In the Benaco refugee camp of northwestern Tanzania, relief efforts—which traditionally focus on food and shelter—now include the first large-scale AIDS intervention ever undertaken in a refugee population. A principal component of this new effort is an innovative condom distribution and communications campaign undertaken by PSI.

This novel program demonstrates that refugees living in a temporary camp need AIDS prevention and other health products just as they did in their home towns and cities. It has also shown that refugees will use the products if convincing motivational activities are combined with availability. While the Benaco camp was born of a bloody civil war, it has provided a concentrated opportunity to teach the refugee population about prudent health behavior.

In the fall of 1994, PSI and CARE, in collaboration with the UNHCR-supported AMREF and IRC, launched an AIDS prevention program funded by the AIDS Control and Prevention (AIDSCAP) Project, that targeted Rwandan refugees but used techniques developed in non-refugee populations. The result, according to PSI President Richard Frank: "Although we traditionally work through the commercial sector, many social marketing techniques can be successfully applied in a confined refugee environment."

Distribution is key to PSI's social marketing efforts. AIDS awareness in the Benaco camp was high, perhaps because the refugees had come from Rwanda where PSI had been undertaking an AIDS prevention program. Condom use in the camp, however, was low; condoms were available only through a limited number of medical outposts. PSI concentrated its efforts on demand creation and the establishment of a large number and variety of distribution outlets. In the process, it has employed creative communication strategies to bring about desired changes in behavior, and made condoms widely available.

PSI assembled a team of condom promoters who, together with the staff of other agencies, educate and motivate the refugee population to protect themselves and their families from HIV/AIDS. These agents are not only promotors, but also serve as distributors as they circulate throughout the camp placing condoms in the clinics and hospitals, with community health workers, and with other AIDS educators.

Beyond these traditional outlets, the PSI team has established distribution points in such places as bars, kiosks, and open-air markets. The availability of condoms in these non-traditional outlets makes them more accessible to the refugee population and helps remove the stigma of condoms being associated with people who have AIDS. Condom distribution in the fourth quarter of 1994 totaled 435,400, which, in a population of about 420,000, translates into an annualized 4.15 condoms per person per year.

One of the goals of the Benaco AIDS prevention effort has been targeting the young adult population. PSI sponsored a dance, "Le Boom Special," which enlisted the support of local leaders and attracted a large number of sexually active youth. Over 6,000 condoms were distributed at this event, which included condom blowing contests to demonstrate their durability, a performance by a local dance troupe, and dissemination of AIDS educational materials.

World AIDS Day on December 1, 1994, provided an opportunity to launch a week of activities designed to encourage people to talk about HIV/AIDS in an open way, and to associate AIDS prevention with life affirming events—such as dances, sports and education-rather than with death.

A large parade inaugurated the week's activities, reaching 15,000 people with AIDS prevention messages, contests, and AIDS songs composed by Scouts. In order to integrate AIDS prevention activities with the surrounding Tanzanian communities, PSI sponsored a soccer match between Benaco and teams from Ngara district. Schoolgirls performed an AIDS prevention song and dance and in the evening a dance was held in a small town that borders the Benaco camp.

PSI also sponsored a large public conference at which motivational speeches were interspersed with songs on AIDS prevention and condom usage performed by the Scouts, a traditional male dance troupe, and a female choir. According to one participant: "At the end, a 60 year-old woman spontaneously rose from the crowd, grabbed the megaphone, and spent five minutes urging the youth in the crowd to protect themselves and their families because she was now caring for two AIDS orphans."

In other events, a group of young students wrote and performed a play about AIDS in the village. Sporting events included a running race and handball match, drawing thousands of spectators. PSI, with the support of the Public Welfare Foundation, will soon add a mobile video van to expand its communications activities.

PSI, its partners, and USAID funders have learned that a refugee population is no different than any other in its receptiveness to educational programs that have a participatory and entertainment component to them. And, as with other social marketing programs, it has become evident that the more condoms are made accessible, the more people will avail themselves of this life-saving product. As Greg Widmyer, PSI's team leader notes, "AIDS prevention programs need continuity to be most effective. Despite the disruption of civil war, the educational and social marketing process begun in Rwanda can be and was carried over successfully to a refugee camp environment."

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