• This report also in French.

(September 2003) Using the latest innovations in social marketing, Population Services International (PSI), a U.S.-based nonprofit group, created and implemented youth-oriented programs in Cameroon, Madagascar, and Rwanda to prevent unplanned pregnancies and sexually transmitted infections, including HIV/AIDS, among 15-to-24-year-olds. Research played a critical role in developing the programs’ strategies and key messages. In addition to advertising products — a common feature of social marketing campaigns — the programs used a creative mix of commercial marketing and interpersonal approaches to motivate young people to either use condoms consistently or not have sex, learn their HIV status, and seek treatment for other sexually transmitted infections.

Working with the private sector, the programs made condoms and other reproductive health products and services — otherwise off-limits to unmarried youth — more accessible and “youth friendly.” The programs combined several features that made them unique among adolescent reproductive health programs:

  • The programs linked motivational campaigns directly with youth-friendly sources of condoms and reproductive health services.
  • They were informed by research about the specific issues and barriers facing the target audiences, and were based on contemporary theories about behavior change.
  • They communicated intensively and often with youth, providing motivational messages through television, radio, print media, and peer educators.
  • Rather than preaching to youth about good behavior, the mass media campaigns treated youth as savvy consumers and portrayed safe behaviors as positive and socially acceptable.
  • The programs used common logos and brand names to identify communication activities as well as products and services.

An external evaluator described this program as “an outstanding, well-conceived, managed, implemented and monitored sexual health intervention with significant opportunities to provide a learning laboratory for PSI’s growing youth portfolio.”1 The programs contributed to measurable changes in youths’ perceptions and behaviors.

  • In Cameroon, youth of both sexes who were exposed to the program were more likely to know how to use condoms correctly and less shy to buy condoms. After 18 months of program activities, 69 percent of young men with high levels of exposure to the program reported using a condom the last time they had sex with a regular partner, compared with only 56 percent of those with low program exposure.
  • In Rwanda, young people exposed to the program were more likely to believe condoms are effective for preventing HIV/AIDS, believe their friends and family support condom use, and know where to find condoms and how to use them. Youth of both sexes who were exposed to the program were also more likely to use HIV counseling and testing services: Eight percent of young women ages 15 to 24 with high program exposure had an HIV test, compared with only 2 percent of those with low exposure.
  • In Madagascar, the number of youth ages 15 to 24 seeking STI treatment and other reproductive health services at youth-friendly clinics rose dramatically, from 122 youth in the first month to 716 youth (predominantly female) in the 24th month of program activities.

The programs achieved these results by making discussion about sex more common and acceptable, creating new social norms for safe behavior, and motivating youth to seek out and use reproductive health services. Still, some program objectives remain to be achieved, such as increasing condom use among sexually active youth in Rwanda, increasing condom use among young women in Cameroon, and increasing young men’s use of reproductive health services in Madagascar. All three programs need to do more to motivate increasing numbers of youth to either abstain from sex or use condoms consistently (every time they have sex). A third round of surveys and additional analysis in 2003 will shed more light on changes in youth behavior in each country and the implications of these trends for future programs.

Josselyn Neukom is senior program analyst at Population Services International, Washington, D.C. Lori Ashford is technical director of reproductive health at PRB.


  1. David Wilson, “PSI Youth Sexual Health Programme: Cameroon, Rwanda, Madagascar,” unpublished report, April 25, 2002.

Excerpted from PRB and PSI’s report Changing Youth Behavior Through Social Marketing: Program Experiences and Research Findings From Cameroon, Madagascar, and Rwanda.