An increase in distribution with web-based ordering system was observed.
By making access to condoms easier and by distributing them in high-priority venues such as syringe exchange programs and homeless shelters, distribution of condoms in New York City rose by 11.5 million between 2004 and 2006, according to data presented at the 2008 National STD Prevention Conference, held recently in Chicago.
We have a big STD problem including HIV with more than 100,000 people infected with HIV in the city of New York and approximately 3,800 new diagnoses in 2006, said Tamar Renaud, MPH, of the Bureau of HIV/AIDS Prevention and Control in the NYC Department of Health and Mental Hygiene. Recent telephone surveys have shown that one-third of people with three or more partners in the past 12 months did not use a condom the last time they had sex.
Because it has been shown that condom availability does promote condom use, the initial objective of the Free Condom Initiative was to make condoms widely available. This was done by increasing the number of organizations that distribute condoms, thus possibly increasing condom acquisition and use. In June 2005, a new website was introduced (www.nyccondom.org) that allowed free ordering by those organizations at any time. Delivery of condoms occurred within 10 days.
Orders and availability
In 2006, the Free Condom Initiative was $1.34 million; this included condoms, shipping, condom bowls, distribution staff and distribution contracts.
To determine the effects of this program, target sites were identified based on venues where people at high HIV risk tend to congregate. These included syringe exchange programs, methadone clinics, homeless shelters, gay bars and organizations funded by the Department of Health and Mental Hygeine that focus on HIV-related services. From 2004 to 2006, condom orders increased from 5.8 million to 17.3 million. Eight hundred seventy-seven organizations ordered condoms in 2006; 59% of these were health care and social service organizations, 21% were private businesses such as clubs or liquor stores and 20% were health department clinics. Among the 18 syringe exchange programs targeted, 94% reported condom availability. Reported condom availability occurred in 74 (85%) of methadone clinics, 116 (78%) of the homeless shelters and 146 (88%) of health departmentfunded sites. Only 40% of the 98 participating gay bars reported condoms were available. Overall, 75% of the 452 targeted venues reported condom availability.
Patron interviews were also conducted to assess condom availability at the various sites. Ninety-three patrons were interviewed at syringe exchange programs whose managers had reported condoms were available, and 97% of these patrons also reported availability. Among 117 patrons at methadone clinics, 84% said condoms were available. Among 99 patrons at homeless shelters, 57% agreed on availability, and 31% of the 42 interviewed at gay bars said condoms were available.
Acquisition of condoms by patrons when they were available was also assessed by interview. Ninety-one percent of patrons at syringe exchange programs, 79% at methadone clinics, 73% at homeless shelters and 74% at gay bars reported condom acquisition when available. For those four types of venues, the percent of patrons reporting condom use when acquired was 86%, 75%, 54% and 77% respectively.
Challenges of distribution
Renaud said that a website works very well for social and health service organizations, but those that are not directly involved in social and health care services may need more direct advertising of the initiative and a lot of support in terms of maintaining the condom supply within their location. She also said that visibility of the condoms once they have reached the locations is also a crucial aspect to increasing acquisition and use.
We had not targeted gay bars in our initial announcements, so many of them did not know that the Free Condom Initiative was available, Renaud said. Also, our assumption that AIDS service organizations would distribute in gay bars, where their client base often congregates, was overly optimistic.
Other limitations of the study included the likelihood of overreporting of condom availability by participating patrons at syringe exchange programs and methadone clinics as well as a lack of investigation on sexual partner type (primary, casual or paid), which is known to influence condom use. – by Dave Levitan
For more information:
- Renaud T, Bocour A, Irvine M, et al. The Free Condom Initiative: promoting condom availability and use in New York City. Presented at: the 2008 National STD Prevention Conference; March 10-13, 2008; Chicago.