Condom Availability Research Articles

Faktor yang Berhubungan dengan Penggunaan Kondom pada ‘Lelaki Seks Lelaki’ di Komunitas Independent Men Of Flobamora Kota Kupang

One of the populations at risk of HIV-AIDS is Men Sex with Men (MSM) because of unsafe sexual behavior, namely through anal and oral sex. One of the preventions of HIV-AIDS in MSM is the consistent use of condoms every time they have sex. There are various factors that influence the use of condom. This study aims to analyze various factors associated with condom use in MSM in the IMOF Community to prevent HIV-AIDS in 2020. The research’s design is a quantitative with a cross-sectional study design. The sampling method was carried out by simple random sampling technique and the sample size was 96 MSM with a questionnaire as the instrument. Data were analyzed using Chi-Square. The results showed that there was a relationship between knowledge (ρ = 0.002), attitude (ρ=0.000), information exposure (ρ=0.042), availability of condoms (ρ=0.022), partner support (ρ=0.000) and support from friends in the community (ρ=0.009) with the use of a condom. From this study, it can conclude that knowledge, attitudes, information exposure, availability of condoms, support from partners, and support from friends in the community are a factor that influences condom use among MSM in the IMOF Community in Kupang City in preventing HIV-AIDS. It hoped that MSM could maintain and increase their knowledge, actively seek information about HIV-AIDS, independently provide condoms to be used, strengthen relationships with partners and friends in the community to help in HIV-AIDS prevention efforts.

Sexual discounting: A systematic review of discounting processes and sexual behavior.

Behavioral processes underlying sexual behavior are important for understanding normal human functioning and risk behavior leading to sexually transmitted infections (STIs). This systematic review examines delay and probability discounting in human sexual behavior through synthesis of 50 peer-reviewed, original research articles. Sixteen studies focusing exclusively on monetary delay discounting found small effect size positive correlations with sexual risk behaviors. Eleven studies examined delay or probability discounting of sexual behavior itself using tasks that varied duration, frequency, or quality of sex to determine value. Results show delay and uncertainty of sex causes systematic decreases in value. These studies also show consistent medium effect size relationships between sexual discounting measures and sexual health and substance use, supporting utility above and beyond monetary discounting. Twenty-three studies have modeled clinically relevant decision-making, examining effects of delay until condom availability and STI contraction probability on condom use. Observational and experimental designs found condom-use discounting is elevated in high-risk substance use populations, is sensitive to context (e.g., partner desirability), and is more robustly related to sexual risk compared with monetary discounting or condom use decisions when no delay/uncertainty was involved. Administering cocaine, alcohol, and, for some participants, methamphetamine increased condom-use discounting with minimal effect on monetary discounting or condom use when no delay/uncertainty was involved. Reviewed studies robustly support that sexual behavior is highly dependent on delay and probability discounting, and that these processes strongly contribute to sexual risk. Future research should exploit these systematic relationships to design behavioral and pharmacological approaches to decrease sexual risk behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Understanding female condom use, acceptance, accessibility, awareness and knowledge among female public health students in a Nigerian university: A cross-sectional study

Background: The female condom is both a means of mechanical contraception and protection against sexually transmitted infections (STIs) and unwed pregnancies. The use and uptake of female condoms have been advocated as one of the safest ways to halt the risk of unplanned/unwanted pregnancies and STIs including HIV. Our study aimed to explore the knowledge, awareness, utilization, acceptance and accessibility of FC among female public health students in a Nigerian University. Methods: One hundred and ninety (190) female public health students took part in the study. A self-administered questionnaire was used to collect the data between August and December 2019. Data analysis was carried out using SPSS version 23. Results: Overall percentage awareness of female condoms usage in this study was 52.0%. Less than a quarter (22.4%) reported having seen a pack of female condoms, while the remaining 77.6% of the participants reported having never seen a pack of female condoms. In addition, the majority (87.4%) of the respondents did not know whether a female condom interferes with sexual pleasure/sensation. The majority of the respondents (77.4%) concurred that utilizing a female condom implies that "I don't trust my partner". Concerning accessibility of the female condom, only 1.8% agreed that FC is easily accessible while more than half (54.2%) are uncertain of the accessibility. Conclusion: Our study revealed a low level of knowledge and utilization of female condoms, and also limited access to the female condom as well as unsatisfactory acceptance and suboptimal awareness level which were suggested by the overall percentages in the study.

Factors associated with access to condoms and sources of condoms during the COVID-19 pandemic in South Africa

BackgroundEvidence has shown that the prescribed lockdown and physical distancing due to the novel coronavirus disease 2019 (COVID-19) have made accessing essential health care services much more difficult in low-and middle-income countries. Access to contraception is an essential service and should not be denied, even in a global crisis, because of its associated health benefits. Therefore, it is important to maintain timely access to contraception without unnecessary barriers. Hence, this study examines the factors contributing to limited access to condoms and sources of condoms during the COVID-19 pandemic in South Africa.MethodsThis study used the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM) wave 1 survey dataset. The NIDS-CRAM is a nationally representative survey of the National Income Dynamics Survey (NIDS) conducted via telephone interview during COVID-19 in the year 2020. This is the first secondary dataset on COVID-19 conducted by NIDS during pandemic. A total of 5304 respondents were included in the study. Data were analysed using frequencies distribution percentages, chi-square test and multivariable logistic regression analysis.ResultsAlmost one-quarter (22.40%) of South Africans could not access condoms, and every 7 in 10 South Africans preferred public source of condoms during the COVID-19 pandemic. Those who were from other population groups [AOR = 0.37; 95% CI = 0.19–0.74] and those who were in the third wealth quintile [AOR = 0.60; 95% CI = 0.38–0.93] had lower odds of having access to condoms while those respondents who were aged 25–34 [AOR = 0.48; 95% CI = 0.27–0.83] and those with a secondary level of education and above [AOR = 0.24; 95% CI = 0.08–0.71] were less likely to prefer public source of condom.ConclusionsThis study concludes that there was limited access to condoms during the COVID-19 pandemic and that the preferred source of condoms was very skewed to public sources in South Africa. Strategic interventions such as community distribution of free condoms to avert obstruction of condom access during the COVID-19 pandemic or any future pandemics should be adopted.

Behavioral economics and safe sex: Examining condom use decisions from a reinforcer pathology framework.

Condom use substantially reduces unwanted pregnancies and sexually transmitted infections. While condom availability is a significant public health priority, effects of condom availability constraints remain relatively under-researched. The limited research on condom availability suggests two major barriers to use: (1) effort/costs and (2) delay to access. To date, we are aware of no study that explores both demand for and discounting of condom availability; the focus of this study was to account for condom decisions using a reinforcement pathology framework. This study used a condom purchase task and the Sexual Delay Discounting Task to quantify behavioral economics of condom use. Low sexual discounting was associated with higher willingness to engage unprotected sex. Demand metrics suggest participants indicating abstinence at condom breakpoint were willing to pay nearly double for condoms relative to individuals indicating unprotected sex at breakpoint. Finally, we grouped participants into reinforcement pathology risk groups based on their discounting and demand indices; these groups significantly differed in self-reported number of sexual partners, unprotected sexual partners, and Sexual Desire scores. This study demonstrates the value of behavioral economic approaches to public health concerns, and further underscores the translational benefits of quantitative metrics to shed novel light on risky health decisions.

Sexual network and condom use among male migrants in the context of China’s gender imbalance

ABSTRACT In the context of China’s gender imbalance, this study addresses the characteristics of sexual networks and their association with condom use in a sample of 713 male migrants (aged 28-64) who have rural hukou (household registration) in China. Descriptive statistics, univariate analyses, and multilevel random intercept models were used to investigate the characteristics of sexual networks and their associations with condom use. We found that age, marital status, type of sex partners, support (the main help given to each sex partner by the participant), type of sexual intercourse, and stability of sexual relationships were associated with condom use. The sexual networks were mainly composed of sex partners of similar age (58.46%), unmarried people (50.53%), and regular partners (49.38%). Married male migrants were more likely to use condoms with casual partners; unmarried male migrants were less likely to use condoms in emotional and stable relationships. Variation in individual factors, sex partners, and sexual relationship characteristics contribute to participation in condomless sex by male migrants. HIV prevention strategies should target unmarried male migrants and their casual sex partners by increasing their awareness of the risk of HIV transmission and the availability of free condoms.

Regional Variation of Family Planning Services in Nigerian Health Facilities

Background: Availability and accessibility of family planning (FP) services are the major factors affecting the fertility pattern and population growth rate in low-resource settings. This study aimed at assessing the availability of contraceptive methods in Nigeria health facilities offering FP services. Materials and Methods: This study compared survey data on FP services available from each of the six geopolitical zones in Nigeria. The study was a descriptive analysis of variations in the availability of FP services and contraceptive methods across the regions. Result: Out of the 767 facilities surveyed, 375 (48.9%) were located in rural areas and 392 (51.1%) in urban areas. The Northwest had the highest male condom availability of 96.2%. The emergency contraceptive method was being offered by 35.8% of the total 636 facilities reportedly offering the service. The proportion of the facilities offering the oral contraceptive method was higher in the Northeast (100.0%), Northwest (94.9%), and South-South (92.0%) than other regions (P = 0.002). While only 9.3% of facilities in the Northeast and 10.0% in the North-Central were offering sterilization for males, higher proportions, 17.7% of South-East and 32.7% of South-South facilities were offering it. The level of stockout of at least one FP method on the day of this survey was high across all regions, with the Northeast (60.8%) and North-Central (59.9%) having the highest proportion and the Northwest having the least stockouts (46.1%). Conclusion: This study found inconsistent FP services across all the six regions. Also, the proportion of facilities that had a stockout of at least one contraceptive method is unacceptably high and deserves improvement interventions.

HIV Pre-Exposure Prophylaxis, Condoms, or Both? Insights on Risk Compensation Through a Discrete Choice Experiment and Latent Class Analysis Among Men Who Have Sex With Men

ObjectivesWe considered how decision making around human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among gay, bisexual, and other men who have sex with men (GBMSM) is made in the context of one’s perceived risk of HIV acquisition and the availability of condoms. MethodsWe recruited 648 GBMSM aged 18 years old and residing in Singapore through Grindr. Participants were given information on PrEP and participated in a discrete choice experiment requiring them to choose between 2 baskets of PrEP attributes and compare the chosen “PrEP only” option to default options of “condoms only” or “PrEP with condoms.” Generalized multinomial logit model was used to examine the scaling effect and preference heterogeneity. Latent class analysis was conducted to examine preference heterogeneity in the sample. ResultsLatent class analysis revealed 3 classes of GBMSM: PrEP conservatives (53.9%), moderates (31.1%), and liberals (14.9%). PrEP conservatives were more likely to report greater utility when using condoms only compared with PrEP only, as well as PrEP with condoms, compared with PrEP only, and more likely to report the lowest utility for PrEP as perceived HIV risk increased. PrEP liberals were more likely to report greatest utilities for PrEP only compared with condoms only, as well as PrEP only compared with PrEP with condoms. The utility for PrEP was not affected by perceived risk of HIV or sexually transmitted infections when risks were low. ConclusionThis study provides some evidence for risk compensation among a class of GBMSM who already perceived themselves to be good candidates for PrEP before the discrete choice experiment.

Disrupted prevention: condom and contraception access and use among young adults during the initial months of the COVID-19 pandemic. An online survey

BackgroundThe initial response to COVID-19 in the UK involved a rapid contraction of face-to-face sexual and reproductive health (SRH) services and widespread use of remote workarounds. This study sought to...

Impact of the coronavirus disease 2019-related global recession on the financing of the global HIV response.

Impact of the coronavirus disease 2019-related global recession on the financing of the global HIV response.

Acceptability and accessibility of condom among men who have sex with men (MSM) in Imo state, Nigeria

HIV prevalence among high risk populations globally is substantially higher than in the general population though men who have sex with men continue to bear a high burden of the infection. The aim of this study was to determine the acceptability and accessibility of condoms among men who have sex with men in Imo State, Nigeria. Hundred and ninety five respondents functional in key population (KP) hot spots in presumptively selected Local Government Areas in the state were randomly selected. Semi-structured questionnaires were used for data collection and data obtained was analyzed using SPSS statistical package version 21. The result showed that 101(51.8%) of MSM had used condom during a sexual intercourse. Majority 97(50.3%) indicated that they would not use a condom they love or are in partnership with whereas 69(35%) used condom occasionally during intercourse. Majority of the respondents 103(52.8%) have practiced unprotected anal sex within the past six months prior to survey. The major constraint to condom accessibility was reported to be cost (26.3%). Other constraints to accessibility include condom prejudice (25.0%) and setting of residence (24.5%). Statistically, the study revealed no association between condom uptake and acceptability (P=0.001) however, there was an association between condom uptake and accessibility (P=0.594). Interventions targeted at the key population to evaluate trends in sexually transmitted diseases especially HIV as well as improvement of condom accessibility cannot be over emphasized.

Weaknesses in primary health care favor the growth of acquired syphilis.

Acquired syphilis is a sexually transmitted infection that affects the general population and has been growing in recent years in many countries. A study was developed aiming to analyze the trends of acquired syphilis associated with sociodemographic aspects and primary health care in Brazil, in the period from 2011 to 2019. This study used secondary data from the national notification systems of the 5570 Brazilian cities and a database of 37,350 primary health care teams, as well as socioeconomic and municipal demographic indicators. The trends of acquired syphilis at the municipal level were calculated from the log-linear regression, crossing them with variables of primary health care and sociodemographic indicators. Finally, a multiple model was built from logistic regression. 724,310 cases of acquired syphilis have been reported. In primary care units, 47.8% had partial coverage and 74.1% had health teams with poor or regular scores. 52.6% had rapid test for syphilis partially available. Male and female condoms are available in 85.9% and 62.9% respectively and 54.4% had penicillin available in the health facility. The increase in trends of acquired syphilis was associated with better availability of the rapid test; lower availability of male condoms; lower availability of female condoms; lower availability of benzathine penicillin; partial coverage of the teams in primary health care; limited application of penicillin in primary health care; higher proportion of teams classified as Poor/Regular in primary health care; higher proportion of women aged 10 to 17 years who had children; higher HDI; higher proportion of people aged 15 to 24 years who do not study, do not work and are vulnerable; and population size with more than 100,000 inhabitants. The following variables remained in the multiple model: not all primary health care teams apply penicillin; higher proportion of primary health care teams with poor/regular scores; population size >100000 inhabitants; partially available female condom. Thus, the weakness of primary health care linked to population size may have favored the growth of the acquired syphilis epidemic in Brazilian cities.

Determining the level of condom use and associated factors among married people in Tshwane District of South Africa.

Introductiondespite the wide availability of free male condoms in South Africa, high rates of new HIV transmissions are reported to occur among married couples. The aim of this study was to determine the level of condom use among the married people and to assess the factors associated with condom use in the Tshwane district of the Gauteng province.Methodsa cross-sectional study was conducted among 325 clients accessing health care services at the Steve Biko Academic Hospital. A self- administered questionnaire was used to collect data, which were entered onto an Excel spreadsheet and imported into Epi info version 7 for analysis. A logistic regression model was used to investigate the association between condom use and the explanatory variables. The odds ratio was used to measure the strength of the associations. The 95% CI and a cut-off point of 0.05 for the p-value were used to indicate statistical significance.Resultsthe mean age of the participants was 41.6 years (SD=7.7). Two hundred and seventy-six (276; 85%) of the 325 participants reported not using condoms. Trust, doing regular HIV testing, and refusal by the husband were among the reasons given for not using condoms. In this study it was found that, the level of education, age and employment status were the determinants of condom use.Conclusionthe level of condom use was low and sero-discordance was found to be the primary motivator for condom use. This study recommends the strengthening of and the widespread implementation of the CVCT service.

Condom Utilization and Affecting Factors Among People Living with HIV/AIDS Attending ART Clinics in Addis Ababa, Ethiopia.

BackgroundHuman immune deficiency virus or acquired immune deficiency syndrome (HIV/AIDS) has been a major public health problem globally as well as in Africa including Ethiopia. To prevent HIV effectively, condoms must be used regularly and consistently. When HIV positive individuals have sex without condom, they can easily transmit the vuirus to a seronegative partner. Condom utilization may be affected by various factors. Therefore, the findings from this study will give an opportunity to understand condom utilization and the barriers to condom use.ObjectiveTo assess condom utilization and associated factors among people living with HIV/AIDS attending anti-retro viral treatment (ART) clinics in Addis Ababa, Ethiopia.Materials and MethodsAn institution-based cross-sectional study was conducted among 677 people living with HIV/AIDS attending ART clinics in Addis Ababa from February 1, 2019 to March 30, 2019. The sampling technique was three-stage sampling and finally, the study participants were selected using a systematic random sampling technique. Data were coded, cleaned and entered in to EPIData version 3.4, and analyzed using SPSS version 23.0. The association between the dependent variable and independent variables was analyzed using binary logistic regression analysis at 5% level of significance.ResultsAbout 677 HIV/AIDS patients receiving ART at health centers participated in the study. From the total participants, 306 (45.2%) utilized a condom in the last six months. Sex (adjusted odds ratio (AOR)=2.02; 95%CI=1.34–3.05), marital status (AOR=0.39; 95%CI=0.19–0.77 and (AOR=0.48; 95%CI=0.24–0.94), employment status (AOR=0.27; 95%CI=0.12–0.59), type of partner (AOR=0.15; 95%CI=0.05–0.48 and AOR=0.46; 95%CI=0.27–0.79), condom access (AOR=3.97; 95%CI=2.04–7.75), disclosure of HIV status (AOR=0.21; 95%CI=0.14–0.33) and attitude towards condoms (AOR=3.76; 95%CI=2.49–5.65) had significant association with condom utilization.ConclusionCondom utilization was found to be low among people living with HIV/AIDS attending ART clinics in Addis Ababa. This finding indicates that high concern shall be given to minimize the gap. Sex, marital status, employment status, disclosure of HIV status, condom access, type of partner and attitude towards condoms were significantly associated with condom utilization. Hence, continuous condom provision, promotion, demonstration, and awareness creation are vital.

Crimes Against Morality: Unintended Consequences of Criminalizing Sex Work*

Abstract We examine the impact of criminalizing sex work, exploiting an event in which local officials unexpectedly criminalized sex work in one district in East Java, Indonesia, but not in neighboring districts. We collect data from female sex workers and their clients before and after the change. We find that criminalization increases sexually transmitted infections among female sex workers by 58 percent, measured by biological tests. This is driven by decreased condom access and use. We also find evidence that criminalization decreases earnings among women who left sex work due to criminalization and decreases their ability to meet their children’s school expenses while increasing the likelihood that children begin working to supplement household income. Although criminalization has the potential to improve population STI outcomes if the market shrinks permanently, we show that five years postcriminalization the market has rebounded and the probability of STI transmission in the general population is likely to have increased.

Hepatitis B, hepatitis C and HIV prevalence and related sexual and substance use risk practices among key populations who access HIV prevention, treatment and related services in South Africa: findings from a seven-city cross-sectional survey (2017)

BackgroundPeople who use drugs including people who inject drugs (PWUD/ID), sex workers (SWs) and men who have sex with men (MSM) are at increased risk of HIV and viral hepatitis infection. Limited epidemiological data on the infections exists in key populations (KPs) in South Africa. We investigated the prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV and selected risk factors among these KPs to inform effective responses.MethodsWe used convenience sampling to recruit a targeted 3500 KPs accessing HIV-related health services across Cape Town (SWs, MSM, PWUD/ID), Durban (SWs, PWUD/ID), Pietermaritzburg (SWs), Mthatha (SWs), Port Elizabeth (SWs), Johannesburg (MSM) and Pretoria (MSM and PWUD/ID) into a cross-sectional survey. An interviewer questionnaire to assess socio-demographic characteristics, drug use and sexual risk practices, was administered. HBV surface antigen (HBsAg); HCV antibody, viral load and genotype, and HIV antibody, was tested.ResultsAmong the 3439 people included in the study (1528 SWs, 746 MSM, 1165 PWUD/ID) the median age was 29 years, most participants were black African (60%), and 24% reported homelessness. 82% reported substance use in the last month, including alcohol (46%) and heroin (33%). 75% were sexually active in the previous month, with condom use at last sex at 74%. HIV prevalence was 37% (highest among SWs at 47%), HBsAg prevalence 4% (similar across KPs) and HCV prevalence was 16% (highest among PWUD/ID at 46%).ConclusionsHBV, HCV and HIV pose a health burden for KPs in South Africa. While HIV is key for all included KPs, HCV is of particular importance to PWUD/ID. For KPs, HBV vaccination and behavioural change interventions that support consistent condom and lubricant access and use are needed. Coverage of opioid substitution therapy and needle and syringe services, and access to HCV treatment for PWUD/ID need to be expanded.

Efficacy of HIV interventions among factory workers in low- and middle-income countries: a systematic review

BackgroundFactory workers in low- and middle-income countries (LMICs) are vulnerable to HIV transmission. Interventions are needed to prevent HIV in this population. We systematically reviewed published literature on the efficacy of various HIV interventions in reducing stigma, risk behaviors and HIV transmission among factory workers.MethodsA systematic review was performed using predefined inclusion and exclusion criteria. Four databases (PubMed, PsycINFO, Scopus and EMBASE) were searched for relevant publications between January 1, 1990 and December 31, 2018. Two independent reviewers assessed the methodological quality of studies.ResultsThirteen articles were included, with 2 randomized controlled trials and 11 cohort studies. Five interventions and their combinations were summarized. Educational intervention increased condom use and reduced the use of recreational drugs and alcohol before sex. Community intervention that proactively provide HIV counselling and testing (HCT) services could increase the detection rate of HIV and other sexually transmitted diseases (STDs). Lottery intervention increased HCT uptake and decreased HIV public stigma. Education combined with community intervention reduced the proportion of workers with casual sex and enhanced HIV knowledge. Peer education combined with community intervention increased the proportion of workers who were willing to take their partners to HCT. Policy intervention combined with peer education enhanced HIV knowledge, perceived condom accessibility and condom use with regular partners.ConclusionsVarious interventions improved HIV knowledge, decreased HIV stigma and reduced HIV-related risk behaviors among factory workers in LMICs. The combination of multiple interventions tended to achieve better efficacy than a single intervention. Persistent combination interventions are essential to address HIV in this population.

Harms of third party criminalisation under end-demand legislation: undermining sex workers’ safety and rights

After Canada’s laws criminalising sex work were struck down by the Supreme Court for violating sex workers’ rights and new end-demand legislation was passed in 2014. These new laws however continue to criminalise sex work third parties (i.e. venue owners/managers) who gain material benefits, despite evidence that managed in-call venues can provide important protections for sex workers. As part of a longstanding community-based study in Vancouver, this analysis drew on 25 in-depth interviews with third parties who provide services for indoor sex workers. We explored how end-demand third party criminalisation shapes indoor sex workers’ working conditions, health and safety. We found that most third parties were women and current/former sex workers, problematising assumptions of third parties as exploitative male “pimps”. Third parties provided client screening, security and sexual health resources for sex workers, yet end-demand laws restricted condom availability and access to police protections in case of violence, thereby undermining sex workers’ health and safety. Our findings highlight that third party criminalisation under end-demand legislation reproduces the unsafe working conditions under the previous laws deemed unconstitutional by Canada’s highest court. Legislative reforms to decriminalise all aspects of the sex industry, including sex workers’ right to work with third parties, are urgently needed.

Barriers to Condom Use Among Female Sex Workers in Tehran, Iran: A Qualitative Study.

BackgroundThere are many barriers for condom use, which was one of the most important methods to prevent the transmission of HIV among female sex workers. Therefore, the aim of the present study was to identify the barriers to condom use among female sex workers in Tehran, Iran.MethodsThis study was conducted with a qualitative approach and conventional content analysis among female sex workers in Tehran. Twenty-two female sex workers were selected through snowball sampling and purposive sampling. The data gathering method was a semi-structured interview and the data were analyzed using Graneheim and Lundman method. Guba and Lincoln criteria were used for evaluating research transferability.ResultsThe results of data analysis were categorized in three categories and seven sub-categories included 1) individual factors (not knowing HIV/AIDS properly, anti-loyalty and love, and personality traits), 2) structural factors (partner’s desire, problems with condom availability), and 3) cultural factors (cultural taboos, following the models).ConclusionThe results showed that lack of condom use is the consequence of different individual, structural, and cultural factors. So, it can be useful to take some initiatives at the individual level by raising awareness and understanding of female sex workers about HIV at the structural level by lowering the price of condoms and providing them extensively and at the societal level, by changing the beliefs and taboos about condoms.

California’s Prisoner Protections for Family and Community Health Act

In 2014, California passed Assembly Bill 966, which required condom access for persons incarcerated in all 35 California state prisons (33 men's and 2 women's prisons). The California Correctional Health Care Services and the Sexually Transmitted Disease Control Branch and the Office of AIDS of the California Department of Public Health collaborated in a prison administration-led multidisciplinary implementation workgroup. Our workgroup, representing public health, correctional health, legal and legislative affairs, labor relations, and prison staff members, participated in 4 planning meetings during May-September 2015. We surveyed prison staff members and incarcerated men to identify and address potential challenges; conceptualized a tamper-resistant condom dispenser; developed educational materials, frequently asked questions for staff members, and fact sheets for the public; and conducted forums for custody and medical staff members at each prison. Key lessons learned included the need for high-level custody support, engagement of labor unions early in the decision-making process, and flexibility within defined parameters for sites to determine best practices given their unique institutional population, culture, and physical layout. Condom access was initiated at 4 prisons in July 2015 and expanded incrementally to the remaining 29 men's prisons through July 2016. A total of 243 563 condoms were accessed in the men's prisons, for an average of 354 condoms per 1000 population per month. The start-up dispenser cost was $69 825 (735 dispensers at $95 each). We estimated an annual condom cost of $0.60 per person. Although staff members and incarcerated men expressed concern that this legislation would condone sex and provide repositories for contraband, no serious adverse incidents involving condoms were reported. California demonstrated that condom access is a safe, low-cost intervention with high uptake for a large correctional system and provided a replicable implementation model for other states. Prison condom programs have the potential to decrease transmission of sexually transmitted infections (STIs) among incarcerated persons and their communities, which are often disproportionately affected by STIs, HIV, and other chronic diseases.