketing. PSI takes an innovative approach toward establishing and promoting VCT services to create demand for and increase access to high quality VCT. PSI plays different roles in this effort depending on the particular country: Sometimes PSI creates and manages its own VCT centers; sometimes it restricts its role to developing and conducting capacity building for centers managed in the public and/or private sectors. Social marketing of VCT uses branded advertising and generic behavior change communication techniques. The sites benefit from common mass media and interpersonal communications strategies that destigmatize VCT and are culturally appropriate and targeted. PSI first got involved with VCT in Zimbabwe in 1999 and, in seven years, the project has developed into a franchised network of 20 VCT centers branded and promoted under the unifying name New Start, where over 15,000 clients are tested per month. As of April 2006, PSI implements VCT projects in 18 countries worldwide and has tested over 1.4 million clients. The other countries are Benin, Cambodia, Côte d'Ivoire, Haiti, India, Kenya, Lesotho, Mali, Mozambique, Myanmar, Namibia, Rwanda, South Africa, Swaziland, Togo, Vietnam and Zambia. In 2006, PSI will launch youth-friendly VCT services in the Top Réseau franchise in Madagascar.

• Abstinence: PSI has been promoting abstinence to young people for avoiding pregnancy and HIV infection since 1988. In Cameroon, research showed abstinence for pregnancy prevention increased significantly as the result of a PSI social marketing project aimed at adolescents. In Zambia, PSI jointly implemented a mass media project targeting youth with JHU-CCP. Research showed that youth aged 15-24 who viewed the mass media campaign messages were 1.7 times more likely to practice abstinence than those who did not see the campaign. HIV prevalence now appears to be either stabilizing or declining among Zambian young people.

• Mutual Fidelity: PSI promotes mutual fidelity to stable couples as their first line of defense against HIV infection. In Nigeria, the 2004 Nigerbus surveys (conducted independently of PSI) found that the proportion of sexually active respondents who had sex with non-marital partner(s) had fallen from 29% in 1998 to 20% in 2002, a decrease of 31%. Moreover, abstinence has increased by 28% and condom use with non-marital partners by 75% over the same period. Although these results cannot be attributed directly to PSI's affiliate the Society for Family Health (SFH), it is true that SFH is PSI's largest program in African and is the only NGO doing national mass media campaigns promoting the ABCs.

• Condom Use: PSI targets risk groups such as commercial sex workers and their clients, migrant workers, truckers and intravenous drug users. The social marketing of male condoms has been found to be the most cost-effective of the six HIV/AIDS prevention strategies studied, averting an HIV infection at a cost of $10. In Cambodia, HIV prevalence has dropped among the general population and among key high risk groups at the same time that condom use has been rising. The policy of 100% condom use in commercial sex establishments is widely credited, and PSI is the leading non-governmental organization providing condoms to these establishments.

* PSI is currently reviewing the cases of AIDS averted model and these will be calculated retroactively early 2006.