Condom Deserts Vs. Condom Swamps: Availability and Accessibility of Condoms and Their Relationship to Sexually Transmitted Infections

Background: Eliminating health disparities is one of the National HIV/AIDS Strategy goals, and thus identifying factors that contribute to geographic disparities in sexually transmitted infections (STIs) is pertinent to their elimination. This study was conducted to assess the relationship between condom availability and accessibility and the locations of STIs in order to better understand these geographic disparities. 

Methods: We conducted a condom availability and accessibility audit where local businesses (beauty salons, barber shops, liquor stores, bars, pharmacies, convenience stores, and gas stations) were contacted as identified using Google Earth. Additionally, we collected the census tracts of individuals who tested positive for gonorrhea, chlamydia and syphilis in 2011; as well as HIV infections from 2006-2011. We conducted geospatial clustering analyses to identify areas were more infections occurred and assessed the ratio condom availability and accessibility within those high and low risk areas.

Results: A total of 850 potential condom-selling establishments participated in the condom availability and accessibility audit in St. Louis City; 260 of those stores sold condoms.  These analyses identified geographic clusters of gonorrhea/chlamydia that housed the highest and lowest cases. We identified that stores within the high incidence clusters housed 82 stores that sold condoms behind the counter, while 9 stores sold them out in the open. In the low incidence cluster, only 13 stores sold condoms behind the counter, while 26 sold them out in the open. We were able to repeat these analyses for HIV and syphilis and identified similar patterns, yet in different locations.

Conclusions:  This study was conducted to provide evidence that condom availability and accessibility differ by geographic region, and likely are an integral component to influencing subjective norms and condom use. These findings have identified that future research needs to consider other neighborhood level factors that may further contribute to geographic disparities.