title: Exploring the condom gap: is supply or demand the limiting factor - condom access and use in an urban and a rural setting in Kilifi district, Kenya.
abstract: OBJECTIVE
  to explore the extent of the condom gap, investigating the relative roles of supply-side and demand-side factors in determining condom use.
  
  
  METHODS
  GPS mapping of condom outlets, and population-based survey.
  
  
  METHODS
  an urban and a rural site were selected within the Epidemiological and Demographic Surveillance Site in Kilifi district, Kenya. Potential condom outlets (n = 281) were mapped and surveyed, and questionnaires on condom access and use (n = 630) were administered to a random sample of men and women aged 15-49. Multivariate logistic regression was performed to assess the relative roles of supply-side and demand-side barriers on condom use.
  
  
  RESULTS
  the median straight-line distance to free condoms was 18-fold higher in the rural versus urban site. Among sexually active respondents, 42% had ever used a condom, and 23% had used a condom over the past 12 months, with lower levels among rural versus urban respondents (P < 0.05). The mean number of condoms used was 2.2/person per year among all sexually active individuals (condom users and nonusers), amounting to 8.2% protected sex acts/person per year. The adjusted odds of condom use (past 12 months) were 8.1 times greater among individuals experiencing no supply-side or demand-side barriers, compared with individuals experiencing both types of barriers. Despite low levels of usage and the presence of supply-side and demand-side barriers, reported unmet need for condoms was low.
  
  
  CONCLUSIONS
  there is an urgent need for renewed condom promotion efforts aimed at building demand, in addition to improving physical access, in resource-limited settings with generalized HIV epidemics in sub-Saharan Africa.
authors.affiliation: Department of Public Health, University of Oxford, Headington, UK. jacqueline.papo@gmail.com
authors.forename: Jacqueline K
authors.initials: JK
authors.lastname: Papo
authors.forename: Evasius K
authors.initials: EK
authors.lastname: Bauni
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Peter
authors.initials: P
authors.lastname: Brocklehurst
authors.forename: Harold W
authors.initials: HW
authors.lastname: Jaffe
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data* / Q000600:supply & distribution; D003695:Delivery of Health Care; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006293:Health Promotion; D006301:Health Services Needs and Demand / Q000592:standards*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012725:Sexual Behavior; D055815:Young Adult