The power of access: the extent and role of condom physical, financial and social accessibility in determining condom use in Kilifi, Kenya

Jacqueline K Papo, Oxford University Department of Public Health and Kenya Medical Research Institute (KEMRI)
Eduard J Sanders, Kenya Medical Research Institute (KEMRI)
Harold Jaffe, Oxford University

In Kenya, while HIV prevalence is high (7.8%), condom use is low. In two sites (urban/rural) in the Demographic Surveillance Area of Kilifi district: (i) all potential condom outlets (n=281) were mapped/surveyed; (ii) questionnaires on condom access/use were administered to a random sample of the population (n=630). Physical and financial measures of condom access (distance and affordability) pointed to greater barriers among rural respondents; and a composite measure of social barriers (embarrassment to get condoms, difficulty asking partner to use, negative attitude towards condoms, and lack of product exposure) indicated similar levels across both locations. Controlling for differences in socio-demographics and sexual-behaviour, individuals with no physical barriers were 2.2-times more likely to have ever used condoms, and individuals with no demand barriers were 3.9-times more likely to have ever used condoms. This highlights the important role of physical/financial and social determinants of access on individuals’ level of condom use.