BMC Public Health 2007, 7:352 http://www.biomedcentral.com/1471-2458/7/352 health communication programs to address these prob- lems [5-9]. Although the focus of the programs varies – with some focusing more on family planning and others more on HIV/AIDS prevention – all of them could poten- tially increase condom use and in turn help reduce the number of new HIV infections. Several studies have exam- ined the impact of specific programs [10,11], as yet the cumulative impact of a wider range of complementary programs has not yet been investigated. Responding to the growing importance of social marketing and health communication programs, the 2001–2002 Zambia Demographic and Health Survey (ZDHS) included a series of questions on exposure to such programs [2]. The purpose of this paper is to examine the reach of selected social marketing and reproductive health communication activities in Zambia, and to assess their cumulative impact on condom use. HIV/AIDS Estimates of the adult prevalence of HIV in Zambia vary, with surveillance-based estimates putting the prevalence close to 20%, which is among the highest in sub-Saharan Africa [5,12,13]. HIV testing in the 2001–2002 ZDHS found a somewhat lower prevalence; 18% of women aged 15–49 and 13% of men aged 15–59 tested HIV positive [2]. HIV prevalence is more than twice as high in urban areas as in rural areas, 26% to 12%, respectively. Due to the relations between female commercial sex workers (CSWs) and long-distance truck drivers, HIV rates are extremely high along major national highways and border posts [14,15]. Recent estimates put HIV prevalence along major highways, borders, trading centers, and farming and mining towns in the vicinity of 30%. Among youth aged 15–24, the estimated HIV prevalence rate in 2001/ 2002 was 13% for men and 18% for women [16]. HIV/AIDS-related knowledge has improved considerably. Currently, approximately 95% of Zambians have heard of AIDS and know it is fatal. Nevertheless, a substantial frac- tion of Zambians continue to engage in risky sexual behavior. The 2001–2002 ZDHS indicates that 17% of men and 3% of women reported having two or more sex- ual partners in the past 12 months. Ten percent of men admitted paying for sex in the past 12 months [2]. Knowledge of male condoms is nearly universal, and more than three out of four adults know a condom source [2,5,17,18]. However, only 45% of females, in contrast with 72% of males, feel confident that they could obtain a condom. Despite the high HIV/AIDS awareness, levels of condom use have remained low, particularly with reg- ular partners [1,2,19]. Only 8% of women and 10% of men reported using a condom in last intercourse with their spouse or cohabiting partner. By contrast, 33% of women and 44% of men reported using a condom in last intercourse with a non-cohabiting partner. Among men who admitted paying for sex in the past year, 45% reported using a condom at last paid sex [2]. Similarly, high-risk groups, such as truck drivers and CSWs, typically do not use condoms consistently [14]. Social marketing and reproductive health communication campaigns Since the mid-1980s, numerous approaches have been used to address these reproductive health problems and to prevent the spread of the HIV virus. At present, numerous reproductive and HIV/AIDS prevention programs are being implemented through the private, public, and vol- untary sectors [3,20-24]. These programs target both the general population and high-risk groups such as women, adolescents, truck drivers, and commercial sex workers. Several programs specifically target adolescents and young adults [25-29]. Most programs use mass media and/or interpersonal communication campaigns to encourage Zambians to use contraceptives, and to prevent the spread of the HIV virus by promoting condom use and safer sexual behavior. The Zambia Social Marketing Program (ZSMP) was launched in 1992, and is implemented by the Society for Family Health (SFH), an affiliate of Population Services International. SFH distributes subsidized Maximum brand condoms, and promotes their use through intensive mass media and interpersonal communications. Like several other organizations, SFH makes extensive use of radio and television to promote healthy behavior, including use of Maximum brand condoms. For example, SFH's Club NTG (New Teen Generation) is a youth-oriented radio program about issues that affect youth, such as teen pregnancy, HIV/AIDS, sexuality and condom use. Similarly, An Inside Look is an interactive television talk show that addresses health and social issues [9]. SFH also produced and broadcast radio and television public service announce- ments with Dr. Kenneth David Kaumba, the former Pres- ident of Zambia. These public service announcements aim to discourage HIV-related stigma, and promote faithful- ness, condom use, and voluntary testing and counseling [8]. Many Zambian health campaigns have made extensive use of print media, song, dance, and drama, but recently radio and television programs have become popular means of educating the public about family planning and HIV/AIDS prevention [5,6]. The Zambia Integrated Health Programme (ZIHP) produces several health- related radio and television programs. The ZIHP radio and television documentary series entitled "Your Health Matters" is broadcast on the Zambia National Broadcast- ing Company's (ZNBC) Radios One and Two and on tel- Page 2 of 12 (page number not for citation purposes)