The Successful Mozambique Condom Social Marketing Project: A Targeted Behavior Change Strategy for AIDS Prevention

Mozambique might be recovering from decades of war and a desperately low per capita GNP, but the country's 18.6 million residents buy and use over 10 million JeitO condoms a year, and have decreased their risk of getting AIDS. Why? Because PSI's Mozambique Condom Social Marketing Project has lowered risky behavior through a comprehensive, integrated communications strategy. This strategy is based on six key factors necessary for behavior change, and uses a variety of communications channels such as mass media, small group activities, and theater presentations. The condom social marketing project in Mozambique is implemented by PSI as a component of the National AIDS Control Program (NACP), with funding from USAID and the Royal Netherlands Embassy.

When Mozambique's civil war ended in 1992, HIV transmission rates increased exponentially, due to a flood of returning refugees and the reopening of borders with its neighbors—all of which had higher HIV rates than Mozambique itself. As a result, in 1994 the NACP invited PSI to implement an AIDS prevention social marketing project to promote safer sexual behavior, including condom use. The World Health Organization now estimates that 14.5% of sexually active adults in Mozambique (over 1 million people) are HIV positive.

PSI launched its JeitO condom (meaning 'style or flair' in Portuguese) in April, 1995. The price for a 4-pack is 1,000 meticais (about $0.02 per condom), which is affordable even in Mozambique, where per capita income ranks among the lowest in the world. Annual sales of JeitO have taken off, rising from 2 million in 1995 to 10 million in 1997. Sales are supported by a network of nearly 2,000 retailers, mostly non-traditional outlets—bars, hotels, kiosks, and markets throughout the country.

To promote safer sex—including delayed sex, partner reduction, STD treatment and the use of condoms—PSI/Mozambique targets six key factors of behavior change, specifically: personal risk perception, condom education, an enabling environment, access to the product, self efficacy, and the brand concept. PSI's approach creates a synergistic relationship among the six factors, linked to the condom brand, in order to facilitate behavior change. Communications especially target high-risk groups such as commercial sex workers, long distance truck drivers, and people with non-regular partners.

PSI's choice of brand concepts is a particularly important factor in behavior change communications. JeitO is a strong, positive brand name that permits powerful double entendres such as "Live with JeitO" and "Get Close with JeitO," promoting the use of JeitO as a positive lifestyle rather than solely as a means of disease prevention. A jingle called "Só Com JeitO" (Only with JeitO) has received wide radio play, and became a popular dance song in its own right.

Performances of "Só a Vida Oferece Flores" (Only Life Offers Flowers) by a well-known theater group, Mutumbela Gogo, have established another positive channel for motivating behavior change. The theme of the play has been so successful on stage that it has spun off into a radio-novella disseminated in 10 local languages, a television production, and a music video and cassette featuring 10 songs by Mozambican musicians.

The drama provokes powerful audience reaction as characters tell the story of a married couple whose lives are disrupted when the man has an affair and becomes infected with HIV. PSI has trained theater groups in each of the country's ten provinces to perform the play in Portuguese and the primary local language. Since its premiere in April, 1995, performances of "Só a Vida Oferece Flores" and three shorter plays, have reached over 280,000 people in more than 2,700 performances.

A network of 80 Community Agents working in 71 priority districts throughout the country are critical to making JeitO affordable and easily available to Mozambicans, and getting the AIDS prevention messages out. Each Community Agent conducts 15 monthly interpersonal communications activities, known as Fogo Cruzado (Crossfire). These small groups focus on "self-efficacy," that is, the confidence to purchase condoms, negotiate their use with one's partner, and use them correctly. Participants practice putting condoms on wooden models and use role playing to practice condom negotiation skills. Community Agents have conducted 18,000 Fogo Cruzado activities for 404,000 participants in the past three years.

Mass media has proven a highly effective vehicle for encouraging behavior change and promoting communications among peer groups. Besides the JeitO jingle, PSI has produced nine radio spots, each targeted toward youth, women or men engaging in high risk behavior. A music video and a drama series based on the play, "Só A Vida Oferece Flores," have aired on television.

Results from a national Knowledge, Attitudes and Practices Study (KAP), conducted by PSI in 1996-97, demonstrate the meaningful impact of this communications strategy on behavior. In the pilot intervention zone, 34% of adults report using a condom with their last non-regular partner, compared with only 16% in the expansion area started two years later. In terms of knowledge, 72% of the respondents in the pilot zone know two ways to prevent sexual transmission of HIV, compared with only 45% in the baseline KAP conducted in early 1995. On a national level, nearly 80% recognize the JeitO brand and nearly 84% consider JeitO easy to find.

In late 1998, PSI launched an initiative focusing on STD treatment. Using STD promotional packets filled with a partner notification card, health brochures and JeitO condoms, the campaign promotes partner referrals, treatment, and preventive behavior. PSI/Mozambique will repeat the KAP survey in the year 2000 to measure changes in preventive behaviors and the impact of the project's activities. Other research plans include surveys to measure annual behavior change among key target groups, and more qualitative research to maintain connection with the project's customers, such as consumer intercepts and focus groups.

UNAIDS predicts that 1.8 million Mozambicans will be infected with HIV in the next five years. PSI believes that social marketing and targeted behavior change communications can significantly reduce this figure. This impact is possible because PSI started its program early in the epidemic (relative to neighboring countries), because there is a conducive environment for AIDS prevention activities (a supportive government and no restrictions on the sale and promotion of condoms), and because PSI and the NACP will sustain this effective social marketing and behavior change strategy.

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