For the first time, the female condom is being mass-marketed in the developing world, where the highest HIV rates are found. Population Services International (PSI)—the world's leading social marketing company, with projects in more than 45 countries—has launched the care female condom brand in Zimbabwe, building on its earlier trial-marketing experience in Haiti, Bolivia, South Africa, Zambia, and Guinea.

PSI's female condom brand enters the health marketplace at a time when AIDS rates continue to climb in the developing world, and the need for alternative ways to protect at-risk sex is increasingly urgent. Until now, the most effective methods for stemming the spread of AIDS have been male condom use, fidelity, and abstinence.

Zimbabwe is among those countries hardest-hit by AIDS, with about 20% of the sexually active population—and as much as 30% to 40% of pregnant urban women—infected with HIV. While male condoms are widely available in Zimbabwe, many women remain reluctant to purchase them or suggest their use. As a result, many Zimbabwean women complain they lack control over their own reproductive health and the risk of contracting sexually transmitted diseases.

The female condom—a lubricated polyurethane sheath inserted into the vagina prior to intercourse—gives the woman more control than does the male condom and, as research has shown, is acceptable to many Zimbabwean men. This in itself recommends it to Zimbabwean women, who in 1996 petitioned their government to make it available.

Called care contraceptive sheath, PSI's female condom targets young, sexually active couples. Its packaging is carefully designed to appeal to both sexes, featuring intertwined male and female symbols, gender-neutral colors, and the slogan "For women and men who care." Because emphasizing STD prevention has negative connotations to Zimbabweans, the brand name instead accentuates family planning, which is viewed as laudable and wholesome (roughly 50% of sexually active women use some form of contraception). This enables women concerned about STDs not only to purchase the product without embarrassment, but to convince their partners to accept its use. And in fact, research in Zimbabwe and elsewhere has shown that women who are successful in persuading their partners to accept the female condom often use contraception as a negotiating point.

PSI had been invited into Zimbabwe in late 1996 to manage a five-year male condom social marketing project. Carried out in conjunction with the Zimbabwean government's national AIDS control program and family planning council, the project is funded by the United States Agency for International Development (USAID) and the British Department for International Development (DfID). The launch of care in July 1997 is part of this larger program.

Care retails for approximately $0.24 (US) for a box of two sheaths, which comes with a detailed instruction leaflet. Because it can be somewhat tricky to insert at first, the product was initially sold only in locations having a trained provider—primarily clinics and pharmacies. Now that consumers are more familiar with care, it is being sold in supermarkets and convenience shops as well. The product is available in urban areas throughout the country.

While efforts to market the female condom in developed countries have yielded modest results, sales of PSI's care thus far have surpassed expectations. Nearly 106,000 sheaths were sold in the first four months—more than three times what had been forecast. Early observations from pharmacies suggest that just as many men as women are purchasing care. Unlike many other condom campaigns, PSI's care project has received no opposition from conservative elements. The product has been featured in dozens of newspaper articles, and brand recognition is already high.

PSI paved the way for the launch of care with an extensive media campaign. The product is advertised in newspapers and magazines as well as on radio-the radio ads featuring endorsements by well-known health authorities. Posters and brochures aimed specifically at couples are provided to all care outlets. Weekly 15-minute call-in radio shows, featuring prominent guest hosts such as the country's minister of health, are broadcast in English, Shona, and Ndebele.

These early results in Zimbabwe are preliminary. More time is needed to determine the sustained demand for care. To aid this process, research on product use will be conducted in early 1998. While care's impact on AIDS prevention is not yet known, its reputation has already crossed Zimbabwe's borders. PSI and its affiliates are about to launch or re-launch branded female condoms in Zambia, Tanzania, Brazil, South Africa, and Venezuela on a similar scale as in Zimbabwe.

• Profiles