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Years of mechanism: 2008 2009
SUMMARY
HLFPPT will support the Maharashtra State AIDS Control Society (MSACS) and the Goa State AIDS
Control Society (GSACS) in implementing the condom social marketing (CSM) program in the two states.
The program will be targeted towards Most-at-Risk Populations (MARPs), who are primarily the clients of
sex workers, and implemented around high-risk areas. The overarching strategy is to enhance the capacity
of State AIDS Control Societies and the National AIDS Control Organization (NACO) in condom
programming at the state and national levels. The key technical strategies are to: enhance access to
condoms for MARPs through focused distribution initiatives in high-risk areas, enhance demand for
condoms among MARPs and promote safe sexual behavior among clients of Female Sex Workers (FSWs)
such as truckers, migrants and selected at-risk youth , and pilot initiatives for female condoms for FSWs,
innovative marketing techniques and positive prevention. .
BACKGROUND
HLFPPT is a para-statal organization that has been working at the national level since 1992 to support the
Government of India to expand access to condoms for family planning and HIV/AIDS prevention. USG is
supporting HLFPPT to improve access to high quality condoms for MARPs and their clients. HLFPPT
works closely with local AIDS authorities, other social marketing organizations and donors to strengthen
capacity while avoiding duplication.
The State of Maharashtra continues to have a growing concentrated epidemic driven by heterosexual
transmission. The prevalence of HIV infection is high among MARPs with 50.2% among Female Sex
Workers (FSW), 43% among Transgender, 11.2% among Injecting Drug Users (IDU) and 6% among Men
who have Sex with Men (MSM) (data source: State Program Implementation Plan). Out of 35 districts in
Maharashtra State, 29 are high prevalence (2006), up from 22 districts in 2005. Hence there is a need to
strengthen the ongoing social marketing program and expand consistent use of condoms among the
MARPs and bridge populations in Maharashtra state in order to prevent new infections and halt the spread
of HIV.
There are currently six CSM organizations working in Maharashtra mainly targeting family planning
activities. Notwithstanding this, recent reports indicate that condom sales in the State of Maharashtra have
been declining since 2001. In 2001, the condom sale was 73 million pieces and it decreased to 58 million in
2004. The market stagnated until 2005; however, in 2006 condom sales registered an increase. During
this period, HLFPPT with support from USG implemented the first phase of the CSM campaign in 22 high-
prevalence districts.
Under the umbrella of the Avert project, HLFPPT has been awarded another four year cooperative
agreement to support the state in scaling-up condom social marketing. In FY08, HLFPPT will build on the
campaign of the previous years and scale up the CSM program while building state and national level
capacity. HLFPPT's limited support for Goa will be additional to the Maharashtra activities.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Generic Condom Promotion Campaign
In FY08, a generic condom promotion campaign will be implemented in the state of Maharashtra and Goa
based on the needs and gaps identified through evaluation of the earlier campaigns. HLFPPT will provide
technical support to MSACS and GSACS in the design, development and operationalization of a condom
campaign. One of the major components of the campaign will be promoting condom use in all non-regular
and non-paying sexual acts and promoting safe sexual behavior among high-risk populations.
The condom promotion campaign with ‘Bhau' (meaning Elder Brother) as its cultural icon will have a 360-
degree approach and will aim to integrate all partners into its implementation. The campaign will use an
effective mix of mass and local media in reaching out to the target audience. Local media activities will
include street plays, puppet shows, bar centered promotions and cinema theatre events located around
high-risk locations.
The campaign will adapt the network concept that has been effectively used in creating behavior change
among MARPs. All societies have certain invisible networks that play a dominant role in diffusion of new
behavior and products. A model will be developed to identify these informal networks and initiatives will be
undertaken to influence these social hubs through outreach and advocacy activities. The campaign will be
effectively linked to service delivery through linkages with condom retailers, NGOs and civil society
ACTIVITY 2: Support to Condom Retailers
The key interventions to enhance access of condoms to MARPs in Maharashtra will include scaling-up of
support activities for condom retailers, including branding of "Red Ribbon Retail Outlets (3R outlets)" based
on a commitment to stock condoms with proper labeling and to visual merchandising of condoms. A retail
sales tracking software system will be established to track the condom sales of 3R outlets and build supply
side efficiency. The project will also establish stockists to supply Government of India (GOI) social
marketing brands to the 3R outlets. By the end of FY 08, HLFPPT will establish over 7500 3R outlets and 2
million condoms will be sold through them.
A condom retail outlet mapping will be carried out in Goa state. Based on the findings of the study, a
condom retailers program will be established and over 400 condom retail outlets will be established. Over
500 condom vending machines will be set up in FY08 in Maharashtra and Goa states and strategically
placed at selected high-risk locations. HLFPPT will also leverage additional resources from the NACO
program to scale up the condom vending machine activities in these states.
ACTIVITY 3: Condom Call Center
In FY08, the condom call center set up in FY07 in collaboration with an IT company will be continued. The
condom call center will be a single point for addressing all condom-related issues ranging from stock-outs,
Activity Narrative: condom promotion materials and consumer information needs by assisting traders, retailers or consumers
facing access problems through a helpline. The Condom Call Centers utility will be broadened with the
involvement of all condom manufacturers, social marketing organizations, NGOs and family welfare/AIDS
Control agencies.
ACTIVITY 4: Thicker Condoms for MSM (Men Having Sex with Men) Population
Based on feasibility studies, HLFPPT has developed thicker condoms with additional water-based lubricant
for the MSM population. A careful analysis indicated that positioning this product as an MSM condom could
result in stigmatization of the condom and consequently low adoption. A new brand has been developed
with imagery that is not homo-erotic. NGOs and other CSM organizations through their peer-based
network, and selected 3R outlets in Maharashtra and Goa states, will market this brand. Advocacy will be
carried out with the GOI to include this brand under the subsidy scheme to enable the MSM population to
access the product at subsidized rates.
ACTIVITY 5: Female Condoms for the Sex Worker Population
In FY08, HLFPPT will support MSACS and GSACS in promoting female condoms among sex workers.
NACO will be supplying female condoms to the SACS. HLFPPT will provide technical assistance in
developing operational guidelines for implementing the female condom program. It will train over 50 NGOs
on female condom promotion including providing onsite technical support. HLFPPT in collaboration with the
Avert project will develop systems to monitor and evaluate the effectiveness of the female condom program.
ACTIVITY 6: Capacity Building of NGOs implementing Targeted Interventions
HLFPPT in collaboration with the Avert project will develop a capacity building program on condom social
marketing for NGOs, addressing MARPs in Maharashtra and Goa States. It will update existing training
modules and will contract two training institutions to train over 1000 outreach workers from 200 NGOs in
Maharashtra and Goa states. The institutions will also provide onsite technical support to NGOs on condom
social marketing.
ACTIVITY 7: Positive Prevention for HIV Positives
With increasing access to treatment through the GOI scale up of services, the need for positive prevention
has been well recognized. In FY08, HLFPPT will work in partnership with Care and Support NGOs
supported by SACS and the Avert project to integrate condom promotion with the positive prevention
program in five districts of Maharashtra and 2 districts of Goa. Through the engagement of PLHA networks,
condom use will be promoted as a social norm among HIV positive people. Condom promotion will be
actively implemented in Counseling and Testing, Anti-Retroviral Treatment and Community Care Centers.
An interpersonal and focused behavior change communication program will be developed to promote
condom use among the PLHAs. .
ACTIVITY 8: Promoting Innovative Marketing Techniques
HLFPPT will collaborate with MSACS and GSACS to partner with 2 social marketing organizations and 3
private condom manufacturers to increase accessibility to condoms in high-risk areas. HLFPPT will support
innovations in packaging, branding and visual communication for the GOI socially marketed brands.
Distribution approaches will be multi-sectoral involving petroleum companies, the National Highway
Authority of India and other marketing networks. Community-based peer workers and NGO staff will also
be involved in condom marketing through a Multi-Level Marketing (MLM) approach. To foster sustainability,
an approach will be piloted wherein other household products needed by the sex workers will also be
marketed through the MLM approach.
Control Society (GSACS) to carry out several formative assessments to support evidence-based condom
social marketing (CSM) programs. These assessments will be aimed at efficient program planning and
implementation.
supporting HLFPPT to improve access to high quality condoms for MARPs and their clients. HLFPPT works
closely with local AIDS authorities, other social marketing organizations and donors to strengthen capacity
while avoiding duplication.
Maharashtra State, 29 are high prevalence (2006), up from 22 districts in 2005. Hence, there is a need to
strengthen the ongoing social marketing program and expand consistent use of condoms among MARPs
and bridge populations in Maharashtra state in order to prevent new infections and halt the spread of HIV.
been declining since 2001. In 2001, condom sales were 73 million pieces; this decreased to 58 million in
Under the umbrella of the Avert project, HLFPPT has been awarded another four year co-operative
agreement to support the state in scaling up the efforts on condom social marketing. In FY08, HLFPPT will
build on the campaigns of previous years and scale up the condom social marketing programs while
building the capacity of the state and the national level program. HLFPPT's limited support for Goa will be
additional to the Maharashtra activities.
ACTIVITY AND EXPECTED RESULTS
There is a paucity of quality data to support evidence-based programming for CSM in both the states of
Maharashtra and Goa. It is critical to support the SACS in conducting formative assessments to expand
and strengthen the CSM programs.
ACTIVITY 1: Mapping of Condom Retail Outlets in Maharashtra and Goa States
The purpose of this activity is to gather information to enhance access to condoms for Most-at-Risk
Populations through focused distribution initiatives in high-risk areas in the state. The landscape and
locations of non-traditional condom outlets is constantly changing. Hence, a fresh mapping of non-traditional
condom outlets will be conducted to understand the latest scenario and to identify new outlets. A research
agency will be engaged to undertake the mapping with support from the program field staff and partner
NGOs and social marketing organizations.
HLFPPT will provide technical support to GSACS in developing the scope of work, selection of the agency
and monitoring the implementation of the mapping study in the state. Additionally, HLFPPT will provide
technical support in utilizing the data for program planning. The non-traditional outlets will be involved in the
condom promotion program.
ACTIVITY 2: Assessment of the Free Condoms Program in Maharashtra and Goa States
HLFPPT will provide technical support to the SACS in developing the scope of work for conducting
assessments of condom wastage and of the free condoms programs. It will assist SACS in selecting the
agency and monitoring the assessment including using the findings for program planning.
ACTIVITY 3: Retail Condom Sales Tracking
HLFPPT will operationalize a retail sales tracking software that will ensure that the non- traditional condom
outlet sales are regularly tracked. Based on the data collected on sales trends, promotional efforts will be
designed to ensure supply side efficiencies. HLFPPT will also provide technical support to MSACS and
GSACS in developing a retail condom tracking system and monitor the condom sales for the outlets
established.
ACTIVITY 4: Assessment of Condom Quality
HLLFPPT will support MSACS and GSACS in designing and implementing a condom quality assessment
study. HLFPPT will collect samples of condoms from retail outlets in high-risk areas and from NGOs
distributing condoms. They will be sent for testing to confirm their quality as per the Schedule R
specifications stipulated by Indian Drug Control Authorities. The findings will be shared with the local
authorities and corrective actions will be planned and monitored.
HLFPPT will provide technical assistance to the Maharashtra State AIDS Prevention and Control Society
(MSACS), Goa State AIDS Prevention and Control Society (GSACS) and District AIDS Prevention and
Control Unit (DAPCUs) in developing and operationalizing the Condom Social Marketing (CSM) plans. This
assistance will involve several priority areas focusing on strengthening various systems, including logistic
and inventory management of free condoms and promotion of female condoms. HLFPPT will also provide
technical support to the National AIDS Control Organization in developing national guidelines on various
components of the CSM program.
HLFPPT is a parastatal organization that has been working at the national level since 1992 to support the
strengthen the ongoing social marketing program and expand the consistent use of condoms among
There are currently six condom social marketing organizations working in Maharashtra mainly targeting
family planning activities. Notwithstanding this, recent reports indicate that condom sales in Maharashtra
have been declining since 2001. In 2001, condom sales were 73 million pieces, which decreased to 58
million in 2004. The market stagnated until 2005; in 2006, however, condom sales registered an increase.
It was during this period that HLFPPT, with support from USG, implemented the first phase of the CSM
campaign in 22 high-prevalence districts.
SACS needs to form strong, ongoing partnerships with social marketing organizations and commercial
manufacturers to increase condom sales for HIV prevention as well as family planning. The present
capacity of the SACS to scale up and manage CSM programs is not adequate. Hence, it is critical to
provide technical support to SACS in strengthening systems to plan, implement and monitor condom social
marketing programs.
ACTIVITY 1: Technical Assistance to MSACS and GSACS
In FY08, HLFPPT will provide technical assistance to the SACS and DAPCUs in developing condom social
marketing plans including operational guidelines and establishing systems to implement and monitor CSM
programs. HLFPPT will provide technical assistance in developing demand projections for the supply of
free condoms, monitoring condom wastage, logistics and inventory management and retail sales tracking.
Technical support will be provided to SACS in developing systems and processes for generic condom
promotion, expanding condom retail outlets including training retailers, partnership with social marketing
organizations, and assessing condom quality. HLFPPT will also provide ongoing technical support to the
SACS in establishing the various systems for planning, implementation and monitoring of the female
condom and of the condom program for MSM.
ACTIVITY 2: Technical Assistance at the National Level
HLFPPT will provide technical assistance in developing operational guidelines at the national level on
various components of the CSM program including the promotion of female condoms and special condoms
for the MSM population. HLFPPT will also provide ongoing technical assistance on specific activities such
as the generic condom promotion program, condom retailers' training, partnership with social marketing
organizations and condom manufacturers, condom quality testing and monitoring condom sales.
