Appropriate channels for condom distribution are key to effective condom use. Receptiveness to condom use is plagued by barriers, including embarrassment or timidity to obtain condoms from sources that require person-to-person contact. Health centres – particularly family planning clinics - are often the only sites for condom distribution, limiting access.
When channels for condom distribution are created that allow privacy and easy access - such as through more non-conventional venues like bars, restaurants, hotels and the workplace, often through vending machines, - condom use increases.
Community based distributors (CBDs) also can play an important role. Flexible and extended opening hours for clinics and centers that are located in busy areas in towns and cities can increase access for patrons of nightclubs, bars, cinemas and other social gatherings.
Cost can influence acquisition of condoms. In some instances, potential condom users cannot afford to purchase condoms at full commercial prices.
Alternatively, charging nominal fees for condoms – e.g., utilizing social marketing techniques - can be successful in cultures where there is a perception that purchased items have intrinsically greater value and therefore, are more likely to be used. Female condoms are more expensive to procure than male condoms (60 cents versus 3 cents per condom).
With increased production and demand for female condoms, the cost is expected to decrease. Endorsement of a safe reuse protocol (currently under investigation) would also reduce their cost. Whether borne by governments or individuals, the cost of condoms for HIV prevention is by far less than the financial and social burden of care and treatment for persons living with HIV/AIDS.
Health service provider attitudes can influence potential condom users. Many providers view condoms only for their role as contraceptives, downplaying or ignoring their infection prevention properties.
Often, when faced with recommending contraceptive choices, providers choose methods that are less user-dependent at the time of sexual relations, such as injectables or oral contraceptive pills. Some providers are openly uncomfortable discussing condoms, will not discuss condoms, or are biased against unmarried youth obtaining condoms. Peer counselors are often better able to relate to the potential condom user, facilitating discussions.
Myths, misperceptions and fears hinder access to and use of condoms. The readiness to use condoms is influenced by personal attitudes that are partly shaped by the socio-cultural environment. Condoms are sometimes associated with promiscuity, feared to be ineffective against HIV, or simply disliked. Ignorance of HIV or perceived low risk of becoming infected also contributes to the reticence to use condoms. Myths such as ‘condoms are HIV-contaminated’ can influence perceptions of entire communities.
Providing correct information and knowledge is important, however, is often insufficient to alter behaviour which requires finding what motivates people to use condoms consistently and correctly, and programming to stimulate and sustain this incentive.
Condoms – both male and female - are not adequately promoted, especially as a method of dual protection2. Encouraging use of condoms as a method of dual protection means promoting them for contraception and STI prevention. Studies indicate that when promoted as a means of dual protection, interest in condom use increases. Until microbicide spermicides become approved for use, condoms remain the leading device for dual protection. Counsellors should inform clients of the risks of STIs/HIV, potential condom failures and chances of unwanted pregnancy, and back up such as emergency contraception.
Unfortunately, competing priorities, especially at the country level, often leave few resources – financial or human - available for condom programming.
Use of male and female condoms requires cooperation of both partners. Some men, for a variety of reasons, are reticent to use male condoms, and women often have difficulty convincing men to use them. Although not a panacea, the female condom gives women a complementary option where they have greater control in initiating use which may aid in equalizing the gender imbalance that currently exists.