Background: The condom market in many sub-Saharan countries is dominated by subsidized condoms?free brands from the public sector and socially marketed (SM) brands from social marketing organizations (SMOs). The commercial sector share of the total market is often small. Freeing up resources devoted to subsidized condoms for use with other urgent priorities requires answering the following questions:
(1) are users of free condoms willing to pay for them?,
(2) are SM users willing to pay commercial prices? and
(3) if commercial brands were to reduce their prices, could they attract SM users?
Methods: Study countries were selected in consultation with government counterparts, condom manufacturers, SMOs, and donors, based on their potential for an increased role of commercial condom brands. The USAID-funded AIDSFree Project conducted cross-sectional household surveys with more than 6,500 adult male condom users in 2017 in Kenya, Nigeria, South Africa, Zambia, and Zimbabwe. Surveys used multiple price determination approaches?bidding game, discrete choice model, and van Westendorp price sensitivity measure?to estimate consumers'' willingness to pay for condoms. Analyses included price sensitivity simulations and secondary source consultation (i.e., demographic health surveys and condom market assessments).
Results: Free condom supplies exceed demand in all countries except South Africa, where recent demand data were unavailable for comparison. In Kenya, Nigeria, and South Africa, free and SM users are willing to pay substantially more than what they currently do for condoms. Yet decreasing the price of commercial brands is unlikely to attract SM users. In Zambia and Zimbabwe, free and SM users are willing to pay marginally more than they currently do.
Conclusions: Our assessment calls for greater alignment between levels of supply and demand for free condoms. In Zambia and Zimbabwe, abrupt funding reductions for free and SM brands would likely prompt a substantial proportion of users to cease using condoms; a gradual, phased approach is recommended. In Kenya, Nigeria, and South Africa, the condom markets possess the right conditions for transition to more commercially sustainable models. However, this does not negate the need for targeted distribution of condoms to vulnerable populations or initiatives that promote condom use.

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