To add some panache to the plain old prophylactic, New York City held a contest to design a new wrapper. Among the original artworks were tasteful takes on a top hat, a manhole cover, and a train entering a tunnel.
The idea generated plenty of interest there, as intended, and here, where entries are now being accepted for another competition: to design a limited-edition package for a new Philadelphia Condom.
"I think it is time for a new awakening, a new approach," said Caroline Johnson, director of the Philadelphia Department of Public Health's Division of Disease Control. For people not in mutually monogamous relationships, "using a condom should be the norm," she said, especially with signs that sexually transmitted diseases may be on the rise.
New York has had its own condom (with lettering based on subway signage) since 2007; it launched the contest a year ago to add another wrapper. The winning design (based on the power button found on digital devices) was introduced two months ago at a Halloween parade. An assistant health commissioner was dressed as a condom queen.
The Big Apple will distribute more than 41 million free condoms this year, with the apparent added benefit that commercial sales of all brands in the city increased at twice the national rate, said Carol Carrozza vice president of marketing for LifeStyles Condoms, citing Nielsen data.
Philadelphia gives out a mere 1.5 million prophylactics a year, including 60,000 female condoms. It has strong incentives to distribute more.
The city's rates of sexually transmitted diseases are among the highest in the country. The one bright spot has been a decade-long decline in gonorrhea. It tends to run in cycles, and preliminary reports for the first nine months of this year show a 33 percent increase compared with the same period in 2009.
Condoms are a key tool against STDs and AIDS.
An ideal public health campaign uses a simple idea in multiple ways to create cultural change, said Jay A. Winsten, director of the Harvard School of Public Health's Center for Health Communication. A condom contest makes sense as a first step, he said.
"People have already gotten the public health message. They just are not acting on it often enough or consistently enough. You have to make it cool," he said, using as an example how people now "feel good about being a designated driver."
The concept of a designated driver did not exist in this country until Winsten's new center imported it from Scandinavia in the late 1980s and led a campaign that was embraced by organizations ranging from Major League Baseball to Hollywood, which he said wrote related messages into more than 160 prime-time television episodes.
"It wasn't a don't message. It was a do message," he said. "The slogan was 'The designated driver is the life of the party.' "
In the campaign's first three years, he said, drunken-driving fatalities nationally declined 25 percent; there had been no change during the previous three years.
Achieving that kind of impact can require large amounts of creativity, commitment, and funding for years.
The New York City health department has marketed its condom in TV spots (to Latin, jazz, and hip-hop beats, in English and Spanish), posters, web banners, and bus, subway, and check-cashing ads. It created a Facebook page with the slogan, used throughout the campaign, "NYC Condom - Get Some!"
New York also runs a broad array of other prevention programs. The condom contest was one more thing.
"If you throw enough stuff against the wall, some of it is going to stick," said Monica Sweeney, assistant commissioner for New York's Bureau of HIV/AIDS Prevention and Control.
It attracted nearly 600 entries. A panel selected five finalists. More than 15,000 ballots were cast online to choose the winning wrapper by Luis Acosta, a 30-year-old graphic designer from Queens who had never before entered a contest nor done HIV advocacy.
His initial ideas involved slogans, and then he tried shapes. "I saw the power [button] on the computer and I thought, 'Wow, this might work.' Subtly speaking, it is one shape entering another shape," he said. Plus, "with the slogan I was also trying to empower New York City."
New York made him into a minor celebrity, briefly. Philadelphia is offering its winner $250. The work must be original and the artist must live in the city.
"This is a Philadelphia Condom," said Johnson, the disease-control director, emphasizing the draw of a brand (though, in actuality, the city's free condoms will all be procured from commercial manufacturers).
The condoms themselves will be paid for with an $85,000 federal grant for STD prevention. Promotion and other activities, however, must come out of the city's shrinking budget.
With the new wrapper, the city hopes to increase its current distribution by at least 50 percent, and to expand availability beyond health centers and community organizations to various types of retailers.
But the scope of the program, which Johnson calls a pilot, is unknown, largely because of funding uncertainties.
Meanwhile, disease rates are rising: Besides the sharp jump in gonorrhea cases, chlamydia and infectious syphilis are each up 8 percent for the first nine months of 2010.
Of particular concern to city health officials is that the preliminary numbers show spikes among teens and young adults. Philadelphia's extensive and long-running screening program in high schools may be partly responsible for pushing STD statistics higher than in other places, as more testing often finds more disease. But it also shows an ominous trend: Many of the same kids are getting infected again and again.
"So the prevention message is not getting through," Johnson said. "We clearly are not changing behavior."
Newly diagnosed HIV infections among teens and young adults in the city also have increased in recent years. Since infection with other STDs raises the risk of contracting HIV, Johnson told a recent meeting of the city Board of Health that she was "very worried" that the spike in gonorrhea cases could presage a further uptick in HIV.
Although the condom contest is not aimed at teens - and you have to be 18 to enter - young people are likely to be one focus of distribution.
Asked if she had a vision of a winning design, Johnson said she was looking for something appealing, colorful, and "attractive to teens."
Iconic images like the Liberty Bell might be problematic, she said, although many of the entries so far, like those in New York, are clever takes on real things rather than abstract designs.
Officials in both cities said that reaction to the contests, both inside and outside the health departments, has been entirely positive.
Running an effective condom campaign means pushing boundaries just so far and no more. What works in New York might not work in Philadelphia. And forget about Sweden.
Stockholm celebrated the launch of its own Kondom last year by stamping each gold pack with a unique number, from 1 to 100,000, and setting up a website where recipients were encouraged to tell their condom's story (and readers could vote for their favorites).
The rather tame winner: How number 30,041 traveled around Europe, half-forgotten, before turning up at an opportune time during a weekend holiday at an island hostel. (English translation: http://go.philly.com/30041/)