Swaziland: A Total Market Approach for Male Condoms

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Abstract

Swaziland has the highest HIV prevalence of any country in the world, with more than one-quarter of the adult population infected. Although large-scale HIV prevention efforts have resulted in a decline in incidence since 1998, risky sexual behavior and insufficient condom use continue to drive the epidemic. Male condoms are a key component of Swaziland’s HIV prevention strategy, and because condoms offer dual protection against both HIV and unplanned pregnancy, they also play an important role in meeting the need for family planning.

In Swaziland, the number of condoms needed to protect all sexual acts from HIV infection and unplanned pregnancy (universe of need) is much higher than the actual number of condoms on the market (volume). Public health efforts encouraging condom use for HIV prevention and family planning have, however, resulted in some very positive trends, and demand for condoms has increased over the years. In 2012, approximately two-thirds of men and women reported using a condom the last time they had sex, compared to fewer than half in 2006. Rates of condom use have also increased among unmarried youth. In addition, condom use is no longer concentrated among just the wealthy: nearly 40% of condom users fell into the bottom two wealth quintiles in 2012, compared to less than 25% in 2006.