“Condom availability was not associated with greater sexual activity
among adolescents but was associated with greater condom use among those who
were already sexually active, a highly positive result,” says Susan
M. Blake Ph.D., of the Department of Prevention and Community Health at George
Washington University School of Public Health and Health Services in Washington,
D.C.
“When condoms are available in schools and are successfully used by
sexually active adolescents, they may be an effective means of preventing potentially
harmful outcomes such as HIV/STDs and pregnancy,” she adds.
Approximately half of all adolescents in grades nine through 12 report that
they have had sex, with nearly 60 percent using condoms during their most recent
sexual encounter, according to research cited in the study.
Blake and colleagues analyzed sexual risk behavior data from the 1995 Massachusetts
Youth Risk Behavior Survey with the goal of seeing how students attending schools
with condom availability programs differed from those whose schools lacked
such programs. Twenty-one percent of the 4,166 students who participated in
the survey were enrolled in schools with condom availability programs.
The practice of making condoms available in schools is fairly controversial
and many of the small fraction of schools nationwide that do so are in Massachusetts.
There, the Department of Education’s HIV/AIDS education policy includes
recommendations that district school boards consider making condoms — along
with instruction on how to use them and HIV/AIDS education — available
in secondary schools.
The researchers found adolescents enrolled in schools with condom availability
were less likely to report being sexually active or to report having recent
sexual intercourse. Also, sexually active adolescents in these schools were
more likely to report having used condoms during their most recent sexual encounter.
The study results are published in the June 2003 issue of the American
Journal of Public Health.
Blake and colleagues found no pregnancy rate differences between adolescents
in schools with and without condom availability programs, possibly because
sexually active students in schools without condoms available were more likely
to use non-condom contraception. Twenty-five percent of sexually active students
in schools without condoms available and 13 percent of students in schools
where condoms were made available used other forms of contraception.
“We suspect that the benefits of increased condom use may have been
offset by use of other contraceptives among students enrolled in the schools
without condom availability programs,” Blake says.
The researchers also found no differences in perceived access to condoms
between those who could get condoms at school and those who couldn’t. Students
may have been intimidated by the process of accessing condoms through school
personnel rather than via a drug store or vending machine. Perhaps “because
accessing condoms was likely to result in embarrassment, students did not perceive
that access to condoms was greater,” Blake says.
But the finding remains that reported condom use was greater among sexually
active teens in condom availability schools. Even if these teens were too embarrassed
to get condoms at the school clinic, the program may have indirectly influenced
them to use condoms:
“It may not have been making condoms available per se that was associated
with greater rates of condom use,” Blake says, “but rather the
fact that the adoption of such programs reflected broader community mores,
communicated positive social norms and environmental supports and facilitated
communication of family values and norms promoting condom use.”
The researchers note the cross-sectional “moment-in-time” nature
of their study as a limitation. Because the study was not designed to examine
changes in condom use from pre- to post-program, they say, its findings don’t
definitively prove the condom availability programs influenced teen sexual
behaviors.
“Nonetheless, our results suggest that making condoms available, a clear
indication of social and environmental support for condom use, may improve
HIV prevention practices,” Blake concludes.
“There is a continuing need for effective HIV, STD and pregnancy prevention
programs that discourage early onset of sexual activity and encourage protection
among adolescents who are already sexually active.”
