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Condom conundrum: What spells program success?
By Rebecca Bowers
This article originally appeared in the December 2007 issue of Contraceptive Technology Update.
Officials at the District of Columbia Department of Health (DOH) are retooling the city's condom distribution program after meeting public resistance to its customized condoms.
The city launched its own private-label condoms, DC Condoms, in February 2007, as part of its "One Million Ways to Stop HIV" condom program. The condoms, packaged in a purple and mustard-yellow package, carried the message, "Coming together to stop HIV in DC."
In its work order for the private-label condoms, the DOH specified that FDA and American Society for Testing and Materials standards must be met in order to offer reliable protection.
To kick off the condom campaign, the DOH partnered with a variety of community providers to distribute an initial 250,000 DC-branded condoms. However, sites that signed up for the distribution program began to see a drop-off in interest in the free condoms as months progressed. Complaints were raised that packets were ripping in purses or bursting open in pockets. As a result, many recipients said they had little confidence that the condoms would offer protection.1
As of September 2007, the DOH said 650,000 condoms had been distributed through 50 community organizations across the city, including DOH clinics, health care and community groups, street outreach projects, youth-serving organizations, as well as at nontraditional locations, including dance clubs, bars, barber shops, beauty salons, and Laundromats.2 The private-label condoms were purchased from Boston-based Global Protection Corp. Some of the condoms were manufactured in China, while others were produced in Malaysia.3
Health officials met with community organization representatives in mid-September. Following that meeting, the public health department has worked with community partners to collect condoms still in storage for return to the manufacturer, says Leila Abrar, MPH, department spokeswoman. Condoms in storage at DOH also are being returned, she reports. The manufacturer is replacing all remaining supplies with brand-name condoms usually found on drugstore shelves.4
What steps are public health officials taking to bolster the condom distribution program? According to Abrar, plans for specific packaging of a DC condom are on hold, based on feedback received from community stakeholders during a Sept. 13 meeting.
"Community partners stressed their preference for brand-name condoms that are clearly identifiable as having been produced by a leading manufacturer," states Abrar. "DOH will continue to seek out recommendations from community partners on retooling the DC condom distribution program to obtain more brand-name condoms; identify more accessible, nontraditional locations; and improve overall public awareness and education on the importance of condom use."
Public health officials also will continue to seek recommendations from its community partners relating to consumer feedback and how to improve the condom distribution program, she states.
What spells success?
The Washington, DC, condom distribution program was designed to complement the health department's goals to encourage residents to be screened for HIV, institute routine screening in all health care settings, educate and equip residents to prevent HIV, and provide care and treatment to people with HIV/AIDS. Public health officials are facing an uphill battle: In 2005, the District of Columbia had the highest rate of AIDS cases — 128.4 cases per 100,000 people — among all jurisdictions in the country conducting AIDS surveillance.2
What aids in implementing a successful condom program? Developing a reliable distribution program is an important factor, says Thomas Farley, MD, MPH, professor and department chair of community health sciences at Tulane University School of Public Health and Tropical Medicine, New Orleans. Farley was involved with the first statewide condom social marketing intervention in the United States. The program, "Operation Protect," was implemented in Louisiana in the mid-1990s.5
"Since they [condoms] are not paid for by users, you can't distribute them through regular business channels," he says. "In a good program, condoms will be distributed by the millions, so any agency involved has to have a robust system to deliver them and make sure the highest-priority sites — eg, gay bars — have them displayed consistently and prominently."
Program staff and partners alike need to understand that condoms are extremely inexpensive and should be distributed in abundance, says Farley. Staff members often want to distribute condoms very stingily and express vague fears that people will "waste" them, he notes. "Condoms are like clean water in a refugee camp: the more the better," Farley states.