Does condom social marketing improve health outcomes and increase usage and equitable access?

Condom social marketing (CSM) has increased condom supplies, broadened commercial markets for condoms and introduced marketing innovations in developing countries. Yet rigorous and reliable evidence of the impact on condom usage and disease prevention is limited, as is evidence of the impact on equity of access to condoms for poor populations, women and people living with HIV. One strand of research on CSM reports mostly on output (e.g. sales and processes) and market growth; but these have been found to be highly unreliable measures of condom usage. Another strand of research reports primarily on changes in sexual behaviour, attitude or condom usage, using survey data. While random sampling is rare, these studies often use representative samples, which provide some measure of validity. There have been attempts to improve the reliability or results to good effect, but challenges remain for researchers, scholars and donors, including the need to supplement output data with measures of behaviour change, use rigorous designs which are built into programmes a priori, report on equity measures, report on potential harms of CSM programmes, and encourage external and systematic reviews.