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104 condoms per man, per year? Why do suddenly feel very inadequate.

It's a tricky problem, because none of the usual policy responses to the underlying market failure (namely that the price of condoms doesn't reflect the positive externalities associated with condom use - though "externality" isn't really the right word since the condom user is one of the beneficiaries, even if he doesn't believe that he is).

Income transfers won't work - people aren't likely to spend the extra income on condoms. You could subsidize all condoms, but as you noted that'll be expensive and inefficient since you end up subsidizing existing users. A voucher/coupon system (exchangeable for free/discounted condoms) would address that concern (since you can target who receives the voucher), and partly addresses the stigma issues (your pharmacist might know you're a no account lose, but your girl won't). On the other hand, in the voucher/subsidy arrangement, you have to retailers for distributing the condoms, which might increase costs (although who knows what the distribution of "free" condoms costs). And as a practical matter, handing free condoms cuts out a step/transaction in getting comdoms to people who need them (a bird in the hand is worth two in... well... you get it).

But I wonder if at least part of the problem is that people who run government programs tend to have different world-views/skillsets that people working in the private sector. Take the name of the "GI" brand condoms "choice" does that strike anyone as an odd name for a condom compared to say "Trojan", "Magnum", "Dr. Long's" or "Lovers Plus"? You'd think a marketing genius could have come up with a South African themed name that might actually appeal to its target market, maybe "Bull Elephant" or "Rhino" (Tagline: "For use when you're horny"), bothbof which play to nationalism and male ego.

Instead, I suspect "Choice" was dreamed up by a committee of public health experts and social workers whose members are well removed from the poor young men they're trying to appeal to. Moreover, this hypothetical's committee's mandate was probably to improve sexual health in South Africa, not to sell condoms, which makes a difference. Consider the tagline for Choice brand condoms "no choice, no play". That's clearly targeted at the very issue of sexual assault in South Africa (which my hypothetical committee would be worried about), but it isn't going to sell Choice condoms to their target market. I suspect my "Rhino" brand tagline would get a better reception.

Bob - "for use when you're horny" - groan!

I think you're right about the marketing, though not about elephants - doesn't work for reasons that would take too long to explain.

One thing that's an issue seems to be the colour - many condoms match European skin tones, not African ones (much like bandaids, or those pale pink crayons that were called 'flesh" when I was a kid). Rainbow bright colours seem to appeal more, be seen as sexier, here. [update: the government's Choice condoms come in multiple colours, see here].

There are ways of introducing choice (so to speak), even when condoms are given away free. E.g. it would be possible to have three or five different types in circulation, get people to try all of them, text in to vote for which one they prefer, and give out random prizes to people who participate.

This is a very cool ad that markets condoms for an African market: http://www.youtube.com/watch?v=5dgyKiCe3xQ

An additional problem is likely that the condoms are distributed without regards to human capital. The really dysfunctional beliefs cited in one of your links (condoms transmit HIV, religious beliefs, etc) are probably concentrated among the less educated, poorer part of society. So many of them aren't going to get the message anyway, or don't want to hear it. You can compare this to gov campaigns like nutritional guides that have zero impact on the poor, whose nutritional profiles and propensity for overweight are the worst. If you pride yourself on consuming information and preening your lifestyle to obtain maximum health (and want to believe in government benevolence), the Canada Food Guide is a dream. If your health habits are guided primarily by habit and convenience, it won't interest you. The problem is that the Canada Food Guide is almost a true public good, whereas free condoms are still a private one.

Is it possible that marketing low status condoms is still achieving the goal of increasing condom use? If you create an environment where there's pressure to have higher quality condoms available if you want to get laid, then there's the expectation that condoms will be worn, which may be plenty adequate.

If the free ones are actually defective, as opposed to simply undesireable, then that's a separate issue, but providing free condoms that perform their minimum disease-protection function with no added value might be a perfectly adequate role for the government.

Here Student's Services provide brand names condoms by the crates (the real menace for middle-class college students is chlamydia, not AIDS but it is a good scare issue). The condoms come in a small plastic bag with a packet of gum...). Is it to avoid low-status material lefy unused or because only good-quality ones are available in Canada? Anyway, providing condoms to anyway is very cheap compared to even a few thousands cases of STDs, the way we don't meter drinking water or most roads, as the administrative costs are too high compared to the cost of the service.

As a voluntary good, marketing is a crucial component and Bob Smith is on to something. A better strategy might be to subsidize the three lowest-cost manufacturers of condoms and distribute them for a nominal fee (a penny a pop, or whatever). People still spent money so they feel they bought it and you get the crucial benefit of a marketing campaign.

I am a person who is too relentlessly logical sometimes, much like those government bureaucrats. Emotion matters.

What is happening to all of those condoms if they are spurned by those who might use them?? While I accept that there is a status question, the relevant margin is free condom vs. no condom. That is where the government should focus.

Shangwen - ignorance is one thing that makes marketing so difficult for governments. So much of marketing is about reinforcing people's beliefs or playing on them (selling snake oil like performance enhancing condoms) - but when people's beliefs are just plain wrong, how does one play to them without lying or...?

blink "what is happening to all of those condoms" On the first day of class, the condom dispenser in the women's washroom at Wits University was empty (though it had been full the day before) - some people are getting the message and using them. Students seem to be a a big part of the market - see, e.g. here At the risk of traumatizing any of my students who might be reading this, may I observe that 104 per year isn't a lot for a healthy young person in a relationship?

The government issue Choice brand is marketed - before Choice, there was another condom that came in AIDS packaging with HIV warnings - now that one really didn't go over well. It's just that it's not marketed as well as it might be.

Determinant: "People still spent money so they feel they bought it " The poverty here has to be seen to be believed, and it's not like people have ready access to shops or transport.

Jacques Rene - interesting observation.

"At the risk of traumatizing any of my students who might be reading this, may I observe that 104 per year isn't a lot for a healthy young person in a relationship?"

Damn! Shoulda gone to Carleton.

"before Choice, there was another condom that came in AIDS packaging with HIV warnings - now that one really didn't go over well"

Which would be consistent with the hypothesis that the people marketing GI-brand condoms are public health experts, not marketing gurus. (As an aside, here's a name for government issued condoms - GI-Johnny. Think Hasbro would be upset?)

Frances, I question your assumption "Yet making condoms that people won't use is a waste of money."

As pointed out by Blink, the question is "condom vs. no-condom". As suggested by Neil, if the unacceptable condom leads to "if you want to get laid, then there's the expectation that condoms will be worn" then the government goal is achieved - even if it is at the cost of wasted plastic bags. (I presume that not-getting-laid and using-a-condom are equally desirable to the government in preventing STDs.)

Along similar lines, I heard that one foreign jurisdiction (not in Canada) had successfully installed the same Electronic Medical Record (EMR) within its jurisdiction - but the usage was poor. Clinicians were then given the freedom to choose any EMR they wanted which has lead to a mishmash of health records that are incompatible across clinics & hospitals as nearly all abandoned the existing EMR. Some analysts think the existing EMR was rejected because it was provided by the government and (just like the condoms) had to be rejected on those grounds alone. The question now is does high usage of a localized EMR trump low usage of a universal EMR?

It is unfair to assess government intervention by solely measuring the direct consumption; you need to look at what caused the government to intervene in the first place and tease out what effect government intervention had on that.

What about the theory at AIDS in Africa is caused by their poor medical infrastructure?

Wonks - is it caused by poor medical infrastructure? The overcoming bias article argues "Much of the transmission may be due to sloppy medical procedures, in particular the reuse of needles for injections."

From what I've read I understand that some people believe reuse of needles for vaccinations helped to get AIDS started in the first place. So reuse of needles does play a role - some people bring needles with them when travelling to Africa to be sure of getting 100% new and sterile ones. But is it "much" as in the majority of transmission? I'd be surprised. I just wouldn't figure people get enough medical care, and especially in South Africa the standard of care isn't that bad.

"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."



I thought you might enjoy this article, Frances.

Rachel - love it! That's classic.

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