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Condom Distribution as a Structural Level Intervention

May 27, 2015

Fast Facts
  • Condom Distribution Programs (CDPs) have been proven to increase condom use, prevent HIV/STDs, and save money.
  • CDPs change the environment so that there is increased availability, accessibility, and acceptability of condom use.
  • CDC requires select grantees to implement CDPs as part of a larger HIV prevention strategy.

Condom Distribution as a Structural Level Intervention

Scientific Support for Condom Distribution

There are several ways to promote condom use among people at high risk for sexual transmission of HIV. Individual and group-level interventions help do this by directly addressing individual's knowledge, attitudes, skills, and behaviors related to condom use, while community-level interventions give a strong emphasis to changing social norms. Although, individual-level, group-level, and community-level interventions demonstrate moderate to high success in promoting condom use, they show the greatest effect in reducing the risk of HIV infection when combined with structural-level interventions.

Structural-level interventions, such as distributing free condoms in diverse venues, social marketing campaigns, or policy change, can address the social, economic, and political environments that shape and constrain individual, community, and societal health outcomes. CDPs become structural interventions when the environment is changed so that there is increased availability, accessibility, and acceptability of condom use.

Recent research reported that CDPs as structural interventions:

Considerations for Implementing Structural-Level Condom Distribution Programs


To design and implement an effective structural-level CDP, organizations are encouraged to adhere to the following elements:

Strategic Planning of Your CDP

Identify the internal and external factors that will help build an effective CDP:

  1. Select your audience:
    • Individuals at high risk;
    • Venues frequented by high-risk individuals;
    • Communities at greatest risk for HIV infection, especially those marginalized by social, economic, or other structural conditions;
    • The general population within jurisdictions with high HIV incidence.
  2. Resources and partners -- Develop a process for identifying and engaging appropriate community partners and agencies that plan, implement, manage, or provide resources to support your program.
  3. Define your obstacles -- Identify difficulties, such as reaching members of vulnerable or hard-to-reach populations and strategies to overcome those challenges.
  4. Assessment -- Conduct an evaluation to identify any structural barriers and ensure that condoms are:
    • Available in the locations where members of the target population are found (e.g., pharmacies, condom dispensing machines, outreach workers).
    • Accessible in venues frequented by the target population (e.g. massive distribution of free condoms).
    • Acceptable to community members and in alignment with social norms (e.g. social marketing of condoms).
  5. Cost and Scale -- Calculate the costs and determine the scale of your CDP.
  6. Policy -- Identify the laws, policies, or practices that may support or hinder a CDP.
  7. Define objective, goals, and measurements -- Define your programmatic objectives, key indicators for measuring the program's performance, and define how data will be collected. Key indicators to consider are:
    • Number of condoms distributed
    • Number of agencies, venues, or settings where free condoms are distributed
    • Estimated number of audience impressions from campaign messages

What CDC Is Doing

In 2012, the CDC began a five-year HIV prevention funding cycle with health departments across the United States and its territories in a new approach to advance high-impact HIV prevention. The $339 million in funding supports health departments in conducting comprehensive HIV prevention programs and requires, as one of four requirements, that all 67 grantees establish and maintain CDPs for people with HIV and people at highest risk of acquiring HIV. Between 2012 and 2014, the programs have distributed over 248 million condoms.

Training and technical assistance on condom distribution is available to health departments, community-based organizations, and healthcare organizations through four CDC-funded capacity building assistance programs.

Examples of Successful CDPs

CDC has identified effective large-scale CDPs whose experience may be useful to other organizations:

Additional Resources:

1-800-CDC-INFO (232-4636)

CDC HIV Website

Act Against AIDS Campaign


  1. Charania MR, Crepaz, N, Guenther-Gray C, Henny K, Liau A, Willis LA, Lyles, CM. Efficacy of Structural-Level Condom Distribution Interventions: A Meta-Analysis of U.S. and International Studies, 1998-2007. AIDS Behav 2011 Oct;15(7):1283-97. Accessed May 13, 2015.
  2. Blankenship KM, Bray SJ, Merson MH. Structural interventions in public health. AIDS 2000 Jun;14 Suppl 1:S11-21. Accessed May 13, 2015.
  3. CDC. Condom Distribution Programs. Accessed April 15, 2015.
  4. CDC. Funding Opportunity Announcement (FOA) PS12-1201: Comprehensive Human Immunodeficiency Virus (HIV) Prevention Programs for Health Departments. Accessed May 15, 2015.
  5. CDC. High-Impact HIV Prevention: CDC's Approach to Reducing HIV Infections in the United States. Accessed May 15, 2015.
  6. Weller SC, Davis-Beaty K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;(1):CD003255. Accessed May 15, 2015.

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