Receipt and Use of Free Condoms Among U.S. Men Who Have Sex with Men

Objectives

Despite large public investments in condom distribution programs for HIV prevention among men who have sex with men (MSM), few evaluations have documented the reach of condom distribution programs or whether free condoms distributed to MSM are actually used. Among MSM recruited from social networking and dating websites, we examined the proportion who reported acquiring and using free condoms, and associations between select characteristics and reported acquisition and use of free condoms.

Methods

We used baseline data from a prospective, online cohort of U.S. MSM. Participants reported acquiring free condoms in the 12 months before interview and, for those who acquired condoms and had anal intercourse, use of the free condoms they acquired. We used multivariable log binomial regression models to describe factors associated with self-reported acquisition and use of condoms.

Results

Of the 2,893 men in the analytic sample, 1,701 (59%) reported acquiring free condoms in the past year. Acquisition of free condoms was higher for men who were younger, more educated, recently tested for HIV, and had higher numbers of sex partners. Seventy-three percent of men who acquired free condoms reported using them; use was higher for men who were black, had been recently tested for HIV, and reported greater numbers of sex partners.

Conclusions

Most MSM in our online sample reported receiving free condoms, and most who acquired free condoms reported using them. These data suggest that condom distribution programs have reasonable reach and utility as part of a comprehensive package of HIV prevention interventions for U.S. MSM.Men who have sex with men (MSM) are the group at highest risk for HIV infection in the U.S. In 2010, 61% of all new human immunodeficiency virus (HIV) diagnoses in the U.S. were among MSM,¹ who only account for an estimated 2% of the U.S. population.² Further, MSM have been the only risk group in which HIV incidence has been increasing since the early 1990s.³Condoms have been identified as a method to prevent sexual transmission of HIV since the early phases of the HIV epidemic in the U.S. In 1986, the Centers for Disease Control and Prevention issued a recommendation for the use of condoms to prevent sexual transmission of HIV, even prior to definitive findings of the effectiveness of condoms to prevent HIV transmission had been released.⁴ Since that time, condoms have been recognized as the most effective method to prevent the sexual transmission of HIV, aside from abstinence,^5–8 and condom promotion remains a mainstay of HIV prevention strategies, including the National HIV/Acquired Immunodeficiency Syndrome (AIDS) Strategy for the United States.⁹Although the effectiveness of condoms to prevent HIV transmission is well recognized, studies have noted that barriers to obtaining condoms, such as cost¹⁰ and embarrassment associated with purchasing condoms,¹¹ may prevent condom use. Given the demonstrated benefits of condoms coupled with the fact that barriers to purchasing condoms may prevent condom acquisition, many health departments, clinics, community-based organizations, and AIDS service organizations have implemented free condom distribution programs to ensure those individuals most at risk for HIV infection, such as MSM, have access to condoms.^12–14 Regardless of the size of the program, distributing free condoms requires the dedication of significant resources. For example, Louisiana''s statewide condom availability program, which distributed more than 33 million condoms from 1994 to 1996, cost an estimated $3 million during the three-year period.¹⁵ The Free Condom Initiative by the New York City Department of Health and Mental Hygiene (NYC DOHMH) distributed 17.3 million condoms in 2006 at a cost of $1.59 million.¹³Because of the considerable financial and organizational commitment involved in distributing free condoms, understanding the impact of free condom distribution is essential. Although it is important to define key indicators, such as the number of condoms distributed,¹⁶ to measure a program''s success, it is critical to determine the type of individuals receiving free condoms to ensure that those most at risk for HIV infection both have access to and make use of free condoms. To date, few studies have examined factors associated with acquisition and use of free condoms among MSM; those studies that have been conducted have been limited in geographic region to either one state¹⁷ or to urban areas.¹⁸ To address these research gaps, we examined characteristics associated with acquisition and use of free condoms using data from a national online HIV prevention survey.