The Free Condom Initiative: Promoting condom availability and use in New York City

Background:
New York City (NYC) has one of the largest HIV epidemics in the US. Condom use has been shown to reduce the risk of HIV infection. Making condoms more available is one approach to increasing condom use.

Objective:
To evaluate the New York City Department of Health and Mental Hygiene's (DOHMH) Free Condom Initiative.

Method:
In 2005, the New York City Department of Health and Mental Hygiene (DOHMH) made free condoms available to organizations through a web-based ordering system. We interviewed managers and patrons in venues where people at high risk for HIV congregate about condom availability, acquisition and use.

Result:
DOHMH condom distribution increased from 5.8 million in 2004 to 17.3 million in 2006. Managers reported making condoms available at 76% (309/409) of high-priority venues, including syringe exchange programs (94%), DOHMH-funded non-profit organizations (88%), methadone clinics (85%), and homeless shelters (78%), but only 40% of gay bars. Only 64% of patrons reported condom availability in the 56 locations where patrons were interviewed and managers had reported availability. Among patrons who saw free condoms, 80% (280/351) reported taking them, and 73% (205/280) reported using them. Over half (58%) the patrons who saw free condoms reported using them.

Conclusion:
Condom distribution was dramatically increased by using a simple, web-based ordering system. In the venues we sampled, the majority of patrons acquired and used free condoms when available and visible, suggesting that increasing free condom availability will increase use.

Implications:
Providing condoms for free led to condom acquisition and use. A web-based ordering system can provide an inexpensive means for large-scale condom distribution. Participation in this initiative by a wide array of organizations was essential to the extensive free distribution of condoms. Special efforts or contracts are needed to ensure availability at gay bars.