Population Services International: Social Marketing in Mali and Burkina Faso

If you are unfamiliar with the term "social marketing," you are still familiar with its handiwork. Social marketers have brought you Smokey the Bear, McGruff the Crime Fighting Dog, trenchant commercials against smoking, billboards about safe sexual practices, and stay in school advertisements. Social marketing firms compete in the marketplace of ideas, in the papers, on the air and in your face. Population Services International (PSI) has been promoting healthy lifestyle decisions throughout the world for a number of decades.

They are a US-based company that was originally formed to exert influences on global population trends according to the desires of the U.S. government. They have a long history of family planning activities in the developing world. When AIDS began to attract international attention in the early 1980s, PSI found it had a new collection of messages that went hand in hand with their standard fare. Since that point, their attention to HIV/AIDS has increased to the point where in many countries it is one of their primary concerns.

PSI is no longer the sole creation of U.S. government and policy. It has earned respect and support from wealthy European countries and other donors; in some places, USAID has only a negligible impact on PSI's budget. As a result, it is very difficult to speak categorically about what this organization does or how its directives are selected. Country to country, it varies tremendously.

In Mali, misinformation about AIDS is common. Obscene stories about the origins of the disease make it a shameful subject: AIDS is contracted when humans copulate with dogs, it is only for homosexuals, prostitutes, or shameful people—similar rubbish was believed by ignorant Westerners when the disease was first making itself known. There are also damaging politically and religiously motivated stories that have taken deep root in Mali. Some believe that AIDS is put into condoms (a theory that is widely blamed on the Catholic Church) or that Western governments are deliberately infecting Africans with AIDS in order to keep their populations down (a theory attributed to the Islamic community). Popular myths of this variety complicate attempts at health education, especially when they are conducted by Westerners.

In many ways, PSI Mali is facing an uphill battle with their AIDS education initiatives—they have only been in the country for a handful of years and the organization that preceded them in terms of funding and directives was fairly unsuccessful. PSI Mali finds it essential to communicate the most basic information about the transmission, prevention, and treatment of the disease. This elemental information, unfortunately, is political and PSI is forced to walk a fine line when addressing the ABC's (Abstinence, Be Faithful, Condoms). President Bush has cut funding to organizations that emphasize planned parenthood, contraception, and condoms, forcing the A's and B's into the spotlight and the C's into the corner. For instance, PSI is experiencing huge difficulties receiving the funding and the go-ahead for its barrage of television commercials for a new condom it is marketing specifically to couples—the resistance comes not from the Malian government but from sources closer to home.

Those who are familiar with Malian culture insist that Malian attitudes towards sexuality have nothing in common with Western ones. Numerous people quoted versions of the saying, "Sex is like water or food, you need it every day," and it is easy to see that in Mali promiscuity is accepted and rampant, whereas fidelity is practically a foreign concept (to say nothing of abstinence). Intelligent communicators tailor their messages to the audience for which they are intended.

Sexual promiscuity, widespread misinformation and a high prevalence of female genital mutilation (a particularly bloody version called excision) combine to make Malians quite vulnerable to the spread of HIV, and many are watching the country's statistics with anxiety. Bob Clark, a well experienced tactical advisor for PSI in Bamako, worked in Tanzania and South Africa in the early 1990s when AIDS was beginning to get out of hand. He sees the same conditions in present-day Mali, and worries for its people. He is particularly frustrated about the difficulty of reaching the country's young Muslim women (Mali is approximately 95% Muslim) with messages of any sort. Such women are the most vulnerable to the disease, but the least accessible to outside education.

PSI Mali has several initiatives in place to get the word out to the populace. They are working hard to promote and enable distribution of their subsidized condoms, they are funding anonymous AIDS testing centers, and they are creating a wide array of media that targets particular audiences with information about sexual health. They have created pamphlets, flip books, videos, radio spots, and a website for the young and techno-savvy: http://100pourcentjeune.org. In Mali, PSI subcontracts much of its work to organizations that are closer to the populations they are hoping to reach—offering these smaller groups the necessary materials, funding and, occasionally, training opportunities.

Adapting to the religiosity of Mali, PSI brought together groups of religious leaders, Christians and Muslims (on separate occasions). PSI presented to these leaders about the reality of AIDS and encouraged them to discuss means of alerting their congregations. The result of the workshops was a series of five sermons and five Friday prayer addresses, jointly composed and agreed upon by the participants. These were published and distributed for use in mosques and churches nationwide. Mr. Clark did not have specific information about how widely the messages were used or how they were received.

Just across the border in Burkina Faso, PSI is much further along. They have been operating in Burkina since 1991, and Steve Luderbeck, the country director, brushed aside the sort of obstacles faced by his counterparts in Mali, saying that "resistance is finished." According to Mr. Luderbeck, the sorts of informative animations and presentations still so urgently needed in Mali would be pointless in most of Burkina. His goal is to "improve evidence-based decision making" within the organization; this involves "lots of survey work." PSI tries to figure out why people who are fully informed about HIV/AIDS are still engaging in risky behavior. To do this, they hit the streets and talk with people. The result of their research informs their newer campaigns.

They have recently been running advertisements about asymptomatic carriers (healthy-looking people with AIDS), and also the perceived decrease in pleasure that condoms cause in sexual activity. After numerous frank discussions with the Burkinabe about their reasons for believing that condoms reduce sexual pleasure, PSI launched an advertising campaign that emphasizes the pleasure after sex with a condom that comes from knowing you have protected yourself. In their advertisement, a young man displays the sleepless and agonizing stress of someone who believes he might have been infected. The advertisement then asserts that such anxiety far outweighs the preceding sexual pleasure, suggesting that condoms can offer pleasure in the form of peace of mind.

The politics of condom talk are also not such a big deal in Burkina. This particular branch of PSI is not funded by USAID, which frees them from the changing politics of U.S. leadership. Also, the Burkinabe are receptive to a wide variety of prevention methods, including abstinence and fidelity. Mr. Luderbeck described a PSI campaign from a few years ago that was called "C'est Ma Vie" (It's My Life). His team was able to convince more than one million citizens of Burkina Faso to sign a pledge that obliged them to do at least one of fifteen specified things to fight the spread of HIV. The list included everything from using condoms and being faithful to talking with one's children about health risks. This initiative was so high-profile that the president of the country actually called the PSI offices to ask when he could publicly sign the pledge. It was also signed by prominent religious leaders of both Muslim and Christian faith.

The AIDS project in Burkina is so well established that it has been handed over to PROMACO, an organization staffed and funded by the government of Burkina Faso. Through PROMACO, PSI are currently targeting two high-risk groups: truck drivers and gold diggers. These populations are selected for direct interpersonal communication, and a staff of former salesman are deployed to the impromptu shanty towns around gold mines and to transit points in order to speak on an individual level with the vulnerable populations there. They use specially designed low-literacy fliers to clarify their messages.

When it comes to measuring PSI's degree of success, there are a couple of possible indicators. Immediately following the launch of any new ad campaign, they conduct "reach in recall" street surveys to discover whether or not their advertisement is being noticed and remembered, they research the number of people capable of recalling information about the AIDS virus, they count signatories to their pledges or tabulate the number of condoms that they distribute per year (nineteen million at last count in Burkina). But one thing Steve Luderbeck does not use as an indicator is the statistical measurement of the population's infection level. He noted that Burkinabe intellectuals and officials publicly debated what it meant when their infection rate fell from 7.17% to 6.98% between one year and another. They did this without ever once mentioning the phrase "margin of error" or questioning how they could possibly have determined the infection rate to the hundredth decimal position. Infection rate statistics are notoriously sketchy and their margin of error could be quite high. Mr. Luderbeck is more concerned with the original data that his canvassers gather from the streets of the country. Naturally, another method of determining their success would be to compare them to their neighbors; in this respect, Burkina's social marketing is healthy and well advanced.


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