Online interventions for sexual behavior change among young people: a descriptive analysis of 19 free condom distribution websites

Theoretical Background and research questions/hypothesis: Condoms are an inexpensive and effective method for the prevention of unplanned pregnancy and sexually transmitted infections. Traditionally, free condoms have been distributed through site-based programs, e.g. at testing clinics, tabling events, as well as bars or stores. More recently, public health programs have begun offering free condom distribution online. Online programs have been shown to be more convenient and more comfortable than site-based programs; furthermore, data on users and sexual behavior can be captured more easily online than through site-based distribution [Butler et al, 2018]. The purpose of this study was to identify existing free condom distribution websites and analyze their content and services in order to formulate benchmarks which could lead to the development of guidelines for future online programs.

Methods: Eligible websites were identified through Google searches, news articles, and recommendations from experts in condom distribution (departments of health, National Coalition of STD Directors, etc.). An 87-item assessment form was used to extract data on website characteristics. Themes included: target population, supplies offered, order/delivery process, and sexual health information. Dual entry was performed and inter-rater agreement using Cohen’s kappa was calculated. Characteristics were summarized descriptively.

Results: 21 websites offered free condoms and delivery to individuals; two websites were excluded due to log-in requirements. Of the 19 included websites, target populations were primarily the general public (53%, n=10) and college students (26%, n=5); less common were teens (n=2), MSM (n=1) and LGBTQIA (n=1). All 19 websites offered male condoms, 11 (58%) offered lubricant, 9 (47%) offered female or internal condoms, and 8 (42%) offered dental dams. Delivery time was not stated on 10 websites (53%) or was greater than 1 week (42%, n=8); only one program delivered supplies within 1 week of placing the order. Topics frequently addressed on the websites were: STI/HIV (n=18), PEP or PrEP (n=15), and how to use a male condom (n=12). Information on consent and sexual abuse was limited (n=6, n=5 websites respectively).

Conclusions: Online condom distribution offers an alternative channel for accessing safer sex supplies, particularly for younger populations, who experience some of the greatest hurdles in condom acquisition and simultaneously the greatest risk of undesired sexual and reproductive outcomes. Websites assessed in this study targeted general populations and college age (18-24), focused primarily on STI/HIV prevention, and provided a variety of supplies. Still some gaps were identified. Delivery time should be shortened / specified to provide more clarity for users. Websites targeting high-risk populations (teens, MSM, LGBTQIA) were under-represented. Information on consent and abuse were missing from most websites, and not one website discussed the role of condoms in pregnancy prevention. These topics are integral to sexual and reproductive health and should be a fundamental part of social marketing campaigns for condom distribution.

Implications for research and/or practice: Online condom distribution has tremendous potential to reach young, high-risk audiences. Furthermore, these programs are conducive to gathering data on sexual behavior change though online survey / data collection at the time of order. Guidelines may be helpful to inform and evaluate online condom distribution programs.