Barriers to accessing free condoms at public health facilities across South Africa.

OBJECTIVES

Lack of access to public sector condoms still presents a fundamental barrier to condom use in most of South Africa. This study investigated the determinants of condom procurement at public health facilities in order to inform improved public sector condom distribution and promotion strategies.

DESIGN

Cross-sectional study.

SETTING

Twelve health facilities in four health regions of South Africa: Boland/Overberg, Empangeni/Jozini, Kimberley, and Pretoria.

SUBJECTS: Consecutive individuals procuring condoms and a sample of individuals not procuring condoms were interviewed on their recent sexual behaviour and condom-related knowledge and attitudes.

OUTCOME MEASURES: Factors associated with condom procurement.

RESULTS

Across all facilities, 554 individuals procuring condoms and a comparison group of 261 individuals not procuring condoms were interviewed. Eighty-three (33%) of those interviewed who were not procuring condoms stated that they would like to do so. Several potential barriers to condom procurement, including female gender and perceived risk of HIV, showed substantially different associations in different study regions. Only two factors, negative partner attitudes towards condoms and the use of other forms of contraception, were consistently associated with a decreased probability of condom procurement across all regions.

CONCLUSIONS

These results suggest that the barriers to condom procurement may vary considerably across South Africa. This heterogeneity suggests that national-level interventions to promote condom procurement and use may be less appropriate than specialised interventions addressing locally relevant factors, including those identified here.