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The fate of free male condoms distributed to the public in South Africa

Myer, Landona; Mathews, Catherineb; Little, Francescac; Karim, Salim S. Abdoola,d

Epidemiology & Social: Concise Communication

Objectives: Public sector male condom distribution in South Africa rose from six million in 1994 to 198 million in 1999 as part of the government's condom promotion efforts for HIV/AIDS prevention. This study investigates what happens to the condoms which are distributed free of charge by the South African Department of Health.

Methods: A prospective study was undertaken during 1998–1999 at 12 representative public health facilities. Five-hundred and fifty-four consecutive subjects leaving the facilities were recruited and followed-up for 5 weeks to ascertain the fate of the 8164 condoms they had procured.

Results: A total of 384 participants (69.3%) and their 5528 condoms (67.7%) were followed successfully. After 5 weeks, 43.7% of the condoms had been used or broken in sex, 21.8% had been given away, 8.5% had been lost or discarded, and 26.0% were still available for use. Increased rates of condom use by participants were associated with active (compared to passive) condom procurement.

Conclusions: In light of the rapidly increasing number of free condoms being distributed by the public health service in South Africa, it is reassuring to note that wastage at 5 weeks is less than 10%. Extrapolating these data to the 198 million public sector condoms distributed in South Africa in 1999, at least 87 million condoms were used in sex. This methodology may be used to help evaluate the impact of existing condom distribution systems and the effectiveness of various condom promotion strategies.

From the aHIV Prevention and Vaccine Research, the bHealth Systems Research Unit, Medical Research Council and the Department of Public Health, University of Cape Town, the cDepartment of Statistical Sciences, University of Cape Town and the dDivision of Epidemiology, Columbia University School of Public Health, New York, USA.

Received: 6 November 2000;

revised: 26 January 2001; accepted: 6 February 2001.

Sponsorship: Supported by the South African Department of Health's HIV/AIDS & STD Research Funding Committee with support from the South African Medical Research Council. Ethical approval was provided by the Research Ethics Committee of the Faculty of Health Sciences at the University of Cape Town.

Requests for reprints to: L. Myer, Senior Scientist, HIV Prevention and Vaccine Research, Medical Research Council—Hlabisa, PO Box 658, Hlabisa 3937, South Africa. e-mail:

© 2001 Lippincott Williams & Wilkins, Inc.