In South Africa the signs of AIDS are subtle, but ever present. Dispensers with free condoms in every university washroom. A red AIDS ribbon painted on the wall of the Knysna hospital. Another on the entrance to the Muizenberg cemetery, where wooden crosses and flowers in plastic bottles mark the resting places of those who die young, and are much missed.
Condoms are simple, cheap and effective weapons against AIDS. The South African government has developed its own brand, Choice, which is given away for free. In Cape Town, for example, the government aims to distribute an average of 104 condoms per year for every man over 15. The problem is, people don't like them. The government-issue condoms are seen as low status. People complain that they are too small, or that they aren't reliable.
As a public finance economist, the question that puzzles me is this: does the dissatisfaction with the South African governmental condom reflect some unique failing on that government's part? Or does the intrinsic nature of government mean that no government-issue condom will ever be seen as truly satisfactory?
A "benevolent government" - one that acts solely to maximize the well-being of the people - faces the following maximization problem:
maximize social welfare, which is a function of condom effectiveness, condom wearability, other government financed goods and services, and tax cuts, subject to the constraint that total government spending on all goods, services, and tax cuts does not exceed revenue available.
Creating a more wearable condom - one that is ultra-thin, ribbed, or comes with special pleasure-enhancing lubricants - costs money. A benevolent government might conclude, after careful analysis, that there are better uses for government funds than enhancing condom wearability, such as financing clean water, solar panels or decent accommodation for people living in the townships. The calculation is the same as that of the landlord or hotel owner who installs high efficiency lightbulbs and low flow shower heads - yes, the user experience may be slightly compromised, but the cost savings are worth it.
Yet making condoms that people won't use is a waste of money, and a better condom could save tens or hundreds of thousands of lives, as well as huge amounts of human suffering. So perhaps there is another explanation? I can only speculate, but here are some possibilities that cross my mind.
First, if the government-issue condoms were too good, people who could afford to buy their own condoms would use free, government-issue ones instead. This would make it more difficult to direct government condoms to the poorest South Africans, cause government condom shortages (or increase the total cost of the program), and alienate businesses - like Dr Long's - who sell and produce condoms.
Second, governments face another constraint: they can't squander their credibility. Dr Long can purvey climax control condoms, with all sorts of claims about enhanced staying power, and no one is likely to subject them to serious scientific scrutiny. If the South African government attempted to make and market performance enhancing condoms, someone would be bound to test them to see if they actually work, and discover that they don't.
Yet, because government-issue condoms are free, and because of the way they're marketed, using them sends a signal: I don't have enough money (or I don't care for you enough) to buy the very best, most pleasure-enhancing prophylactic. As one young South African put it in an interview:
You feel shy, you know, if you’re going to have to take out a free condom. At least, when you’re taking out, let’s say Lovers Plus, you’re proud. The chick must see it and everything, you know. When you roll it on, whatever, you don’t mind. You don’t mind her seeing that.
[Though my favourite line about the government-issue Choice condoms in that interview was this comment on the packaging and marketing: "However, at 28 years, my first impression when a promoter offered me a pack of ‘Choice’ at a taxi-rank was to immediately mistake it for a packet of biscuits and I politely declined."]
Another issue is that governments must not only be fiscally responsible, they must be seen to be responsible. That's my theory as to why government buildings in Ottawa and Gatineau are so uniformly bland - stunning architecture or stone facing or anything other than glass and concrete would be seen as wasteful extravagance. Ribbed condoms are not perceived as fiscally prudent.
A final possibility is that the government is simply incompetent or, worse, corrupt. There have been media allegations that a manager at the South African Bureau of Standards accepted money from the manufacturer in exchange for certifying defective condoms. However, as this study points out, "it is difficult to disentangle corruption from mismanagement and system failure."
Can government-issue condoms ever be sufficiently sensitive? I don't know. But at least the South African has made massive progress from the days when former president Thabo Mbeki denied that AIDS was a sexually transmitted disease. Things aren't perfect, but they're better.