Obstacles to access: An evaluation of a condom distribution program in rural Zambia

An extensive body of literature exists about HIV/AIDS prevention methods and programs promoting condom use in sub-Saharan Africa; however, there is a dearth of research investigating condom distribution in the region. In order to address some of the gaps in the literature about obstacles to condom access, this study estimates the effect of travel time and price on condom acquisition through an analysis of data collected in conjunction with a social marketing program (SMP) for condoms in rural Zambia. The SMP was implemented in 92 villages that are naturally clustered into nine regions. A community health volunteer located in each region sold subsidized condoms from their home, supplementing those available for free at the one health clinic in the area. Condom sellers were located at varying travel times from the free clinic and were randomly assigned one of two prices. Data were collected for every person who received condoms from the clinic or SMP over a 50 day period. Individual level data include demographic information, village of residence, and beliefs about condoms. Data were also collected at the village level including travel time to clinic and population size. I used zero-inflated Poisson regression models to compare villages before and after the introduction of the SMP to estimate the impact of the SMP on condom distribution. Random-effects models were used to estimate the effects of price and travel time on condom distribution. A multi-level logistic regression model was used to compare people who purchased condoms through the SMP with those who received condoms from the clinic. The condom acquisition rate in the population was very low, less than one percent per week, before the introduction of the SMP. The SMP doubled the number of condoms received and tripled the number of people receiving condoms; however, the condom acquisition rate remained low after its introduction. Findings suggest that travel time to the clinic and price both affect the impact of the SMP on condom distribution. Although improving condom distribution does not sufficiently raise the condom acquisition rate, it is one necessary condition for increasing the number of people acquiring condoms