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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. [1]

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. [2] 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.” [3].

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.” [4]

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.” [5]

‘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.

Scientific Evidence:

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.” [6]

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.” [7]

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. [8]

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. [9]

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. [10]

Some condom availability program highlights:

NYC Condoms

  • Since 2007, the New York City’s Department of Health and Mental Hygiene has branded, packaged, and supplied its own ‘NYC Condom’ to appeal to local communities.
  • Partner organizations include public high schools, community-based organizations, shelters, private and public health clinics, bars, barbershops, clothing stores, and hotels.
  • Demand for condoms through this program has grown from 5.8 million condoms in 2004 to 17.3 million in 2006 to 41.5 million in 2009.
  • Social marketing campaigns are conducted annually and include TV and subway ads, web banners, and posters. Ad designs are tailored to particular communities in the city.
  • The website also provides information on free condoms by zip code and borough, correct condom use, and other HIV/STD resources in the city. [11]
  • Evaluation of the ‘NYC Condom’ initiative demonstrates its success at raising awareness and condom use among sexually active people: 76% of study respondents had heard of NYC condoms; of those, 75% of those had taken a NYC condom, and of those, 68% used one. [12]

Washington D.C.’s ‘Rubber Revolution’

  • In 2010 the District of Columbia Department of Health launched the “Rubber Revolution DC,” a city-wide condom availability program featuring a media campaign, educational materials, and interactive social media to encourage and reinforce consistent condom use. Local media personalities serve as ambassadors to encourage condom use and safer sex. The Department of Health conducted focus groups with District residents to ensure that the campaign’s messages would be relevant and effective.
  •  Demand for condoms grew from 500,000 free condoms in 2007 to 3.5 million by the program’s launch.
  • More than 300 partner organizations including clinics, hospitals, private social clubs, laundromats, convenience stores, beauty shops, nail salons, barber shops, and liquor stores, make free condoms available to their communities. Condoms can also be ordered through a Rubber Revolution website.
  • A social marketing campaign includes customized condom packages, dispensers, information cards, stickers, t-shirts, and posters/decals to promote condom use and emphasize condom availability at participating locations. 
  • The program website provides information on where to obtain free condoms and instruction on correct condom usage.
  • Youth-specific information campaigns have been developed for youth-serving community-based organizations and schools to help them become part of condom availability programming. [13,14]

 [1] 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.

 [2] Andrea Tone, Devices and Desires: A History of Contraceptives in America (New York: Hill and Wang, 2001).

 [3] “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.

 [4] Ibid.

 [5] 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.

 [6] 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.

 [7] 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.

 [8] “Condom Distribution as a Structural Level Intervention.”

 [9] 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.

 [10] 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.

 [11] “Condom Distribution as a Structural Level Intervention.”

 [12] 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/.

 [13] 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.

 [14] “Condom Distribution as a Structural Level Intervention.”

 

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