social marke tin g resea rch s erie s

Transcription

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
Research & Metrics
Population Services International
1120 Nineteenth Street NW, Suite 600
Washington, D.C. 20036
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 06500
Mexico, D.F.
Tel : + 52 55 55661528
Fax: + 52 55 55667315
Email: aospina@psimex.net
Pamela Faura
PSI/Mexico Country Representative
Email: pfaura@psimex.net
Ricardo Román Vergara
Deputy Director PSI/Mexico
Email: rroman@psimex.net
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.
Table of Contents
Executive Summary................................................................................................... - 1 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
MAP 2008 – Executive Summary
Mexico, 2009
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;
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Mexico, 2009
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 2009.
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 2009. 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
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Mexico, 2009
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.
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MAP 2008 - Findings
Mexico, 2009
Findings
Coverage of Condoms
Table 1. Condom Coverage by Supervision Area in Cancun, Playa del Carmen and Veracruz.
Mexico, 2007-2009
Hotzones in which at least 20% of non traditional outlets have condoms Hotzones in which at least 80% of traditional outlets have condoms City No. of Hotzones Year 2007 2009 2007 2009 Cancun (Direct %) 8 8 0 (0.0%) 5 (62.5%) Playa Del Carmen (Direct %) 5 5 4 (80.0%) 4 (80.0%) Veracruz (LQAS %) 19 19 5/19 (40.0%) 9/19 (60.0%) 14/19 (95.0%) TOTAL (Direct %) 32 32 9 (28.1%) 18 (56.2%) 27 (84.4%) 2007 2009 Minimum Standard: Hotzones in which at least 20% of non‐
traditional and 80% of traditional outlets have condoms 2007 2009 8 8 (100.0%) (100.0%) 0 (0.0%) 5 (62.5%) 5 5 (100.0%) (100.0%) 4 (80.0%) 4 (80.0%) 16/19 (95.0%) 5/19 (40.0%) 8/19 (55.0%) 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.
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MAP 2008 - Findings
Mexico, 2009
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.
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MAP 2008 - Findings
Mexico, 2009
Figure 1 –Comparison in Condom Coverage by EA’s in Cancun 2007 - 2009.
Coverage of condoms. Cancun, 2007
Coverage of condoms. Cancun, 2009
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MAP 2008 - Findings
Mexico, 2009
Figure 2 –Comparison in Condom Coverage by EA’s in Playa del Carmen. 2007 - 2009
Coverage of condoms. Playa del Carmen, 2007
Coverage of condoms. Playa del Carmen, 2008
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MAP 2008 - Findings
Mexico, 2009
Figure 3 –Comparison in Condom Coverage by EA’s in Veracruz 2007 - 2009.
Coverage of condoms. Veracruz, 2007
Coverage of condoms. Veracruz, 2009
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MAP 2008 - Findings
Mexico, 2009
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 PSI4

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. 2007 - 2009
Standard: Condoms are available in at least 80% of traditional outlets and 20% of non‐
traditional outlets AND: 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 Number hotzones that met minimum standard Total number of hotzones in each city Cancun (Direct %) 2007 2009 0.0% 12.5% (n= 0) (n= 1) 0.0% 37.5% (n= 0) (n= 3) 0.0% 62.5% (n= 0) (n= 5) 0.0% 62.5% (n= 0) (n= 5) Quality of Coverage (%) Playa del Carmen Veracruz (Direct %) (LQAS %) 2007 2009 2007 2009 0.0% 20.0% 0.0% 0.0% (n= 0) (n= 0) (n= 0) (n= 1) 0.0% 50.0% 40.0% 20.0% (n= 2) (n= 0) (n= 1) (n= 7) 60.0% 50.0% 60.0% 20.0% (n= 3) (n= 3) (n= 1) (n= 7 80.0% 55.0% 60.0% 20.0% (n= 3) (n= 4) (n= 1) (n= 8) Aggregated for the 3 cities (Direct %) 2007 2009 6.0% 0.0% (n= 0) (n= 2) 31.0% 9.0% (n= 3) (n= 10) 47.0% 13.0% (n= 4) (n= 15) 53.0% 13.0% (n= 4) (n= 17) 0 5 4 4 5 8 9 17 8 8 5 5 19 19 32 32 3
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)
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MAP 2008 - Findings
Mexico, 2009
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 2009. 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 2009.
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 2009.
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 2009 53% 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
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MAP 2008 - Findings
Mexico, 2009
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 2009. 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 2009. 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.
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MAP 2008 - Findings
Mexico, 2009
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 2007.
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. 2007 - 2009 5
Year Total target population 2007 2009 Cancun 1693 390 Playa Del Carmen 191 235 Veracruz 1993 950 Total 3877 1575 City Access ‐ All target Total FSW Access ‐ FSW groups 2007 2009 2007 2009 2007 2009 96.2% 83.6% 78.7% 100.0% 259 670 100.0% 100% 100.0% 100.0% 134 162 100.0% 92.3% 83.1% 100.0% 573 862 Average: Average: Average: 1694 966 100.0% 92.0% 99.1% 87.2 % Total MSM 2007 2009 1023 131 29 101 1131 377 2183 609 Access – MSM 2007 2009 88.6% 86.8% 100.0% 100.0% 100.0% 100.0% Average: Average:
95.6 % 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
2009.
5
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.
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MAP 2008 - Findings
Mexico, 2009
In Cancun, while in 2007 78.7% 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 2009. As MSM already had reached 100.0% of
access to condoms in 2007, no change was reported for 2009.
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 2007 - 2009 6
% of bars, night clubs , brothels & other FSW % of grocery stores City establishments with with condoms condoms 2009 2007 2009 2007 2009 2007 50.0% 15.3% 64.4% 0.0% 0.0% 0.0% Cancun (n= 0/2) (n= 2/4) (n=0/26) (n= 6/41) (n=0/9) (n= 7/11) 0.0% 71.0% 41.1% 20.0% 0 Playa del Carmen ‐ (n= 0/19) (n=2/10) (n= 12/19) (n=0/4) (n= 9/22) 46.4% 8.1% 21.2% 15.38% 11.11% 0.0% Veracruz (n=2/13) (n= 26/56) (n=9/81) (n= 11/136) (n=0/7) (n= 7/33) 13.33 % 35.4% 9.40% 15.0% 0.0% 35.0% Total (average) (n=2/15) (n= 28/79) (n=11/117) (n= 29/196) (n=0/20) (n= 23/66) % of Hotels / Motels / Pensions with condoms % of Discos, bars & other MSM establishments with condoms 2007 2009 30.0% 0.0% (n=0/9) (n= 3/10)
100.0% 100.0% (n=1/1) (n= 1/1) 14.3% 33.33% (n=4/12)
(2/14) 22.73% 24.0% (n=5/22) (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.
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MAP 2008 - Findings
Mexico, 2009
increase: from 0.0% in 2007 to 35.0% in 2009. 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 2009.
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 2007 11.0% 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 2009. No changes were reported for Playa del Carmen as there is only one
MSM hotspot and condoms had already been available since 2007. 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 2007.
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MAP 2008 -Limitations
Mexico, 2009
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
MAP 2008 -Limitations
Mexico, 2009
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
MAP 2008 - Conclusions and Programmatic Recommendations
Mexico, 2009
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 2009. 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
Mexico, 2009
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
Mexico, 2009
•
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
Appendix 1 – Sampled Areas
Mexico, 2009
Appendix 1: List of Sampled Areas
City Cancun Playa Del Carmen Veracruz Hotzone ID
101 102 103 104 105 106 107 108 201 202 203 204 205 301 303 305 306 309 309 310 311 313 314 315 316 318 321 323 325 327 329 333 Hotzone Name 8 Ejecutivos Playa Mercado Parián Calle de las sirenas Las Jarras Andador Turístico Puerto Juarez Plaza 21 Playa Delfines Andador turistico Las Hamacas Bartolos Babys Hot Bar la Hueva El Tigre Barrocos El Bucanero Kokobongo Barahaima Bar Mexico Mercado Hidalgo Hotel Campoamor La Otra El Nuevo Mamey La casa de papá Top Gold La Chica Loca Climax Cine lips Barradas Hot mamacitas Fandangos 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
Appendix 2 – Additional Maps
Mexico, 2009
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 - Mexico, 2009.
%
Note: In this map is not included hotzone Nb. 8 (Dolphins Beach, where there is not any outlet with condoms available)
21
Mexico, 2009
Having Promotional Material. Playa del Carmen - Mexico, 2009
%
22
Mexico, 2009
Having Promotional Material. Veracruz - Mexico, 2009
%
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
Mexico, 2009
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 – Mexico, 2009
%
24
Mexico, 2009
Retailed Prices at or Below the Recommended price. Playa del Carmen– Mexico, 2009
25
Mexico, 2009
Retailed Prices at or Below the Recommended price. Veracruz– Mexico, 2009
%
available
26
Mexico, 2009
Map 10. Hotzones which Accomplish the Minimal Standard for Coverage and Percentage of Outlets in Hotzones with Condoms
Visible. Cancun - Mexico, 2009.
%
27
Mexico, 2009
Visible. Playa del Carmen - Mexico, 2009
28
Mexico, 2009
Visible. Veracruz - Mexico, 2009
%
available
29
Mexico, 2009
Map 13. Hotzones which Accomplish the Minimal Standard for Coverage and Percentage of Outlets in Hotzones Without Stock
out of Condoms. Cancun - Mexico, 2009.
%
30
Mexico, 2009
out of Condoms. Playa del Carmen - Mexico, 2009.
%
31
Mexico, 2009
out of Condoms. Veracruz - Mexico, 2009.
%
available
32
Mexico, 2009
Map 16. Outlets Participants of The Shingón Campaign within Hotzones. Cancun - Mexico, 2009.
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
Mexico, 2009
Map 17. Outlets Participants of The Shingón Campaign within Hotzones. Zoom of the area where Hotzones are concentrated
Playa del Carmen – Mexico, 2009
34
Mexico, 2009
Map 18. Outlets Participants of The Shingón Campaign within Hotzones. Zoom of the area where Hotzones are concentrated.
Veracruz - Mexico, 2009
35
Appendix 3 – Audit Sheet
Mexico, 2009
Appendix 3: Audit Sheet
MAP Study on Condom Coverage in Hotzones in Cancun, Playa del Carmen and Veracruz
Population Services International - PSI Mexico
P001
P002
MAP Study para el análisis de la cobertura de condones en Cancún, Playa Del Carmen and Veracruz
Segunda Ronda
Nombre del Entrevistador
Playa Del
1 Cancun
2
Carmen
Ciudad
3 Veracruz
P003
Nombre del establecimiento
P004
Dirección completa (incluir entre
que calles)
P004A
Código Postal
P004B
Colonia
P005
Información de posicionamiento
geográfico
P006
Hotzone No.
P007
P008
P009
Fecha y hora de visita
Tipo de establecimiento
Día de trabajo (marcar los días en
los que el establecimiento abre)
P010
Hora de Apertura
P011
Hora de cierre
P012
Poblaciones que frecuentan el
establecimiento
P013
Lat
Long
Error
Día de la
semana
Hora
Fecha
(dd/mm/aaaa)
__ : __ hrs
2
Discoteca
12
Farmacia
3
Bar Gay
13
Tienda de
autoservicio
4
Cinema
14
Sexshop
5
Gimnasio/vapor/baño
15
Supermercado
6
Lugar de encuentro
sexual
16
Tienda de
abarrotes
7
Table Dance
17
Hipermercados
8
Cantina
18
Tiendas
departamentales
9
Casa de citas
19
Tiendas de
conveniencia
10
11
1
2
3
4
Hotel/Motel
Estética
Domingo
Lunes
Martes
Miércoles
20
Misceláneas
5
6
7
Jueves
Viernes
Sábado
1 HSH
3 MTS
2 HTS
4 TTT
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
Appendix 3 – Audit Sheet
Mexico, 2009
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? (S I
APLICA)
1
Si
2
No
P018
¿Hay lubricantes disponibles?
1
Si
2
No
P019
¿Hay algún material promocional
sobre condoes o prevención de
VIH? (SI APLICA)
1
Si
2
No
1
Display
3
Posters
P020
¿Qué tipo de material promocional
existe en el establecimiento? (SI
APLICA. Marque todas las
opciones correspondientes)
2
Flyers
4
Folletos
1
Si
2
No
1
En la entrada
3
En los baños
2
En la barra
4
Otro lugar
1
Si
2
No
P021
¿Hay algún material promocional
de la campaña Shingón?
P022
¿Dónde está localizado el material
promocional? (SI APLICA)
P023
¿Es un establecimiento
participante de la campaña
Shingón?
Fin de la Encuesta
-- End of Questionnaire –
37
Appendix 4: LQAS Percentage Chart