Structural Impediments to Condom Access in a High HIV/STI-Risk Area

Abstract

As embarrassment is a known obstacle to condom acquisition, selling condoms from physically inaccessible places that require personnel assistance constitutes a barrier to access. This study investigates the extent of this barrier in the Bronx, a high HIV/STI prevalence county of New York. 75 of 320 listed Bronx pharmacies were sampled via computer randomization. Investigators coded condom placement and physical accessibility within these pharmacies and 140 surrounding stores. 91% of sites sold condoms. In 82%, condoms could not be accessed without assistance. Condoms were physically inaccessible in venues most encountered in the community: grocery stores versus pharmacies (OR=15; 95% CI, 5–48), independent versus chain pharmacies (OR=32; 95% CI, 6–235). They were physically inaccessible more in the lowest SES/highest HIV prevalence areas versus the highest SES/lowest HIV prevalence areas (OR = 4.3, 95% CI, 1.1–17). Findings can inform efforts to increase accessibility of condoms, distribute condoms in alternative settings, and prompt similar investigations in other high-risk communities.