The Role of Free Condom Distribution Programs in STI Prevention

Despite being ‌preventable, STI (sexually transmitted infection) cases have increased in the U.S. over the past decade. Each year, approximately 20 million new cases of STIs occur, resulting in a total number of 68 million Americans affected by an STI.

Most new infections occur in those who do not use condoms or use them inconsistently or incorrectly. Condom distribution programs are a public health measure that can decrease the transmission of STIs by increasing the availability, accessibility, and acceptability of using condoms. 

In this article, we discuss the impact of STIs, who is at risk for contracting them, and primary prevention techniques. And here, you can find a map that GoodRx has developed to illustrate which states provide free condoms by mail, which you can share with patients. 

Rates of STIs

Alarming statistics from the U.S. Department of Health and Human Services (HSS) show that more than one-half of Americans will acquire an STI during their lifetime. 

Over the past decade, the rates of STIs have increased dramatically. From 2014 to 2018, the rates of reported cases increased as follows:

• Chlamydia: 19% increase

• Congenital syphilis: 185% increase

• Gonorrhea: 63% increase

• Primary and secondary syphilis: 71% increase

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Human papillomavirus (HPV) is the most common STI, with 14 million new infections occurring each year. 

Based on these rates and the high cost of treating STIs (more than $2 billion each year), the HHS has developed a national strategic plan, which is to be implemented through 2024. 

This plan focuses on the four STIs with the highest morbidity rates, which are:

1. Chlamydia

2. Gonorrhea

3. HPV

4. Syphilis

HIV infections are covered under a separate national strategic plan, as are Hepatitis B and C infections. 

The long-term impact of STIs and who is affected 

STIs produce harmful, sometimes irreversible, and costly problems. Some of the sequelae of STIs are:

• Cancer

• Chronic pelvic pain

• Ectopic pregnancy

• Facilitation of HIV transmission

• Fetal and perinatal health problems

• Infertility

• Pelvic inflammatory disease

Some groups seem to be disproportionately impacted by STIs. According to HHS data, these are: 

• American Indians/Alaska Natives (AI/AN) and African American (Blacks): These groups have higher rates of chlamydia, gonorrhea, and syphilis. 

• Men who have sex with men (MSM): More than one-half of the primary and secondary syphilis infections in 2018 occurred among MSM. 

• People who misuse substances: There is an association between substance misuse and the occurrence of STIs.

• Teens and young adults: The age group of 15 to 24 accounts for one-half of new infections each year, but only comprises about one-fourth of the sexually active population

Free condom distribution programs are an answer

Even though they recognize that using condoms helps prevent STIs, young adults continue to report inconsistent condom use. Experts believe there is a lack of perceived vulnerability to STIs — believing that “it won’t happen to me.” The lack of perceived vulnerability contributes to risky sexual behavior. Add alcohol into the mix, and the risk becomes even higher. Alcohol use impairs cognitive function and motor skills, while reducing inhibitions. Young adults who binge drink are more likely to engage in risky sexual behavior and not use condoms consistently. 

So how can healthcare providers (HCPs) help stop the spread of STIs? Following the HHS strategic plan guidelines, using primary prevention methods, and raising education and awareness are key components. 

Recommendations for HCPs that are included in the strategic plan are:

• Assessing sexual behaviors that increase risk for STIs

• Obtaining a sexual history and providing counseling on risk-avoidance and risk-reduction during the patient encounter

• Recommending pre-exposure vaccination for HPV and hepatitis

• Distributing free condoms

Condom distribution programs have been shown to save money, increase the use of condoms, and aid in STI and HIV prevention. Programs like these have also been shown to increase the acceptability, availability, and accessibility of condoms. The CDC and the American Academy of Pediatrics support condom distribution programs as an approach to STI prevention. 

Research has shown that condom distributions programs have:

• Increased carrying and use of condoms

• Promoted delayed sexual initiation or abstinence among youth

• Reduced future medical care costs by preventing HIV infections

• Helped reduce HIV and STI risk among a wide range of groups including youth, adults, commercial sex workers, and other populations with high rates of STIs

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Written by:

Windy Watt, DNP, APRN, FNP-BC

Windy Watt, DNP, APRN, FNP-BC, is a board-certified family nurse practitioner with 30 years of experience. She has an extensive background in critical care, internal medicine, family practice, and urgent care.

Edited by:

Lindsey Mcilvena, MD, MPH

Lindsey Mcilvena, MD, MPH is board certified in preventive medicine and holds a master’s degree in public health. She has served a wide range of roles in her career, including owning a private practice in North County San Diego, being the second physician to work with GoodRx Care, and leading teams of clinicians and clinician writers at GoodRx Health.

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