Questions and Answers: Condom Availability Programs
What Are Condom Availability Programs?
Condom availability programs are intended to reduce the barriers—financial, logistical, and social—that would otherwise deter sexually active teens from using condoms to reduce their risks for HIV/STD infection or unintended pregnancy. Condom availability programs typically operate in schools, health clinics, and other places where adolescents congregate; make condoms available at low or no cost to teens; and increase access to condoms in ways that reduce embarrassment or discomfort about acknowledging sexual activity.
According to the 2011 High School Youth Risk Behavior Survey, 47.4% of U.S. students in grades 9-12 have engaged in sexual intercourse, 15.3% have had sexual intercourse with four or more persons, and 60.2% of sexually active students used a condom during last sexual intercourse. 
Condom availability programs are not new. The U.S. Armed Services have made condoms available to sexually active soldiers through various programs for most of the past century.  Public high schools in New York City began to make condoms available to sexually active high school students in 1991, as one response to the HIV epidemic. But most U.S. school districts remain inexperienced at planning and implementing condom availability programs for their students.
Why Do We Need Condom Availability Programs?
The U.S. Centers for Disease Control and Prevention (CDC) states that “structural-level condom distribution interventions or programs (CD programs) are efficacious in increasing condom use, increasing condom acquisition or condom carrying, promoting delayed sexual initiation or abstinence among youth, and reducing incident STIs.” .
When health promotion specialists advocate for condom availability programs, it is most often for the purpose of reducing HIV transmission and preventing the need for costly HIV/AIDS medication and treatment services: “CD programs have been shown to be cost-effective and cost saving. It was estimated that one statewide CD program led to saving millions of dollars in future medical care costs by preventing HIV infections.” 
Many public health experts support condom availability programs for sexually active teens because use of condoms at the start of one’s sexually-active years increases the likelihood that one will use them consistently and correctly into adulthood: one study noted, “condom use at adolescent sexual debut was associated with a twofold increased likelihood of condom use during most recent sex.” 
‘Availability’ Versus ‘Distribution’:
It is more accurate to describe these programs as condom availability programs rather than condom distribution programs (the latter term is still widely used despite the misunderstandings it creates). Condom availability ensures access to condoms for youth who are sexually active, without “handing out” condoms to youth who are not seeking them. Many school-based condom availability programs require students to meet with a health counselor when they request condoms for the first time. Many also give parents the opportunity to inform the school in writing if they do not want their child to have access to the program (often called an “opt-out”). Some condom availability advocates argue these counseling and consent features are structural barriers for sexually active youth that discourage them from requesting condoms out of discomfort or embarrassment.
A review of multiple studies on the effectiveness of condom availability programs in the U.S. and elsewhere found “significant intervention effects… for the following outcomes: condom use, condom acquisition/condom carrying, delayed sexual initiation among youth, and reduced incident STIs.” 
A study performed in Holyoke and Springfield, MA found a “47% decrease in the rates of gonorrhea and chlamydia infection combined over three years after the implementation of a condom availability program [in a Holyoke school], whereas similar aged males in a Springfield school [without a condom availability program] had a 23% increase in the rates of gonorrhea and chlamydia infection.” 
Other studies of interest:
Condom Availability Programs Today:
By the first decade of the 21st century, condom availability programs have been established by public health departments and/or public high schools in most major U.S. cities (e.g. Philadelphia, Washington D.C., Los Angeles, Chicago, and New York City). In San Francisco and Chicago, female condoms have been made available in addition to traditional latex condoms. These programs are typically managed with funds and other support from city health departments. Health departments also often provide the condoms (and other supports, such as training and staffing) to school-based condom availability programs. In addition to health department- and school-based condom availability programs, health promotion specialists have provided education about condoms through social marketing campaigns and partnerships with community-based organizations and public health officials. 
In Los Angeles, the ‘Next Sex Symbol’ initiative is one of the newer large-scale condom availability programs and is funded by CDC and the Los Angeles County Department of Public Health. Inspired by the New York City Department of Health and Mental Hygiene’s own program which includes resident-designed, city-specific packaging for its condoms, ‘Next Sex Symbol’ has launched a package design contest to increase Angelinos’ awareness and support for the program. 
The state of Oregon has embarked on a condom availability program targeting specific counties, based on the number of new HIV diagnoses. Counties are eligible to receive condoms and lubricants from the Oregon Health Authority if they have reported at least 4 new HIV diagnoses between the years 2009-2011. Of Oregon’s 36 counties, 15 are eligible and 11 of these have actively participated as of 2013. 
Some condom availability program highlights:
Washington D.C.’s ‘Rubber Revolution’
 High School Youth Risk Behavior Survey, 2011, (Atlanta: U.S. Centers for Disease Control and Prevention), accessed September 9, 2013 at http://apps.nccd.cdc.gov/youthonline/App/QuestionsOrLocations.aspx?CategoryId=4.
 “Condom Distribution as a Structural Level Intervention” (Atlanta: U.S. Centers for Disease Control and Prevention, October 2010), accessed September 9, 2013 at http://www.cdc.gov/hiv/pdf/prevention_programs_condom_distribution.pdf.
 Taraneh Shafii et al., “Is Condom Use Habit Forming? Condom Use at Sexual Debut and Subsequent Condom Use,” Sexually Transmitted Diseases 31.6 (June 2004): 366-372, accessed September 9, 2013 at http://www.ncbi.nlm.nih.gov/pubmed/15167648.
 Mahnaz R. Charania et al., “Efficacy of Structural-Level Condom Distribution Interventions: A Meta-Analysis of U.S. and International Studies, 1998-2007,” AIDS and Behavior 15.7 (October 2011): 1283-1297, accessed September 9, 2013 at http://link.springer.com/article/10.1007%2Fs10461-010-9812-y.
 Sharon R. Wretzel, Paul F. Visintainer, and Laura M. Pinkston Koenigs, “Condom Availability Program in an Inner City Public School: Effect on the Rates of Gonorrhea and Chlamydia Infection,” Journal of Adolescent Health 49.3 (September 2011): 324-6, accessed September 9, 2013 at http://www.ncbi.nlm.nih.gov/pubmed/21856527.
 Condom Distribution Programs, Diffusion of Effective Behavioral Interventions project (DEBI), accessed September 9, 2013 at http://www.effectiveinterventions.org/en/HighImpactPrevention/StructuralInterventions/CondomDistribution/HealthDepartmentPrograms.aspx.
 Condom Distribution Plan (Salem: Oregon Health Authority, 2013), accessed September 9, 2013 at https://public.health.oregon.gov/DiseasesConditions/HIVSTDViralHepatitis/HIVPrevention/Documents/plan/OregonCDPlan2013.pdf.
 Ryan C. Burke et al., “The NYC Condom: Use and Acceptability of New York City’s Branded Condom,” American Journal of Public Health 99.12 (December 2009): 2178-2180, accessed September 9, 2013 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775787/.
 Emily Judem, “The Case for Condoms: Washington, DC’s Public Distribution Campaign,” Global Post, June 18, 2012, accessed September 9, 2013, at http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/washington-dcs-public-sector-condom.