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Barriers to Purchasing Condoms in a High HIV/STI-Risk Urban Area

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Abstract

The Centers for Disease Control and Prevention (CDC) have identified Atlanta, Georgia as a high-risk environment for STI/HIV infection. Condoms are an inexpensive and effective method for preventing STI/HIV infection. The majority of individuals acquire their condoms through purchase, rather than through free condom distribution programs. However, individuals purchasing condoms in stores encounter numerous barriers. This study assessed the environmental and physical barriers surrounding condom purchases in stores in downtown Atlanta. The findings revealed a combination of high environmental and physical barriers, low visibility of condoms in stores and limited selection of safer sex supplies. In the most densely populated area of the city, stores which sold condoms were few (n = 25), equating to 1 store per ~ 7000 people. In 80% of stores, personnel were required in order to access the condoms. In 28% of stores, condoms were hidden underneath the counter. The majority of stores offered only one brand of male condoms with a limited selection of lubricants and no dental dams or internal condoms. Barriers and discomfort surrounding purchasing condoms can contribute to embarrassment, which has a negative impact on condom acquisition and ultimately on condom use. Efforts must be made to lower barriers in Atlanta and make condoms more readily available to high-risk populations. Community advocacy has been effective in removing barriers to condoms. Access can furthermore be improved by: installing condom vending machines in public locations, offering self-check-out in stores that do not have physical barriers and encouraging individuals to order condoms online.

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Author information

Authors and Affiliations

  1. Emory University School of Medicine, Jane Fonda Center for Adolescent Reproductive Health, 46 Armstrong Street SE, Atlanta, GA, 30303, USA

    Megan McCool-Myers, Annabelle Myo & Jacqueline Ann Carter

Authors
  1. Megan McCool-Myers
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  2. Annabelle Myo
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  3. Jacqueline Ann Carter
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Corresponding author

Correspondence to Megan McCool-Myers.

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Appendix

Appendix

Survey

Store location and information

  1. 1.

    Store name

  2. 2.

    Store address

  3. 3.

    Store types

    • Gas station

    • Pharmacy

    • Convenience/grocery store

    • Other ______

  4. 4.

    Environment around the store (select all that apply)

    • Strip mall

    • Gas station, residential area

    • Gas station, non-residential area

    • Stand-alone store

    • Mixed-use community

    • Other: ______

  5. 5.

    Store hours: M-Th

    • Open/close

  6. 6.

    Friday

    • Open/close

  7. 7.

    Saturday

    • Open/close

  8. 8.

    Sunday

    • Open/close

  9. 9.

    Are they closed any day of the week?

Condom location and visibility

  1. 10.

    Does this store carry condoms?

    • Yes

    • If no, ask cashier for the reason.

  2. 11.

    Are condoms openly visible in the store (could you find them without the assistance of an employee)?

    • Yes

    • No

  3. 12.

    In which area of the store can you find the condoms?

    • Front

    • Middle

    • Back

    • Other

  4. 13.

    Where are the condoms in the store?

    • Aisle

    • Behind the cash register/counter

    • In front of a counter with personnel

  5. 14.

    Is there any nearby signage indicating the location of the condoms?

    • Yes

    • No

    • n/a

    • What does the sign say?

Free response: ______________________________________

  1. 15.

    Can you see the selection of safer sex supplies (condoms, lubricant, etc.) clearly at closest proximity?

    • Yes/No

  2. 16.

    Can you see the selection of brands clearly at closest proximity?

    • Yes/No

  3. 17.

    Can you see the prices clearly at closest proximity?

    • Yes/no

Condom access and condom variety

  1. 18.

    What are the types of products surrounding the condom selection (select all that apply)

    • Sex toys

    • Lubricant

    • Feminine hygiene products

    • Pregnancy tests

    • STD Testing Kits

    • Baby section

    • Stand-alone section

    • Other:

  2. 19.

    Is there a physical barrier in the condom section?

    • Yes, a glass case

    • Yes, a locked glass case

    • Yes, each condom is in locked cases

    • Yes, other: _____

    • No

  3. 20.

    Are store personnel required to procure the condoms?

    • Yes

    • No

  4. 21.

    Is the condom section under direct surveillance by store personnel?

    • Yes, a pharmacist

    • Yes, a cashier

    • Yes, a security guard

    • No

  5. 22.

    Are the condoms in an area that is accessible during all open hours?

    • Yes

    • No

  6. 23.

    Which brands of condoms are available?

    • Trojan

    • Durex

    • Lifestyles

    • One

    • SKYN

    • Nuvo

    • Okamoto

    • Other: ________

    • Other: _______

    • Cannot see selection

  7. 24.

    Which types of safer sex supplies are available?

    • Male condom (latex)

    • Lubricated male condoms (latex)

    • Male condoms latex-free

    • XL

    • Flavored male condoms

    • Colored/novelty male condoms

    • Internal condoms

    • Dental dams

    • Other: _______

    • Cannot see selection

  8. 25.

    Is lubricant available?

    • Yes

    • No

  9. 26.

    Does the store (if it’s a chain) have their own brand of condoms?

    • Yes

    • No

  10. 27.

    Which brands, if any, are offered at a discounted rate?

    • Free response

Condom pricing

  1. 28.

    What is the cheapest condom available at the lowest unit?

    • Brand, type, count, price

  2. 29.

    What is the most expensive condom available at the lowest unit?

    • Brand, type, count, price

  3. 30.

    What is the range of the amount of condoms in a package?

    • Free response

  4. 31.

    How much does a 12-pack of Trojan Enz (red box) w/o lubricant cost?

    • $___ for ___ condoms

    • This condom is not available

    • Cannot see selection

  5. 32.

    How much does a 12-pack of durex extra-sensitive (purple box) cost?

    • $___ for ___ condoms

    • This condom is not available

    • Cannot see selection

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McCool-Myers, M., Myo, A. & Carter, J.A. Barriers to Purchasing Condoms in a High HIV/STI-Risk Urban Area. J Community Health 44, 836–843 (2019). https://doi.org/10.1007/s10900-019-00670-5

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  • DOI: https://doi.org/10.1007/s10900-019-00670-5

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