It's a dilemma that has frustrated global public health workers for years: How can we encourage condom use in AIDS-prone countries whose populations may be skeptical or outright opposed to safer-sex practices? (Not to mention, how can we do this within the confines of George W. Bush's infamous "global gag rule"?) Generally, the solution has been to launch public education campaigns touting the benefits of condom use. But as the global AIDS epidemic shows no sign of letting up any time soon, we have to test new strategies.
Family Health International, through its Aksi Stop AIDS (ASA) Project, is doing just that in Indonesia, where AIDS is on the rise and its prevalence among sex workers constitutes what the U.S. government calls a "severe concentrated epidemic." Along with more traditional measures, the organization launched a program that provides working girls in the country's Malang district with an incentive for using condoms: lottery tickets. Sex workers receive a ticket for every 20 condom wrappers they produce, and winners receive prizes like TV sets and DVD players.
And the program seems to be working. The percentage of brothel-based female sex workers with an STI has decreased from 8.5 percent to 7.9 percent in the past five years. In 2003, 65 percent of working girls said they never used condoms; by 2008, that figure had dropped to 40.8 percent.
Public opinion on condom use may vary from culture to culture, but apparently television's appeal is universal. If there's a take-home lesson here, perhaps it's that sometimes the best solutions -- even to situations as enormous and dire as the global AIDS crisis -- can also be the simplest ones.
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