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2 Condom Support and Sources
Goals: Since it is not sex itself but unprotected sex that spreads HIV in most countries, increasing condom use has been a central intervention strategy for many AIDS programmes. Support for condom use and access to good quality condoms are a prerequisite for their use.

There are a number of dimensions to the accessibility of condoms. First, they have to be available in the country, either manufactured or imported in sufficient quantities to meet the needs of the population. Secondly, they must be distributed throughout the country and be conveniently available to the people who need them. Thirdly, they must be affordable to the people that want them. Other dimensions of accessibility include real or perceived barriers to condom acquisition such as restrictions on the age of those who can obtain them or social barriers to women or young people buying condoms.

The quality of condoms is also of great importance, since if they are of poor quality (poorly manufactured or improperly stored) they will not provide effective protection. In some cases misconceptions that condoms do not protect one from HIV transmission have been fuelled by distribution of poor quality condoms. Because increasing condom use is one of the keys to stemming the epidemic, it is essential that stocks of condoms are readily available and of high quality.

In general, AIDS programmes should try to make high quality, affordable condoms accessible to anyone who is likely to have sex, preferably at or near the venues where riskier sex is most likely to occur. For example, making condoms available at drinking and dancing establishments will make it easier for people to access them --many national programmes have begun incorporating such interventions in response to the reality of human behaviour. Measuring the effectiveness of the intervention will require new methods to include non-traditional retail and social establishments in condom distribution assessments.

The fact that condoms are available does not mean they are used. Indicators of condom use are discussed in the section on sexual behaviour. 

Key Questions: Are condoms consistently available within a country?
Are condoms available to consumers at the right time, place and price?
Challenges: Condom availability ought to be among the easiest areas of programming to track. A condom is either there or it is not --surely that can be measured? Unfortunately, poor information systems, a plethora of sources of condoms and accountability problems conspire against simplicity. And barriers to accessibility other than simple absence of condoms are often subjective and therefore difficult to measure. Condoms may be widely available in pharmacies, for example. But what help is that to a woman who finds herself unexpectedly choosing to have sex with a new partner after all the pharmacies have closed? If condoms are not readily available to her at that stage, has the programme met its goals or not?

Previous attempts to measure condom availability at the peripheral level (such as by WHO/GPA Prevention Indicator 3) have combined retail surveys with survey questions asking people whether they know where they can get condoms. Responses to individual questionnaires may however be poorly correlated with actual distribution patterns. Such measurement efforts are therefore of limited use in assessing the success of condom distribution nation-wide.

All of the indicators of condom availability and accessibility could equally be used for the female condom. 

USAID | UNAIDS | UNICEF | WHO | CDC | US Census Bureau
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