There is a global crisis in the availability of all reproductive health materials, particularly condoms and other contraceptives. Distribution is spotty, supplies are erratic, prices are unpredictable, and the quality may be unreliable. Broader questions of access, user perspective and culture also arise in any programme to make condoms widely available.

Condom programming is a management system developed to respond to this crisis systematically at global and national levels. Condoms are an essential reproductive health commodity, and the UN Population Fund supports programmes that not only supply them but also build a country's capacity to meet its own reproductive health needs. Condoms are an effective method of preventing HIV/AIDS infection for both men and women. They also prevent sexually transmitted infections (STIs), reducing the risk of AIDS linked to STIs.

Male and female condoms can be made available in non-traditional outlets such as small shops, bars, vending machines, workplace restrooms, etc., at highly affordable prices. Condom programming also includes advocacy for development of microbicides and other woman-controlled methods of contraception.

The problem:

• An estimated 6 billion condoms are distributed every year,¹ far short of current need, and the need is growing rapidly.

• Earth's population of 6.1 billion includes the largest generation ever of 15- 25- year-olds--1 billion young people just entering reproductive life.

• Demand for condoms and family planning is growing worldwide with the spread of health care and rising awareness of the HIV/AIDS pandemic.

• The current condom supply in sub- Saharan Africa, where AIDS is worst, now equals three for every man per year.

• Having a STI increases the risk of HIV infection tenfold.1 Every year, 333 million new STIs are reported-about one million per day or 650 per minute. Most occur among young people age 15- 24.

• Only four percent of married women in developing countries report that their partners use condoms, making condoms and vasectomies the least-used contraceptive methods worldwide.

Challenges to increasing condom use:

• Condoms may be seen as clumsy, reducing pleasure, breaking easily or appropriate only for illicit sex outside marriage.

• The perception that women or girls who ask their partners to use condoms are either unfaithful, or are planning to be, silences women, who fear reprisal or scandal.

• Men may assign women responsibility for contraception but still refuse to use condoms.

• Government agencies and decisionmakers may not see the long-term benefits of acting to finance and create the infrastructure required for adequate distribution.

• The cost of quality contraceptives and condoms needed is projected to rise in the next 15 years from US $810 million per year to US $1.8 billion.

The solution:

In 2000, the UN Population Fund and its partners developed the Global Strategy for Reproductive Health Commodity Security, integrating it into all UNFPA country programmes. To ensure a worldwide supply of commodities that is adequate, dependable and diverse-the right thing, at the right time, in the right place, at the right price (see box).

The partnership brings together major donors, technical experts, NGOs and the private sector to develop models for making affordable commercial products and services more accessible.

Social marketing uses advertising, subsidies and creative promotion to create demand for contraceptives and keep prices low, especially for condoms, especially among men, and to take stigma out of their use. The campaigns also seek to demystify sexuality and make it possible to discuss HIV/AIDS, while promoting abstinence, monogamy and safer sex.

Careful promotional and educational campaigns can make condoms acceptable in traditional cultures. Men in particular need education and encouragement to become personally involved and motivated in the effort to stop AIDS.