South Africa is rebranding its condom campaign: will it work this time?

The South African National Department of Health has launched a new safe sex campaign. Over the next three years it plans to distribute 3 billion scented male condoms, 54 million female condoms and 60 million sachets of lubricant to 4000 sites countrywide. It will cost taxpayers R3.5 billion.

The logic behind the department’s plan is to promote safe sex and reduce the risk of HIV among the country’s 15 to 24-year-olds. The campaign is also designed to ensure the government meets its target of halving HIV/AIDS, STI and TB infections by 2016. South Africa has one of the highest incidence of HIV in the world.

Condoms have been shown to be an effective way to prevent the spread of HIV when they are distributed freely from clinics, universities and various locations accessible to the majority of the population. But use across all age groups in the country has declined. Condom use is highest among 15 to 24-year-olds, but even in this age cohort it has declined. Between 2002 to 2012, over 52.9% of the participants interviewed in the HSRC survey never used condoms.

The campaign targets these declines in an attempt to encourage teens to use these rebranded condoms.

But the question remains: how effective this campaign will be, considering the increase in HIV infections among young adults over the past few years?

Looking at the figures

The rates of people living with HIV have increased in the past few years, from 4.09% to 5.51%.

A recent survey, showed that there were 469 000 new infections in the country in 2012. This factors in an increase from 5 253 493 people living with HIV in 2008 to 6 422 179 people living with HIV in 2012. In 2008 the national prevalence estimate was 10.6% and in 2012, the prevalence rate was 12.2%. The statistics indicate a slow but steady increase over time.

These figures are alarming considering that 30% of global anti-retroviral treatment patients are in South Africa.

The 2012 research also suggests that South Africans are increasingly having sex with multiple partners, not making use of condoms and not taking the risk of HIV transmission seriously.

Four different surveys conducted by the HSRC between 2002 and 2012 showed an increase in multiple sexual partners from 11.5% to 18.3%. Among the reasons for the increase was allegedly a decline in people’s knowledge about HIV transmission and reduced education and communication campaigns.

Increased infection rates have been attributed to a successfully expanded anti-retroviral treatment programme because it has translated into more HIV positive people living for longer.

Challenges first time round

Condoms have been freely distributed in South Africa since 1992 and are accessible to the majority of South Africans. By 2007, over 300 million condoms were being distributed.

The campaign was not as successful as intended, because it was targeted at South Africa’s young people who viewed the standard freely issued condoms as being too clinical and “uncool”.

In addition to these negative perceptions, the campaign suffered a further blow when there was a mass recall of 20 million condoms in 2007. This followed reports alleging that a testing manager at the South African Bureau of Standards (SABS), the testing industry responsible for ensuring that all manufactured condoms conform to World Health Organisation standards, had accepted a bribe from a condom manufacturer to certify defective condoms.

A health department official responded to the reports by saying that only 7 million of the 20 million recalled condoms were compromised. The affair cast a shadow over the government’s attempts to provide safe condoms.

This legacy could compromise the effectiveness of the new condom campaign. Young people who are aware of the recall may not want to use even the rebranded free condoms, foregoing safe sex for unprotected sex in the belief that the condoms may not work anyway.

More than a condom campaign

As yet there is no evidence that the distribution of colourful condoms has any effect on student and youth usage. There is also no specific evidence of a campaign like this working elsewhere. But, if successful, it could be used as best practice for other countries with high prevalence rates.

The effectiveness of the campaign will only be seen after analysing whether or not there has been an increase in HIV infections or decreases over time.

Additional ways to address the challenge could be to increase resources channelled into education campaigns at universities and schools. The South African Department of Health would benefit from partnering with regional organisations and civil society to run a renewed education campaign. The risk of this is campaign fatigue. Students could eventually choose not to listen if they are continually bombarded with facts.

The government could also put its weight behind solid research into the behavioural patterns of 15 to 24-year-olds. The emphasis must be on what young adults would respond to, whether it be colourful condoms or shock tactics.

The condom campaign is good a way to rethink prevention for the epidemic in the country because the fight to end infection is not over yet. It indicates a determination to keep HIV infection rates down in South Africa - a positive step for the fight against HIV. Will it work? Only time will tell.

Erica Penfold receives funding from the Economic and Science Research Council. She is affiliated with the South African Institute of International Affairs.