Wall Street Journal - March 3, 2005
David Wessel at capital@wsj.com

PSI asks one question: What works? "In the commercial market, what works is the key," says Richard Frank, who has been PSI's president for 16 years. "In the nonprofit world, what works isn't the criterion," he says. He brags that his outfit is an exception, and he'd love to show you numbers to prove his point.

Now PSI finds itself in the cross hairs of some conservatives upset that PSI gets slightly less than half its $250 million annual funding from the U.S. foreign-aid budget. "It is time to stop funding immorality at taxpayer expense," an aide to Sen. Sam Brownback, the Kansas Republican, wrote in a memo reported by my colleague Michael Phillips. PSI funds "obscene" and "suggestive over-sexualized" ads for condoms, it complained. (Sen. Brownback wasn't available to comment.)

Like the U.S. government, PSI subscribes to the A-B-C approach to fighting AIDS : Abstinence -- Be Faithful -- Condoms. In Zambia, its posters shout: "Abstinence Ili Che!" or "Abstinence is cool!" In Malawi, its billboards show a teenage girl shunning the entreaties of three boys with the headline: "Sex Can Wait, but My Future Cannot."

The caption of PSI's Prudence brand condom says "Do like I do... always have one with you!"

Its marketing is clever and bold. In Central America, PSI collaborated with local artists to produce songs for popular radio stations to reach teens with messages about abstinence, fidelity and safer sex. "Te Esperare" ("I'll Wait for You") is set to soft-rock music. "La Fidelidad si Paga" ("Fidelity Pays") is set to salsa. And the merengue "Proteccion" ("Protection") reminds listeners that "your life is worth using protection." PSI promotions feature a mascot called Perinollo, an animated penis that the company says breaks the ice and makes the serious public-health message entertaining.

Sex sells. Gillette uses it to sell razors. Coca-Cola uses it to sell soda. It seems somewhere between silly and prudish to suggest that ads for condoms avoid the implication that they will be used for their intended purpose. PSI embraces what Mr. Frank calls "First World advertising." Why? "It works. What's the alternative? Bad advertising? Or the government saying: Thou shalt not...?"

Ads are usually cleared with the local health authorities. In Afghanistan PSI sells condoms for contraception, known there as "birth spacing." But the instructions for condoms, in deference to local sensibilities, are all in words. No drawings. Sometimes, it has to pull back. A few years ago, it yanked an ad that had aired for a year on state television in Laos after complaints from the Culture Ministry: The ad showed a woman using a water-filled Number One brand condom to carry a goldfish after a plastic bag she had been using burst. The slogan: "Number One can save your life."

PSI's recent critics argue that promoting condoms promotes sex among those who would otherwise avoid it. They want the U.S. government to focus almost exclusively on promoting abstinence and fidelity and to avoid organizations that do otherwise. This raises (at least) three questions.

One is democracy. Insisting that all governments respect human rights is a moral imperative, but should the U.S. decide whether countries devastated by AIDS should promote condoms to prevent its spread? Chad, where half the people are Muslim, issued a postage stamp last year with a silhouette of a man and woman facing each other, and the headline: "Prudence," a PSI condom brand. Should the U.S. Congress object?

Two is whether the U.S. should fight poverty and disease only through public-health groups that share the politics of the party in power. PSI's president worked in Jimmy Carter's Commerce Department, and I'll bet most of its employees voted for John Kerry. But Frank Carlucci, defense secretary in the first Bush administration, is on PSI's board, and it has alliances with faith-based organizations in 20 countries. Should any of that matter?

Three is Mr. Frank's simple, but powerful, question: What works? It prizes results above prejudices. It sees more bang-for-the-buck from prevention than treating AIDS ; it shies away from antiviral-drug programs. It's skeptical about the track record of using drugs to block mother-to-child transmission of AIDS in poor countries; it spends sparingly on that.

Experts debate what led to Uganda's success in fighting AIDS : Was it that young people waited longer? That adults had fewer partners? Or that condoms were more widely used? PSI pragmatically says all of the above. It promotes all three.

If it works, do it.

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