In Brazil, condoms become popular by emphasizing fun, not responsibility

DKT promoted its Prudence brand of condoms in the São Paulo Carnival of 2019, as they do every year.

This was originally published by Knowedge4Health Blog on March 11, 2019.

SÃO PAULO, Brazil — In 1991, a non-profit social marketing organization set out to make condoms accessible and affordable in Brazil at a time when condoms were hard to find and expensive and the number of Brazilians infected with HIV was climbing. In the process, DKT Brazil made its brand Prudence the number one condom in the very competitive Brazilian market, and also helped enhance contraceptive security. 

The result is that condoms have become normalized in Brazil – more used and less stigmatized – and that has helped limit the spread of HIV.

In 1990, the World Bank estimated that Brazil would have 1.2 million people living with HIV by 2000. However, that never happened: By 2000, there were fewer than 500,000 infections. After peaking in 1996, according to UNAIDS, AIDS-related deaths have remained fairly stable. Brazil is now considered an HIV success story. Condoms – distributed both by the public and private sectors – played an important role in that success.

Prudencehas become the most popular condom in Brazil by taking a very different approach to the positioning and marketing. While most commercial condom distributors marketed their products for responsibility and protection, DKT eroticized its condom messaging, celebrated sexuality and used humorous vernacular, with no medical jargon. Its advertising was daring and provocative: The PrudenceYouTube page demonstrates that.

Brazil anti-tobacco forces score yet another victory but work is not yet done

ACT and their anti-tobacco coalition after an advocacy activity at the National Congress in Brasilia. Photo: ACT Promoção da Saúde

This was originally published on Global Health TV on May 30, 2018.

RIO DE JANEIRO, Brazil — This country has one of the best tobacco control programs in the world, resulting in a series of laws to protect non-smokers that the Brazilian government been put into place over 20 years. During this time, cigarette smoking has fallen by more than half.

And yet smoking is still a huge problem. Almost 15 percent of adult Brazilians still smoke, according to the Ministry of Health, causing 156,000 deaths per year. Every day, second-hand smoke kills seven Brazilians.

Though smoking has fallen dramatically among both men and women, there are still 21.5 million smokers in Brazil, which puts it in the top 10 countries in terms of number of smokers. And for every success achieved by the tobacco control movement – and there have been many – the cigarette industry fights back with all of the considerable resources at its disposal.

For global health, 2017 was a year of progress, near triumphs and threats

A trained community health workers in Bangalore, India takes photos of an oral lesion with a mobile phone during an oral cancer screening. Cancer is growing everywhere in the world. Photo: Biocon Foundation, Courtesy of Photoshare.

This was originally published on Global Health TV on Jan. 2, 2018.

In looking back over my last 12 blog posts here at Global Health TV, it is clear that 2017 was a year of progress, near triumphs and threats to global health.

In September, I reported that great progress has been made against diseases and health conditions that kill us (like respiratory infections, diarrhea, neonatal preterm deaths and communicable diseases like AIDS and malaria) while new threats had emerged  that are generally less fatal — things like obesity and mental illness.

In particular, we have made progress against communicable diseases but now face a rising tide of non-communicable diseases (NCDs) like cancer, diabetes, hypertension and cardiovascular diseases, as I wrote at the beginning of 2017.  Cancer is growing almost everywhere in the world. For example, cervical cancer causes over 500,000 new cases every year, even though vaccination, early screening and treatment of precancerous lesions can prevent most cases.

Suelen and her family: A Brazil child health success story

Ricardo, Ana Luiza, Suelen and Luis Ricardo in their newly renovated home in Nova Iguaçu, Brazil. Ana Luiza has a successful food truck and is going to law school but still doesn't feel middle class. Photo: David J. Olson

This was originally published on Global Health TV on October 31, 2017.

NOVA IGUAÇU, Rio de Janeiro State, Brazil — In 2012, Suelen hit rock bottom. She was living in extreme poverty with her husband and young son in a dilapidated house with a roof that was leaking water. While she was pregnant with her second child, her husband left her. When that child, Ana Luiza, was born, she was sick with pneumonia and asthma.

Suelen was at her wit’s end. Every day was a struggle. She made a living selling empanadas out of a canvas tent here in this city of 800,000 about 40 minutes from downtown Rio de Janeiro. “I was working all the time every day just to pay for food for the next day,” said Suelen. “I didn’t think about the future, just how I was going to eat tomorrow.”

Today, the situation of the family is the reverse of what it was five years ago. The health and wealth of the family is thriving. They have a highly successful food truck (that is expanding to home delivery). The children are going to good schools. And Suelen is going to law school so she can defend the rights of other black women who are being oppressed.

Controversy brewing over the greatest barriers to access to medicine

A worker selects medicine from the MEDS (Mission for Essential Drugs and Supplies) warehouse in Nairobi. MEDS is jointly owned by the Kenya Conference of Catholic Bishops and the Christian Health Association of Kenya. Photo: Bedad Mwengi

This was originally published on Global Health TV on July 16, 2016.

In comments last week at the International AIDS Conference in Durban, South Africa, UN Secretary General Ban Ki-moon said four things deserved credit for getting the AIDS pandemic under control — people living with HIV, biomedical companies, generic medicines and international finance.

But despite his gratitude to biomedical companies and generic medicines, the secretary-general is overseeing a process that threatens to undermine those companies' ability to improve access to medicine in developing countries.

The World Health Organization says an estimated 2 billion people (27% of the world’s population of 7.5 billion) lack access to essential medicine, most of them in Africa and Asia, but a full three-quarters of the world’s population (around 5.5 billion) have no access to proper pain relief treatment.

To address this staggering problem, the Secretary-General set up a High-Level Panel on Access to Medicines earlier this year. The purpose of the panel was “to review and assess proposals and recommended solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.”

Sounds like a great and noble idea, right? But some expert commentators say the panel is on track to do more harm than good because of its terms of reference.

Brazil struggles to contain damage of mosquito that transmits Zika virus

Dr. Sylvia Lordello of Saúde Criança speaks to a group of parents about Zika.

This was originally published by Global Health TV on March 31, 2016.

RIO DE JANEIRO, Brazil — A group of about 20 poor parents (mostly women) from the slums gathered this month in the offices of Saúde Criança (“child health” in Portuguese), a social enterprise that works with impoverished children and their families in a holistic way. After a meditation, they got down to the main point of the meeting — the Zika virus and how to avoid it.

These poor young mothers are prime candidates for Zika. Aedes aegypti, the mosquito that transmits Zika, will suck anyone’s blood — rich or poor. But they thrive in the densely populated favelas of Rio and other Brazilian cities where few people have screened windows and where even mosquito repellant may be a luxury. Many people have water cisterns on their roofs, usually not covered, which makes an ideal breeding ground for Aedes aegypti.

Dr. Sylvia Lordello, a medical doctor on staff at Saúde Criança, told the parents that prevention starts at home and reviewed a series of steps that could be taken to make their homes less hospitable to mosquitoes, such as covering their cisterns and not leaving water in the plates under house plants.

“If the whole country fights Zika, the mosquito cannot win,” Dr. Lordello told the parents. “Zika is not stronger than the country.”

Stymied by Less Smoking in Richer Countries, Big Tobacco Shifts Focus on Developing Countries

Anti-tobacco demonstrators in Brazil demand implementation of the national Tobacco Control Law. Credit: Aliança de Controle do Tabagismo

This was originally published by Global Health TV on March 2, 2015.

Between 1990 and 2009, cigarette consumption decreased by 26% in Western Europe, but in Africa and the Middle East, it increased 57%, according to the American Cancer Society (ACS). In response, many of these developing countries are stepping up their efforts to fight tobacco with new laws and restrictions. Big Tobacco is using its deep pockets to finance creative attempts to circumvent those laws.

The problem is so daunting that ACS named rising use of tobacco in developing countries as one of it “Three Top Cancer Challenges of the 21^st Century” earlier this month when it observed World Cancer Day. Comedian John Oliver covered the issue very well in this segment from his HBO show “Last Week Tonight.”

An estimated 8 million of the 14.1 million new cancer cases diagnosed in 2012 occurred in developing countries with 82% of the world’s population, according to Global Cancer Facts & Figures, 3^rd Edition. Smoking causes at least 12 types of cancer, according to the U.S. Surgeon General, and accounts for a fifth of all global cancer deaths. Tobacco use is the cause of nearly 6 million premature deaths annually, notes the report.

In Brazil, a charity makes successful transition to social enterprise

A DKT Brazil promoter hands out samples of Prudence condoms in downtown São Paulo, Brazil on World AIDS Day. Photo: David J. Olson

This blog was originally published on Devex Impact on Nov. 28, 2014.

SÃO PAULO, Brazil — In its 24 years of existence, DKT Brazil has transformed itself from a charity entirely dependent on international donors to a social enterprise dependent only on its own business and marketing savvy.

Brazil has become one of the centers of the social enterprise world. In 2012, the Social Enterprise World Forum was held there. I’m reading more articles, like this one in the Guardian, which claims that social enterprise is becoming the norm, “a really valid option proposed for anyone wanting to start or grow a business in Brazil.”

When DKT Brazil was launched in 1990 as a condom social marketing organization, it considered itself a charity and received most of its funding from the U.S. Agency for International Development and other donors. But when it lost its USAID funding in 2003, it was forced to become financially sustainable.

It achieved 100% financial sustainability, and more. All of its Prudence condom products make money, yet many of them are within the contraceptive affordability index, which dictates that the cost of a year of contraception should not be more than 0.25% of a family’s disposable income. In fact, DKT’s cheapest condom is only 0.22%; even its most expensive brand does not reach 0.5%. DKT believes it prevented over 9,000 HIV infections in Brazil in 2013.

DKT Brazil believes it has lessons to offer other social enterprises in Brazil and elsewhere. DKT Brazil Country Manager Dan Marun offers three:

Condom flavors like strawberry and caipirinha key to social marketing success in Brazil

A print ad for DKT's new caipirinha condom brand.

This was originally published on the Huffington Post on June 10, 2014.

SÃO PAULO, Brazil — “DKT do Brasil,” the social marketing juggernaut of South America, started in 1991 with one variant of Prudence condoms (now called Prudence Clássico). Over 23 years, DKT has grown that product line into 40 variants, with its latest offering featuring the flavor and scent of caipirinha, the iconic Brazilian cocktail made from cachaça, lime and sugar.

Over that same time period, its condom sales increased from 30,840 in 1992 to 124 million in 2013. This is considerably more than the combined total sales of every other condom social marketing project in all Latin America — South America, Central America and the Caribbean — according to DKT contraceptive social marketing statistics.

And yet DKT do Brasil does not consider itself a commercial enterprise, but a social enterprise. All of its products make money, and yet all are within the contraceptive affordability index, which dictates that the cost of contraception should be less than 1% of a family’s annual income. In fact, its cheapest condom, Prudence Clássico, is only 0.22% and even its most expensive brand is less than 0.5%.

How has DKT do Brasil been able to become the largest social marketing operation in Latin America, and one of the largest condom distributors in Brazil, while remaining true to it mission of “improving lives by encouraging family planning, sexually-transmitted disease prevention, pleasure and well-being; offering products that are accessible, diverse, innovative and high quality in Brazil and South America”?

Social enterprise for health, Brazilian style

With the leaders of Saúde Criança at their headquarters in Rio de Janeiro.

This was originally published on Global Health TV on April 27, 2014.

RIO DE JANEIRO, Brazil — One is poised to become the condom market leader in Brazil, with 40 variants in its Prudence condom line. Its newest offering features the flavor and scent of caipirinha, the iconic Brazilian cocktail made from cachaça, lime and sugar. DKT believes it prevented over 9,000 HIV infections in 2013.

Another rescues the poorest and unhealthiest children from the urban slums of Rio de Janeiro, Sâo Paulo and other cities, and nurses them – and their families – back to health.  Since its creation, an estimated 50,000 people have benefitted from its work.

They are very different global health organizations, with very different operating models, but both call themselves social enterprises, Brazilian style, and both were created in 1991.

Years of investments put health workers on global stage

Two midwives in a low-income area of Jakarta, Indonesia that are part
of DKT's "Andalan" social franchising network.

This article was originally published in The Huffington Post on Sept. 23, 2013.

For almost 10 years, I managed health programs in Africa, Asia, and South America that harnessed social marketing techniques to produce tangible benefits for poor consumers. Our programs made low-cost products such as condoms, contraceptives, and oral rehydration salts available at reduced, affordable prices. We worked mostly through the private sector and were proud of our bottom-line health impact. We didn't think much about underlying health systems or how to improve them. And if we had, we probably would have dismissed health system strengthening as overly ambitious.

But I've been thinking more about health systems lately, as I have seen governments and their nongovernmental partners carefully and patiently nurse ailing systems to health. The payoffs are not immediate -- far from it -- but as we move away from the segmented solutions to global health that prevailed in the 2000s (such as in the cases of AIDS and malaria) and toward greater country ownership, there is a growing consensus that we need stronger health systems to make sustainable improvements in global health.

This means more, better trained, and better managed frontline health workers -- the backbone of health systems.

I've heard that mantra for the last few years but, in 2012 and 2013, I saw it play out repeatedly as I traveled to very different countries in Africa, Asia, and Latin America:

Changing lives of poor Brazilian families, Saúde Criança wants to do the same globally

Saúde Criança offers job training, like this class for aspiring cooks.

NOTE: This originally appeared in the Huffington Post on Sept. 3, 2013.
 
RIO DE JANEIRO, Brazil -- Maria do Carmo has no husband, but has a daughter, Simone, "who is 37 but acts like she is three," she says, and is completely dependent on her. Simone was impregnated during a rape and gave birth to a son, Victor Hugo, now three, who is blind and mute, has cerebral palsy, gastroenteritis and almost died of pneumonia. This was Maria's life two years ago. The family had no government benefits even though both Maria's daughter and grandson are eligible. She wept as she told her story.

Then Saúde Crianca, a social entrepreneurial non-profit organization founded in Rio de Janeiro in 1991, came into her life. They helped her understand her rights as a citizen, and to obtain benefits for her grandson. She still needs help for her daughter but, unfortunately, the government only allows benefits for one person per family. Saúde Criança is prepared to give her job training, but Maria has no time for classes, because she has to take her grandson to the doctor everyday.

Maria is an extreme -- but not unusual -- example of the kinds of cases that Saúde Criança handles everyday in their offices in the green splendor of Parque Lage in the neighborhood of Jardim Botânico. It was created by Dr. Vera Cordeiro after several years of treating patients at Hospital da Lagoa, where she noticed that many sick children were admitted and cured only to return to the hospital later, almost always with the same disease. Dr. Cordeiro founded Saúde Criança to try to break this devastating cycle of disease-hospitalization-discharge-misery-disease.

In Brazil, using Carnaval to fight HIV

A dancer at the World AIDS Day rehearsal I attended.

This piece was originally published by the ONE Campaign on Feb. 8, 2013.

SAO PAULO, Brazil — Brazilians are bracing for the six days of Carnaval. The annual bacchanalian festival held 40 days before Easter, begins this weekend across this country of almost 200 million people. Many will participate directly as musicians, dancers and support staff. Millions will watch the parades, in person or by television. Companies sponsoring Carnaval see it as an opportunity for promoting their brand and selling their products, and many will use Carnaval as a license to engage in worldly pleasures of all kinds before the deprivations of Lent.

But one company, DKT Brazil, is taking a different approach and using Carnaval to promote responsible behavior — using condoms, specifically its Prudence brand, to prevent HIV infection. Typical Carnaval sponsors are companies like Mercedes Benz, Cacau Show (chocolate), Bombril (cleaning products) and beer companies. This is apparently the first time a company has sponsored Carnaval for a social purpose.

Taking HIV prevention to the streets, and cyberspace, in Brazil

A DKT promoter hands out a condom sample on the streets of São Paulo.

This piece was originally published on the Huffington Post on Jan. 25, 2013.

SÃO PAULO, Brazil — On Dec. 1, World AIDS Day, "Prudence Trooper" repeatedly battled it out with HIV on the streets of downtown São Paulo. HIV was trying to infect pedestrians but Prudence Trooper defended them, because he had Prudence, one of the leading condom brands in Brazil, in his arsenal.

The two characters were mascots created by DKT Brazil, a social marketing enterprise that distributes Prudence condoms for HIV prevention and family planning, and are an example of the creative, in-your-face methods it uses to encourage young Brazilians to protect themselves against HIV, which currently affects more than 600,000 Brazilians.

Using sexiness to stop unsafe sex

Sexy condom ads like this helped DKT increase condom sales in Brazil.

This article was published originally by Fast Company's Co.EXIST blog on October 5, 2012.

Sex and sexuality have long been used to market a variety of consumer products in wealthy countries. But when it comes to HIV prevention and family planning in developing countries, global health practitioners have mostly shied away from using the titillating strategies so effective in the commercial world.

The Pleasure Project and a small group of like-minded nonprofit partners are trying to change that, by shaking up an international reproductive health community that tries to promote safer sexual behavior by influencing the most intimate aspects of the lives of people in developing countries. With their motto, “Putting the sexy back into safer sex,” the Pleasure Project is spreading that message far and wide. At the XIX International AIDS Conference in Washington, D.C., this summer, they held a session entitled “Pleasure at AIDS 2012: Everything You Wanted to Know About Pleasurable Safer Sex but Were Afraid to Ask” that explored whether pleasure and eroticism can be harnessed to enhance HIV prevention. The conclusion was that they can indeed, even though most campaigns don’t even try.