SOCIAL MARKETING RESEARCH SERIES

Transcription

1 SOCIAL MARKETING RESEARCH SERIES México (2008): MAP Study Evaluating Coverage and Quality of Coverage for Condoms in Cancun, Playa del Carmen and Veracruz Second Round MAP: Measuring Access and Performance Mexico, 2008 PSI s Core Values Bottom Line Health Impact * Private Sector Speed and Efficiency * Decentralization, Innovation, and Entrepreneurship * Long-term Commitment to the People We Serve

2 Research & Metrics Population Services International 1120 Nineteenth Street NW, Suite 600 Washington, D.C México (2008): MAP Study Evaluating Coverage and Quality of Coverage for Condoms in Cancun, Playa del Carmen and Veracruz. Second Round : PSI Research & Metrics Year Population Services International, 2009 Contact Information: Angélica Ospina Escobar Research Manager PSI/Mexico Manuel Villalongín No. 150 PA Col. Cuauhtémoc CP Mexico, D.F. Tel : Fax: aospina@psimex.net Pamela Faura PSI/Mexico Country Representative pfaura@psimex.net Ricardo Román Vergara Deputy Director PSI/Mexico rroman@psimex.net

3 Acknowledgements This report represents the work of many individuals. The research was conducted by the Research Department, PSI Mexico: Angélica Ospina (Research Manager) and Patricia López Villalobos (Research Assistant). Technical assistance was provided by Benjamín Nieto-Andrade (PSI Regional Researcher for Latin America and the Caribbean). Fieldwork was carried out by IPSOS Marketing Research (IPSOS BIMSA) and by members from the PSI/Mexico field team: Alberto Cuevas Jacobo, Santos Hernández Arango and Jorge Peralta. This study was funded by ABT Associates and the United States Agency for International Development (USAID). Special acknowledgement goes to Ricardo Villajuana and Octavio Martínez for their support during the field work.

4 Table of Contents Executive Summary Findings...4 Coverage of Condoms...4 Quality of Coverage of Condoms...9 Access to Condoms...12 Penetration of Condoms...13 Limitations...15 Conclusions and Programmatic Recommendations...17 Appendix 1: List of Sampled Areas Appendix 2: Additional Maps Appendix 3: Audit Sheet Appendix 4: LQAS Percentage Chart

5 MAP 2008 Executive Summary Executive Summary Background PSI s interventions in Mexico focus on the prevention of HIV/AIDS. Its program for increasing condom availability in non-traditional outlets was launched in 2006 and targets primarily Men who Have Sex with Men (MSM) and Female Sex Workers (FSW). Research Objectives MAP studies allow programmers to make an assessment of product availability and accessibility using pre-defined criteria for coverage, quality of coverage, access and penetration. Its goal is to increase the overall efficiency of social marketing product and service delivery systems. The main objectives of the PSI/Mexico 2009 MAP surveys were to (1) monitor the coverage and quality of coverage of condoms in non-traditional outlets; and (2) monitor access and market penetration of condoms in high-risk areas for HIV/AIDS (hotzones). The study was designed to make comparisons between the first round (2007) and this second round in three supervision areas: Cancun, Playa del Carmen and Veracruz. Methodology MAP methodology employs the Lot Quality Assurance Sampling (LQAS) technique to draw a random sample of 19 Enumeration Areas (EAs) from each supervision zone under study: Cancun, Playa Del Carmen and Veracruz. Nevertheless, because in Cancun and Playa del Carmen less than 19 EAs were identified, LQAS was not used in these two supervision zones. Instead, a census of hotspots and outlets in EA s of Cancun and Playa del Carmen was conducted: the percentages presented for these cities are direct percentages rather than LQAS percentages (see methodological appendix). Only in Veracruz was LQAS methodology applied to sample 19 EA s: here the percentages presented are not direct percentages, but the result of calculations showed in the appendix 4. In the case of Veracruz, this LQAS assessment of coverage determines the proportion of each EA in this supervision zone. In addition to providing a basic measure of product coverage, the LQAS assessment also determines quality of coverage, i.e. the proportion of each administrative region, in which the products conform to additional minimum standards. The quality standards were measured using following indicators: (1) Promotional materials are visible; (2) Condoms are for sale at or below the recommended price of PROFECO or PSI; (3) Condoms are visible; (4) There has not been stock out of condoms during the 4 weeks prior to the survey; - 1 -

6 MAP 2008 Executive Summary All outlets in the selected EAs were audited. EA are defined by a clustering of at least 2 hotspots within 250 meters contiguous catchments. Hotspots include bars, night clubs, discotheques, brothels, cinemas and open public places where the target populations gathered. Data was collected between December 2008 and January Main Findings After one year of program implementation, the general coverage of condoms has increased from 28.1% (9 out of 32 EAs) in 2007 to 52.1% (17 out of 32 EAs) in The major increase was in Cancun, where in 2007 there was no EA with the minimum standard for coverage, and in 2009, 5 out of 8 EAs (62.5%) had achieved it. In Playa del Carmen, no changes were found in terms of coverage, where in both years 4 out 5 EAs accomplished the minimal standard. In Veracruz, 8 out of 19 sampled EAs (55.0%) in 2009 had coverage of condoms, compared with data from 2007 where 5 out of 19 sampled EAs (40.0%) had it, representing an increase of 15.0 percentage points. In terms of quality of coverage, the most critical indicator was having promotional materials in at least 20.0% of the outlets within each EA: Only 2 out of 32 EAs (6.0%) achieved this standard at the city level. In Cancun and Veracruz, only 1 out of 8 and 19 EAs respectively (12.5% and 20.0% respectively) achieved the standard; in Playa del Carmen no EA achieved the standard. By contrast, the indicators of quality of coverage with higher percentages of success were: Not having stock out of condoms (53.0%: 17 out of 32 EAs at the combined city level), visibility of condoms (47.0%: 15 out of 32 EAs at the combined city level) and selling condoms at or below the recommended price (31.0%: 10 out of 32 EAs at the combined city level). Access to condoms among the targeted populations (MSM and FSW) was very high. All FSW had access to condoms in the three cities; while all MSM had an access in Playa del Carmen and in Veracruz, but not in Cancun, where the level of access to condoms was 88.6%. In 2009 penetration of condoms in selected outlets of interest for the project showed improvements compared with 2007 data, when the penetration was quite low. In 2009 the average penetration of condoms in hotels and motels for the three cities was 35.4% (28 out of 79), which represents an increase of 22.0 percentage points in comparison with 2007 data. The average penetration of condoms in FSW establishments such us bars, brothels, cantinas - 2 -

7 MAP 2008 Executive Summary and strip clubs was 15.0%, while the average penetration of condoms in MSM establishments such as bars, discos and cantinas was 24.0%. The average penetration of condoms in grocery stores was 35.0%. Programmatic Recommendations Open public places continue to be a challenge for the improvement of coverage of condoms. A mobile strategy is highly recommended to have condoms available in those places. This could be achieved by having kiosks with condoms for sale or having peer promoters distributing condoms. Focusing on zones without coverage in Playa del Carmen and Cancun, especially improving penetration of condoms in hotels and FSW establishments in those hotzones could help to increase both penetration and coverage of condoms. To improve the indicator of quality of coverage of condoms, it is recommended: o Making condom distribution one of the activities done directly by the Projectpromoters could help to improve the proportion of outlets which do not report stock out of condoms. o Having an incentive program for those outlets that participate in the campaign and that sell condoms at or below the recommended prices. o Offering attractive displays for condoms that are appealing to the owners/managers of the hotspots could help improving the indicator of condom visibility To improve access to condoms among MSM in Cancun, it is necessary to have condoms available in hotzone number 8 (Dolphins beach), which implies the need to have a mobile strategy to make condoms available in open public hotspots

8 MAP Findings Findings Coverage of Condoms Table 1. Condom Coverage by Supervision Area in Cancun, Playa del Carmen and Veracruz. Mexico, City No. of Hotzones Hotzones in which at least 20% of non traditional outlets have condoms Hotzones in which at least 80% of traditional outlets have condoms Minimum Standard: Hotzones in which at least 20% of nontraditional and 80% of traditional outlets have condoms Year Cancun (Direct %) (0.0%) 5 (62.5%) 8 (100.0%) 8 (100.0%) 0 (0.0%) 5 (62.5%) Playa Del Carmen (Direct %) (80.0%) 4 (80.0%) 5 (100.0%) 5 (100.0%) 4 (80.0%) 4 (80.0%) Veracruz (LQAS %) /19 (40.0%) 9/19 (60.0%) 14/19 (95.0%) 16/19 (95.0%) 5/19 (40.0%) 8/19 (55.0%) TOTAL (Direct %) (28.1%) 18 (56.2%) 27 (84.4%) 29 (90.6%) 9 (28.1%) 17 (53.1%) Coverage of condoms The combined city coverage for PSI condoms, defined as the presence of condoms in at least 80.0% of traditional outlets 1 and 20.0% of non-traditional outlets 2, showed improvement comparing data from 2007 and 2009 with a 25.0 percentage point growth over the period: from 28.0% to 53.0%. Such improvement was exclusively due to increases of condom availability in non-traditional outlets. In traditional outlets no changed is observed over time. The city with the highest improvement was Cancun, where in 2007 the coverage of condoms was zero and in 2009 the coverage was 62.5%, which means that in 5 out of 8 hotzones or Enumeration Areas (EAs) the standard of coverage was reached. 1 Nontraditional outlets include hotels/motels/pensions, brothels, grocery stores and other establishments where FSW and MSM gather. 2 Traditional outlets include pharmacies, convenience stores and supermarkets. 4

9 MAP Findings By contrast, Playa del Carmen does not show any change between 2007 and 2009, the same proportion of condom coverage was found in traditional and non-traditional outlets over the period. Figure 1 shows a comparison between the EAs with coverage in 2007 (in the left) and 2009 (in the right). We can see that the EAs are the same for both years. The unique EA without changes in coverage is the EA no. 8, allocated in the tourist zone of the city (at the bottom right of the maps) mainly due to the difficulty of having condoms available in open/public places such as beaches, parks, streets, etc. For the rest of the EAs changes in coverage of condoms are prominent. Appendix 2 shows the number of each hotzone in their respective maps. Figure 2 shows the same comparison in coverage between 2007 and 2009 for Playa de Carmen. Like Cancun, we can see that the selected EAs are the same between the two years, so, we can see whether the EAs have experienced any change in terms of coverage of condoms during the period. Figure 3 shows the same comparison in coverage between 2007 and 2009 for Veracruz. Unlike Cancun and Playa del Carmen, we can see that the selected EAs are different between the two years, so, we cannot make a specific analysis about the specific zones of the city where coverage shows a larger improvement. We can say, according to the information displayed by the map that most of the EAs located at the center of the city area reached the standard for coverage of condoms, while there EAs in the outskirts of the city need to improve coverage of condoms. 5

10 MAP Findings Figure 1 Comparison in Condom Coverage by EA s in Cancun Coverage of condoms. Cancun, 2007 Coverage of condoms. Cancun,

11 MAP Findings Figure 2 Comparison in Condom Coverage by EA s in Playa del Carmen Coverage of condoms. Playa del Carmen, 2007 Coverage of condoms. Playa del Carmen,

12 MAP Findings Figure 3 Comparison in Condom Coverage by EA s in Veracruz Coverage of condoms. Veracruz, 2007 Coverage of condoms. Veracruz,

13 MAP Findings Quality of Coverage of Condoms In the present study quality of coverage is reached by an EA when the minimal standard for coverage has been achieved, and additionally: Promotional materials are visible in at least 20.0% of outlets At least 20.0% of outlets sell condoms at or below recommend price by PROFECO 3 or PSI 4 At least 20.0% of outlets have condoms visible to clients At least 20.0% of outlets do not have stock out of condoms Table 2. Quality of Coverage of Condoms for selected Indicators in Cancun, Playa Del Carmen and Veracruz, Mexico Standard: Condoms are available in at least 80% of traditional outlets and 20% of nontraditional outlets AND: Quality of Coverage (%) Cancun (Direct %) Playa del Carmen (Direct %) Veracruz (LQAS %) Aggregated for the 3 cities (Direct %) At least 20% of outlets have promotional material At least 20% of outlets sell condoms at or below recommend price by PROFECO or PSI At least 20% of outlets have condoms visible to clients At least 20% of outlets don t have stock out of condoms 0.0% (n= 0) 0.0% (n= 0) 0.0% (n= 0) 0.0% (n= 0) 12.5% (n= 1) 37.5% (n= 3) 62.5% (n= 5) 62.5% (n= 5) 0.0% (n= 0) 40.0% (n= 2) 60.0% (n= 3) 60.0% (n= 3) 0.0% (n= 0) 0.0% (n= 0) 60.0% (n= 3) 80.0% (n= 4) 0.0% (n= 0) 20.0% (n= 1) 20.0% (n= 1) 20.0% (n= 1) 20.0% (n= 1) 50.0% (n= 7) 50.0% (n= % (n= 8) 0.0% (n= 0) 9.0% (n= 3) 13.0% (n= 4) 13.0% (n= 4) 6.0% (n= 2) 31.0% (n= 10) 47.0% (n= 15) 53.0% (n= 17) Number hotzones that met minimum standard Total number of hotzones in each city The National Office for the Consumer Defense. Depending on the brand the suggested price for a package of three condoms ranges from $15 to $41.90 Mexican pesos (USD$1.15 USD$3.22) See: ww.profeco.gob.mx/revista/pdf/est_00/condones.pdf. 4 Depending on the brand and the city the suggested price for a package of three condoms ranges from $20 to $35 Mexican pesos (USD$ 1.53 USD$2.69) 9

14 MAP Findings As showed in table 2, the aggregated percentage for the first indicator of quality of coverage: having promotional material visible in at least 20.0% of outlets within each EA, is 6.0% (2 out of 32 EAs). Despite an improvement in 2009 compared to 2007, the proportion of outlets with promotional material remains quite low. Cancún and Veracruz show a slight improvement in this indicator, passing from 0.0% in 2007 to 12.5% and 20.0% respectively, while there is no improvement in Playa del Carmen, where no EA achieved the minimal standard. The main reason for the minimal improvement in this indicator was the financial situation of the project for almost six months prior to the study, which made it impossible to produce sufficient promotional materials for all the outlets: at the time of data collection, the project was facing a stock out of promotional materials. In terms of prices of condoms, the aggregated percentage for the three cities is 31.0% (10 out of 32 EAs). Compared to 2007, there is an improvement of 22 percentage points, growing from 9.0% (3 out of 32 EAs) in 2007 to 31.0% (10 out of 32 EAs) in While Cancun and Veracruz show improvements in this indicator, Playa del Carmen experienced a decrease from 40.0% (2 out of 5 EAs) in 2007 to 0.0% in For the indicator of having condoms visible in at least 20.0% of the outlets, aggregated data for the three cities show an improvement from 13.0% in 2007 (4 out of 32 EAs) to 31.0% (15 out of 32 EAs). The city with the best performance in this indicator in 2009 was Cancun, where 62.5% (5 out of 8 EAs) achieved the minimal standard, while in 2007 no EA got this standard. In Playa del Carmen 60.0% of the EAs (3 out of 5) got the standard for visibility of condoms in 2009, no change compared to 2007 data. Veracruz increase the visibility of condoms in 2009 compared with 2007 passing from 20.0% (1 out of 19) in 2007 to 50.0% (4 out of 19 EAs) in Finally, the indicator of not having stockout of condoms also experienced an increase at the aggregated level for the three cities, as in 2007 only 13% of the EAs reached the minimal standard, while in % reached it. All the three cities showed important changes over time: In Cancun there was an increase 62.0 percentage points, in Playa del Carmen of 20.0 percentage points and in Veracruz of 35.0 percentage points. Summarizing, in terms of quality of coverage, in the three cities as a group, the four indicators of quality of coverage show improvements from 2007 to 2009: the percentage of EAs with the 10

15 MAP Findings minimum standard of coverage, also met the standard of each indicator of quality of coverage, increased over time. Looking at the indicators by city, only Playa del Carmen shows no improvements in three out of four indicators: visibility of condoms and promotional materials, that remained at the same level in both years (0.0% and 60.0%, respectively); and price, which decreased its level from 2007 to 2009 (from 40.0% to 0.0%). Contrary to Playa del Carmen, in Cancun and Veracruz, all four indicators of quality of coverage showed improvements over time. By contrast, the indicator with the greatest improvement over time was not having stockout of condoms, which increased from 15.0% in 2007 to 53.0% in All three cities showed important improvement in this indicator, reaching a level up to 80.0% in Playa del Carmen. Nevertheless, the city with the highest increment with respect to 2007 was Cancun, going from a level of 0.0% to 62.5%. The second indicator for quality of coverage with greatest improvements over time was condom visibility, presenting an overall change from 13.0% in 2007 to 47.0% in In this indicator, the major change was seen in Cancun (going from 0.0% to 62.5%); followed by Veracruz, where the change went from 20.0% to 50.0%. No changes were reported in Playa del Carmen. Although PSI/Mexico cannot control the prices at which condoms are sold and can only suggest a retailed price and talk to the outlet personnel responsible about the importance of having competitive prices to increase the demand for condoms, improvements were found in this indicator in Cancun and Veracruz, which changed from 0.0% to 37.5% and from 20.0% to 50.0% during the period respectively. These findings suggest that in general, improving coverage of condoms through a social marketing campaign also generates improvements in the quality of this coverage. As the distribution system improves and promotion to outlet owners/managers on the importance of having condoms visible and sold at competitive prices continues, outlets can experience an increase in demand for condoms from their clients. Appendix 3, map 4 - shows how these indicators are displayed geographically in the three cities. 11

16 MAP Findings Access to Condoms Table 3 presents access to condoms, defined as the proportion of target population in hotzones where there is at least one outlet (traditional or non-traditional) with condoms available. It should be noted that the amount of people counted in 2009 was substantially lower compared to 2007, because in 2009 the research agency hired to conduct the study visited the hotspots during the afternoon hours, avoiding late night hours when they felt they would be in danger. By contrast, in 2007, the target population was counted at night by PSI local promoters at night, when they conduct the BCC activities. This difference could explain the evident lesser volume of targeted population found in 2009, compare with Table 3. Access to Condoms among Female Sex Workers (FSW) and Men who have Sex with Men (MSM) in Cancun, Playa Del Carmen and Veracruz-Mexico City Total target Access All target population groups Total FSW Access FSW Total MSM Access MSM Year Cancun % 96.2% % 100.0% % 88.6% Playa Del Carmen Veracruz Total % 100.0% 92.3% 100.0% Average: 92.0% Average: 99.1% % 100.0% 83.1% 100.0% Average: 87.2 % % % 100.0% 100.0% 100.0% Average: 95.6 % Average: 97.5 % Although access to condoms in 2007 is very high among the target populations, mainly due to the large amounts of convenience stores and drugstores located around the hotspots, results for 2009 show a slight rise over time by both targeted populations in Cancun and Veracruz. In Playa del Carmen, the level of access for both populations was 100.0% in 2007 and remained the same in The percentages of this table were not calculated using LQAS. The percentages are direct calculation of number of MSM or FSW that are in an area with condoms available (catchment area),over the total number of MSM and/or FSW in the entire number of hotzones analyzed. 12

17 MAP Findings In Cancun, while in % of FSW had access to condoms within the identified areas, in 2009 this percentage climbs to 100.0%, which means that in all identified hotzones there is at least one outlet with condoms available. For MSM, there is also a small increase in access to condoms, with a change from 86.8% to 88.6%. In Veracruz the overall increase in access is explained by the increment experienced by FSW, which changes from 83.1% in 2007 to 100.0% in As MSM already had reached 100.0% of access to condoms in 2007, no change was reported for Penetration of Condoms Table 4 shows the proportion of penetration of condoms in different types of non-traditional outlets. Penetration is the proportion of outlets with condoms available over the total number of outlets. The project focuses specifically on improving penetration in hotels, FSW gathering places, grocery stores and MSM gathering places. Table 4. Penetration of Condoms by Type of Non-Traditional Outlets in Cancun, Playa Del Carmen and Veracruz-Mexico. November % of bars, night clubs, % of Discos, bars & % of Hotels / Motels brothels & other FSW % of grocery stores other MSM City / Pensions with establishments with with condoms establishments condoms condoms with condoms % 50.0% 0.0% 15.3% 0.0% 64.4% 0.0% 30.0% Cancun (n= 0/2) (n= 2/4) (n=0/26) (n= 6/41) (n=0/9) (n= 7/11) (n=0/9) (n= 3/10) 0.0% 20.0% 71.0% % 100.0% 100.0% Playa del Carmen (n= 0/19) (n=2/10) (n= 12/19) (n=0/4) (n= 9/22) (n=1/1) (n= 1/1) 15.38% 46.4% 11.11% 8.1% 0.0% 21.2% 33.33% 14.3% Veracruz (n=2/13) (n= 26/56) (n=9/81) (n= 11/136) (n=0/7) (n= 7/33) (n=4/12) (2/14) Total (average) % (n=2/15) 35.4% (n= 28/79) 9.40% (n=11/117) 15.0% (n= 29/196) 0.0% (n=0/20) 35.0% (n= 23/66) 22.73% (n=5/22) 24.0% (n= 6/25) In the three cities together, penetration of condoms improved in all venues: the percentage of venues with condoms increased over time. Grocery stores are the venues with the highest 6 The percentages of this table are not calculated through LQAS. They are direct calculations: number of outlets that sell condoms over the total number of outlets of the respective type. 13

18 MAP Findings increase: from 0.0% in 2007 to 35.0% in Within this type of venue, Cancun is the city with the most impressive scale up of penetration of condoms (going from 0.0% to 64.0%), followed by Playa del Carmen (from 9.0% to 41.0%) and Veracruz (from 0.0% to 21.0%). Hotels/Motels/Pensions also show an important increase in penetration of condoms (from 13.0% in 2007 to 35.0% in 2009), with Cancun being the city with the highest increase, followed by Veracruz. Only Playa del Carmen shows no improvement, keeping its original level: 0.0% in 2007 and in Bars, night clubs, brothels and other FSW establishments show improvements over time in Cancún (from 0.0% to 15.0%) and Playa Del Carmen (from 20.0% to 71.0%). Only Veracruz shows a decrease in the percentage of penetration of condoms : in % of these venues had condom availability, while in 2009 only 8.1% had it. Finally, penetration of condoms in MSM hotspots has increased in Cancun, going from 0.0% in 2007 to 30.0% in No changes were reported for Playa del Carmen as there is only one MSM hotspot and condoms had already been available since In Veracruz data showed a decrease in penetration of condoms in MSM hotspots, going from 33.3% in 2007 to 14.0% in 2009, this could be explained by the fact that the EAs sampled in 2009 were different from those sampled in

19 MAP Limitations Limitations In methodological terms, it is important to take certain things into consideration when reading the percentages presented in this report. Comparisons between Cancun and Playa del Carmen, on the one hand, and Veracruz on the other hand, should be made taking into account that percentages for coverage and quality of coverage in the first two cities are direct percentages while in Veracruz, LQAS was used to calculate percentages. In Cancun and Playa del Carmen less than 19 EAs were identified and all of them were included in this study. Consequently, the percentages in these cities always used the total number of EAs as denominator. In Veracruz 34 EAs were identified in 2009 and only 19 of those EAs were randomly selected, using the LQAS tables to calculate the percentages for coverage and quality of coverage (see appendix 4). It is also important to take into account that despite the efforts to identify as many hotspots as possible, many of them still remain hidden or are clandestine, such as brothels. In this study we accept this limitation and we recognize that there may be many more hotspots than those identified here. This is especially significant in Cancun, were the local government has pushed to locate the FSW hotspots outside of the city and has closed the remaining openly FSW hotspots left in the downtown area. Another limitation during the implementation of this study was that the hired research agency did not comply with the terms of the contract and did not follow all of the requirements needed to conduct the fieldwork. As there was explained before, they visited hotspots at early hours of the night to avoid any potentially dangerous situations. This meant that the volume of population they counted was quite low in comparison to the volume detected in the first round. In addition, other inconsistencies were found in the data they presented, which made it mandatory to return to the field and re-collect the data needed 7, delaying the process of analysis and data dissemination. The maps available for the three cities only provide geographic information at the city/municipal level, not including other suburban areas. That explains why the maps of Veracruz and Cancun have some points (outlets and hotzones) outside the mapped areas. In the case of Veracruz, the available map does not contain geographic information for the municipality of Boca del Rio, where some sampled hotzones are located at the right bottom of the map, nor for the highway to 7 Specifically, the interviewers did not apply the audit sheet to the person with the required information (owners or persons in charge of the outlets) and they did not confirm the presence of promotional material. 15

20 MAP Limitations Xalapa, at the left bottom of the map, where other sampled hotzones are located. In the case of Cancun, just one hotzone is located outside of the map area, where, as previously mentioned, most of the FSW establishments are located within the margins of the city. On the other hand, the situation of the war against drug trafficking posed by the National government has pushed drug dealers to look for new places for drug distribution. Strip clubs have been seen as new possible drug outlets and as a result, many have been forced to close, creating more changes in the dynamics of these venues: constant openings and closures of new places. Finally, in terms of the implementation of the project itself, the main factors that made difficult to achieve the quality of coverage standards include: Distribution of condoms to non-traditional outlets has depended completely on local distributors stock, time and human resources. Since the Abt Team does not have its own condom brand, it has to rely on the private sector to fulfill its distribution needs. Local distributors and non-traditional outlets have complete control of the prices of condoms. In this regard the Abt team can only suggest prices. The new Shingón promotional material was not available for dissemination during this quarter and the old material had not been available for months prior to the study, as a result, so few promotional material where found during the data collection. 16

21 MAP Conclusions and Programmatic Recommendations Conclusions and Programmatic Recommendations After one year of implementation of the PSP Condom Availability Project, the general coverage of condoms has increased from 28.1% (9 out of 32 EAs) in 2007 to 52.1% (17 out of 32 EAs) in The major increase was seen in Cancun, where in 2007 there was no EA with the standard minimum for coverage and in 2009, 5 out of 8 EAs (62.5%) had reached it. In Playa del Carmen no changes were found in terms of coverage: in both years 4 out 5 EAs accomplished the minimum standard. In Veracruz 8 out of 19 sampled EAs (55.0%) had coverage of condoms, compared with the data from 2007 where 5 out of 19 sampled EAs (40.0%) had it, representing an increase of 15.0 percentage points. In terms of quality of coverage, the indicator that improved the most from 2007 to 2009 was visibility of promotional materials in at least 20.0% of the outlets within each EA: only 2 out of 32 EAs (6.0%) achieved this standard at the combined city level. In Cancun and Veracruz only 1 out of 8 and out of 19 EAs respectively (12.5% and 20.0%) achieved the standard; in Playa del Carmen not EA achieved the standard. By contrast, the indicators for quality of coverage with higher percentages of success were: Not having stock out of condoms (53.0%: 17 out of 32 EAs at the combined city level), Visibility of condoms (47.0%: 15 out of 32 EAs at the combined city level) and selling condoms at or below the recommended price (31.0%: 10 out of 32 EAs at the combined city level). It is important to highlight that these indicators were especially low during the first round MAP study in 2007, particularly in Cancun were none of the EAs achieved the minimal standard. Access to condoms among the targeted populations (MSM and FSW) was very high. All FSW had access to condoms (100.0%) in the three cities. MSM had 100.0% access in Playa del Carmen where there is only one hotspot for MSM- and in Veracruz where there are 13 hotspots. In Cancun access to condoms for MSM is 88.6%. Penetration of condoms in selected outlets of interest for the project showed improvements in 2009 compared with 2007 data, when the penetration was quite low. In 2009 the average penetration of condoms in hotels and motels for the three cities was 35.4% (28 out of 79), representing an increase of 22.0% in comparison to 2007 data. For FSW establishments the 17

22 MAP Conclusions and Programmatic Recommendations increase in penetration of condoms in the three cities went from 9.4% to 15.0%; while the average penetration of condoms in MSM establishments went from 22.7% to 24.0%. Based on the above findings, the following programmatic recommendations should be considered: Open public places continue to be a challenge for the improvement of coverage of condoms. A mobile strategy is highly recommended to have condoms available in those places. This could be achieved by having kiosks where condoms are for sale or having peer promoters who distribute them. There are still opportunity windows to increase coverage with minimal efforts in Cancun and Playa del Carmen: o In Cancun, having just one non-traditional outlet with condoms available in hotzone number 2 (Parian Market zone) is enough to accomplish the minimal standard. To get the minimal standard for coverage in hotzone 3 (Sirenas street) it is only necessary to have condoms available in two additional non-traditional outlets. If these hotzones achieve the coverage of condoms, this will mean that Cancun will reach a coverage of 87.5% o In Playa del Carmen, adding two more non-traditional outlets with condoms available in hotzone number 1 (touristic zone) is enough to have a 100.0% coverage in this city. Making condom distribution one of the activities of the Project promoters, could help to improve the proportion of outlets which do not report stock out of condoms. To improve the indicator of quality of coverage of condoms, it is recommended: o Having an incentive program for those outlets that participate in the campaign and that sell condoms at or below the recommended prices could help to improve the indicator of quality of coverage of condoms. o Offering attractive displays for condoms appealing to the hotspot owners/managers could help to improve the indicator of condom visibility. o Improving penetration of condoms in hotels and FSW establishments is highly recommended, especially in Cancun and Veracruz. This could also help to increase condom coverage in these cities. 18

23 MAP Conclusions and Programmatic Recommendations To improve access to condoms among MSM in Cancun it is necessary to have condoms available in hotzone number 8 (Dolphins beach), which implies the need to have a mobile strategy that makes condoms available in open public hotspots. Although the access to condoms among MSM in Veracruz is 100.0%, it is important to increase the penetration of condoms in MSM gathering places. 19

24 Appendix 1 Sampled Areas Appendix 1: List of Sampled Areas City Hotzone ID Hotzone Name 8 Cancun Playa Del Carmen Veracruz 101 Ejecutivos Playa 102 Mercado Parián 103 Calle de las sirenas 104 Las Jarras 105 Andador Turístico 106 Puerto Juarez 107 Plaza Playa Delfines 201 Andador turistico 202 Las Hamacas 203 Bartolos 204 Babys Hot 205 Bar la Hueva 301 El Tigre 303 Barrocos 305 El Bucanero 306 Kokobongo 309 Barahaima 309 Bar Mexico 310 Mercado Hidalgo 311 Hotel Campoamor 313 La Otra 314 El Nuevo Mamey 315 La casa de papá 316 Top Gold 318 La Chica Loca 321 Climax 323 Cine lips 325 Barradas 327 Hot mamacitas 329 Fandangos 333 Obsesion 8 In most of the cases it was decided to call hotzones with the name of the most important hotspots allocated in there. 20

25 Appendix 2 Additional Maps Appendix 2: Additional Maps Map 4. Hotzones which Accomplish the Minimal Standard for Coverage of Condoms and Percentage of Outlets in Hotzones Having Promotional Material. Cancun -. % Note: In this map is not included hotzone Nb. 8 (Dolphins Beach, where there is not any outlet with condoms available) 21

26 Appendix 2 Additional Maps Map 5. Hotzones which Accomplish the Minimal Standard for Coverage of Condoms and Percentage of Outlets in Hotzones Having Promotional Material. Playa del Carmen - % 22

27 Appendix 2 Additional Maps Map 6. Hotzones which Accomplish the Minimal Standard for Coverage of Condoms and Percentage of Outlets in Hotzones Having Promotional Material. Veracruz - % Note: Points appearing outside the map are not misallocated, but they belong to a municipio for which PSI-Mexico does not have cartographic information available 23

28 Appendix 2 Additional Maps Map 7. Hotzones which Accomplish the Minimal Standard for Coverage Condoms and Percentage of Outlets in Hotzones with Retailed Prices at or Below the Recommended price. Cancun % Note: In this map is not included hotzone Nb. 8 (Dolphins Beach, where there is not any outlet with condoms available) 24

29 Appendix 2 Additional Maps Map 8. Hotzones which Accomplish the Minimal Standard for Coverage Condoms and Percentage of Outlets in Hotzones with Retailed Prices at or Below the Recommended price. Playa del Carmen 25

30 Appendix 2 Additional Maps Map 9. Hotzones which Accomplish the Minimal Standard for Coverage Condoms and Percentage of Outlets in Hotzones with Retailed Prices at or Below the Recommended price. Veracruz % Note: Points appearing outside the map are not misallocated, but they belong to a municipio for which PSI-Mexico does not have cartographic information available 26

31 Appendix 2 Additional Maps Map 10. Hotzones which Accomplish the Minimal Standard for Coverage and Percentage of Outlets in Hotzones with Condoms Visible. Cancun -. % Note: In this map is not included hotzone Nb. 8 (Dolphins Beach, where there is not any outlet with condoms available) 27

32 Appendix 2 Additional Maps Map 11. Hotzones which Accomplish the Minimal Standard for Coverage and Percentage of Outlets in Hotzones with Condoms Visible. Playa del Carmen - 28

33 Appendix 2 Additional Maps Map 12. Hotzones which Accomplish the Minimal Standard for Coverage and Percentage of Outlets in Hotzones with Condoms Visible. Veracruz - % Note: Points appearing outside the map are not misallocated, but they belong to a municipio for which PSI-Mexico does not have cartographic information available 29

34 Appendix 2 Additional Maps Map 13. Hotzones which Accomplish the Minimal Standard for Coverage and Percentage of Outlets in Hotzones Without Stock out of Condoms. Cancun -. % Note: In this map is not included hotzone Nb. 8 (Dolphins Beach, where there is not any outlet with condoms available) 30

35 Appendix 2 Additional Maps Map 14. Hotzones which Accomplish the Minimal Standard for Coverage and Percentage of Outlets in Hotzones Without Stock out of Condoms. Playa del Carmen -. % 31

36 Appendix 2 Additional Maps Map 15. Hotzones which Accomplish the Minimal Standard for Coverage and Percentage of Outlets in Hotzones Without Stock out of Condoms. Veracruz -. % Note: Points appearing outside the map are not misallocated, but they belong to a municipio for which PSI-Mexico does not have cartographic information available 32

37 Appendix 2 Additional Maps Map 16. Outlets Participants of The Shingón Campaign within Hotzones. Cancun -. Note: In this map is not included hotzone Nb. 8 (Dolphins Beach, where there is not any outlet participating in the Shingón Campaign) nor hotzone nb.7 (plaza 21) where there is a kiosk which participates in the Shingón Campaign 33

38 Appendix 2 Additional Maps Map 17. Outlets Participants of The Shingón Campaign within Hotzones. Zoom of the area where Hotzones are concentrated Playa del Carmen 34

39 Appendix 2 Additional Maps Map 18. Outlets Participants of The Shingón Campaign within Hotzones. Zoom of the area where Hotzones are concentrated. Veracruz - 35

40 Appendix 3 Audit Sheet Appendix 3: Audit Sheet MAP Study on Condom Coverage in Hotzones in Cancun, Playa del Carmen and Veracruz P001 P002 P003 P004 P004A P004B P005 P006 P007 Population Services International - PSI Mexico MAP Study para el análisis de la cobertura de condones en Cancún, Playa Del Carmen and Veracruz Segunda Ronda Nombre del Entrevistador Ciudad Nombre del establecimiento Dirección completa (incluir entre que calles) Código Postal Colonia Información de posicionamiento geográfico Hotzone No. Fecha y hora de visita Lat Long Día de la semana 1 Cancun 2 3 Veracruz Error Hora Playa Del Carmen : hrs Fecha (dd/mm/aaaa) 2 Discoteca 12 Farmacia 3 Bar Gay 13 Tienda de autoservicio 4 Cinema 14 Sexshop 5 Gimnasio/vapor/baño 15 Supermercado P008 Tipo de establecimiento 6 Lugar de encuentro sexual 16 Tienda de abarrotes P009 P010 P011 P012 P013 7 Table Dance 17 Hipermercados 8 Cantina 18 Tiendas departamentales 9 Casa de citas 19 Tiendas de conveniencia 10 Hotel/Motel 20 Misceláneas 11 Estética 1 Domingo 5 Jueves Día de trabajo (marcar los días en 2 Lunes 6 Viernes los que el establecimiento abre) 3 Martes 7 Sábado 4 Miércoles Hora de Apertura Hora de cierre 1 HSH 3 MTS Poblaciones que frecuentan el 2 HTS 4 TTT establecimiento 5 Clientes de trabajadores(as) sexuales Número aproximado de población que se encuentra en el establecimiento (SI APLICA ) P012A No. De HSH P012C No. De MTS P012B No. De HTS P012D No. De TTT P012E No. De clientes de trabajadoras/es sexuales 36

41 Appendix 3 Audit Sheet P014 Hay condones disponibles al momento de la visita? 1 Si 2 No P015 Se quedaron sin condones las últimas 4 semanas? 1 Si 2 No P016 Cuáles son las marcas y los precios de condones que venden en el establecimiento (SI APLICA) Marcas Precios P016A P016B P016C P016D P016E P017 Los condones están visibles? (SI APLICA) 1 Si 2 No P018 Hay lubricantes disponibles? 1 Si 2 No P019 P020 P021 Hay algún material promocional sobre condoes o prevención de VIH? (SI APLICA) Qué tipo de material promocional existe en el establecimiento? (SI APLICA. Marque todas las opciones correspondientes) Hay algún material promocional de la campaña Shingón? 1 S i 2 No 1 Display 3 Posters 2 Flyers 4 Folletos 1 Si 2 No P022 P023 Dónde está localizado el material promocional? (SI APLICA) 1 En la entrada 3 En los baños 2 En la barra 4 Otro lugar Es un establecimiento participante de la campaña 1 Si 2 No Shingón? Fin de la Encuesta -- End of Questionnaire 37

42 Appendix 4: LQAS Percentage Chart