Abstract
BackgroundHIV and other sexually transmitted infections remain a burden on men who have sex with men in the era of effective combination antiretroviral therapy. New prevention efforts are therefore needed. One of these approaches is the current country-wide free condom distribution at gay bars with darkrooms and gay saunas in the Netherlands. This study assessed the effects of free condom distribution on incidence and burden of disease of HIV and other sexually transmitted infections.MethodsA static model was constructed to calculate the impact of free condom distribution on HIV, hepatitis C, chlamydia, gonorrhoea, and syphilis among men who have sex with men visiting these venues. Outcomes included new infections averted and disability-adjusted life years averted. Scenario studies were performed to predict the effects of a further increase of condom use, condom effectiveness and coverage. Lastly, cost-effectiveness and sensitivity analyses were performed.ResultsOur model showed that condom use at public sex venues increased after the intervention. Annual incidence risk decreased, ranging from 5.73% for gonorrhoea to 7.62% for HIV. The annual number of new infections averted was largest for chlamydia and gonorrhoea (261 and 394 infections, respectively), but 42 new HIV infections were averted as well. In scenarios where condom use and condom effectiveness were further increased, the number of infections reduced more extensively. Over 99% of the decrease in burden of disease was due to HIV. The intervention was cost-effective and cost-saving (for every €1 spent on condom distribution, €5.51 was saved) and remained this in all sensitivity analyses.ConclusionsFree condoms at public sex venues could reduce the transmission of HIV and other sexually transmitted infections. Condom distribution is an affordable and easily implemented intervention that could reduce the burden of disease in men who have sex with men substantially.
Highlights
HIV and other sexually transmitted infections remain a burden on men who have sex with men in the era of effective combination antiretroviral therapy
An increase in number of protected acts to 100% would result in a maximum of 126 HIV infections and 620 Disability-adjusted life year (DALY) averted, while the number of condoms needed would increase with 13.9% to 423,743
If only the condom effectiveness was increased to 100%, 302 HIV infections and 1490 DALYs would be averted
Summary
HIV and other sexually transmitted infections remain a burden on men who have sex with men in the era of effective combination antiretroviral therapy. This study assessed the effects of free condom distribution on incidence and burden of disease of HIV and other sexually transmitted infections. Promoting condom use has been part of HIV prevention strategies since the beginning of the epidemic among men who have sex with men (MSM) [1]. As the use of condoms and other safe sex practices became common, the incidence of HIV dropped sharply [3]. This lower incidence was maintained throughout the 1990s, until the introduction of effective combination antiretroviral therapy (cART) in 1996. Sexual risk behaviour, such as unprotected anal intercourse (UAI), has increased among MSM, and prevalences of various sexually transmitted infections (STIs) have risen [9, 10]; the incidence of HIV increased [3]
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