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Exploring the condom gap: is supply or demand the limiting factor – condom access and use in an urban and a rural setting in Kilifi district, Kenya

Papo, Jacqueline Ka,b; Bauni, Evasius Kb; Sanders, Eduard Jb,c; Brocklehurst, Petera; Jaffe, Harold Wa

doi: 10.1097/QAD.0b013e328341b9b8
Epidemiology and Social

Objective: To explore the extent of the condom gap, investigating the relative roles of supply-side and demand-side factors in determining condom use.

Design: GPS mapping of condom outlets, and population-based survey.

Methods: An urban and a rural site were selected within the Epidemiological and Demographic Surveillance Site in Kilifi district, Kenya. Potential condom outlets (n = 281) were mapped and surveyed, and questionnaires on condom access and use (n = 630) were administered to a random sample of men and women aged 15–49. Multivariate logistic regression was performed to assess the relative roles of supply-side and demand-side barriers on condom use.

Results: The median straight-line distance to free condoms was 18-fold higher in the rural versus urban site. Among sexually active respondents, 42% had ever used a condom, and 23% had used a condom over the past 12 months, with lower levels among rural versus urban respondents (P < 0.05). The mean number of condoms used was 2.2/person per year among all sexually active individuals (condom users and nonusers), amounting to 8.2% protected sex acts/person per year. The adjusted odds of condom use (past 12 months) were 8.1 times greater among individuals experiencing no supply-side or demand-side barriers, compared with individuals experiencing both types of barriers. Despite low levels of usage and the presence of supply-side and demand-side barriers, reported unmet need for condoms was low.

Conclusions: There is an urgent need for renewed condom promotion efforts aimed at building demand, in addition to improving physical access, in resource-limited settings with generalized HIV epidemics in sub-Saharan Africa.

aDepartment of Public Health, University of Oxford, Headington, UK

bCentre of Geographical Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya

cCentre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Headington, UK.

Received 30 July, 2010

Revised 13 October, 2010

Accepted 20 October, 2010

Correspondence to Jacqueline Papo, Department of Public Health, Rosemary Rue Building, Old Road Campus, Roosevelt Drive, Headington, Oxford OX3 7LF, England, UK. Tel: +44 1865 289 200; fax: +44 1865 289 260; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.