Condom Social Marketing in the Dominican Republic
Overall HIV/AIDS prevalence in the Dominican Republic (DR) has been estimated at around 1.1 percent; however, one of every 25 commercial sex workers (CSWs) is infected with HIV. In 2003, USAID provided a small amount of funding to Population Services International (PSI) to begin a condom social marketing program targeting CSWs in the DR. I was transferred to the DR to create the program and serve as Country Representative, moving from PSI's program in Haiti, where I worked as Regional Technical Advisor. With a shoestring budget, I began meeting with organizations already working with sex workers and other local NGOs to understand how we could create a collaborative project with national reach.
What emerged was a program driven by CSWs. They received intensive training from PSI and sold the subsidized condoms to peers, sex establishments of all types, pay-by-the-hour motels and colmados (corner stores) in areas with high rates of sex work, earning a small but decent margin on each box sold. They designed the condom slogan, "Por Amor a la Vida, Usa Condon" (For the love of life, use a condom), took to the streets en masse every carnival and World AIDS Day to raise awareness, and implemented educational programs in brothels. CSWs were employed by PSI/DR to pack condoms through a revolving work program that gave hundreds of women an opportunity to take a break from sex work, earn regular income, and in many cases save up enough money to invest in their own businesses and leave sex work altogether.
This direct integration of the target population at every step of the project design helped solidify their identification with the product and increase use. A national survey revealed that 87.7 percent of all CSWs reported using Pante, the project condom, in their last sex act with a new client (TRaC Survey with Commercial Sex Workers in the Dominican Republic, Horwath Consulting, 2006). Within the first year sales reached 12 million units, and have steadily continued climbing ever since. According to a mapping evaluation conducted in 2006, 72 percent of all sex workers in DR could access the project condom within 100 meters of where they work. Not only did this collaborative model help PSI to quickly surpass project indicators, but, more importantly, it helped to empower the sex workers by recognizing them as valued project partners (rather than simply "end beneficiaries") and by providing them with welcome and viable alternatives to sex work. To me, this is true development: providing opportunities for empowerment to marginalized people in ways that are respectful, sustainable and based on their needs and their reality.
Elizabeth Beachy recently returned to the U.S. after four years as PSI's Country Representative in the Dominican Republic, and she now works as a consultant for various international health organizations.
