1. Reassessing HIV Risk in Sub-Saharan Africa: Have We Been Targeting the Right Populations? Robert W. Porter, PhD. and Margot Fahnestock, MPP.

2. 2 Overview Topics addressed: Market segmentation Data for segmentation, Demographic Health and AIDS Indicator Surveys Priority segments for HIV prevention Segment-based interventions Implications for prevention marketing

3. 3 Market Segmentation Only useful if it leads to segments that are : 1. Identifiable. There must be some basis for determining who belongs and who does not 2. Large. So that health marketing efforts are worthwhile 3. Accessible... To communications, product distribution, and service delivery systems 4. Responsive. If the response of selected segments is no stronger than that of the population at large, there is no reason for a segmentation program

4. 4 Data for Segmentation Representative household surveys collecting HIV biomarker data, particularly for couples Surveys of prevention behaviors, products, and services

5. 5 HIV Prevalence by Marital Status, Uganda Percent

6. 6 Marital Status of Individuals with HIV (15-49 years), Uganda

7. 7 Partners’ HIV Status—Couples with HIV, Uganda

8. 8 Partners’ HIV Status—Couples with HIV, Six Countries

9. 9 Sources of New HIV Infections, Uganda (2005) Source: Uganda National AIDS Commission, 2006

10. 10 Sources of New HIV Infections, World Regions, 2005* Source: The Futures Institute, 2007 * Some data used are from earlier years

11. 11 Interventions to Address Couple Discordance The clinical perspective The “index case” (the infected partner) is diagnosed with HIV This person discloses their status The other partner learns his or her status and the couple is identified as discordant Actions are taken to reduce the likelihood of transmission

12. 12 Interventions to Address Couple Discordance The public health perspective Counseling and testing Mutual fidelity/partner reduction Consistent condom use

13. 13 Profiling Married Condom Users Findings from the WHO condom study Married women are not as powerless and husbands are not as hostile to condoms, as they are frequently portrayed to be Wives’ and husbands’ attitudes to condom use and their perceived risk of HIV infection are important predictors of condom use Urban women have more favorable attitudes toward condoms, and also report self-efficacy regarding HIV prevention.

14. 14 Implications for Social Marketing Married couples are an important segment for targeted HIV prevention Married couples can be reached Most married couples are building families, so HIV prevention can be positioned as a family health offering

15. 15 Implications for Social Marketing Condom use within marriage is starting to take hold, even though married couples have not been a priority target for condom marketing Couples practicing family planning may be more amenable to condom use