School-Based Condom Availability Programs



The Effects of School-Based Condom Availability Programs (CAPs) on Condom Acquisition, Use, and Sexual Behavior: A Systematic Review

Timothy Wang1 • Mark Lurie2 • Darshini Govindasamy3,4 • Catherine Mathews3,4

Published online: 17 June 2017

� The Author(s) 2017. This article is an open access publication

Abstract We conducted a systematic review to assess the

impact of school-based condom availability programs

(CAPs) on condom acquisition, use and sexual behavior. We

searched PubMed to identify English-language studies

evaluating school-based CAPs that reported process (i.e.

number of condoms distributed or used) and sexual behavior

measures. We identified nine studies that met our inclusion

criteria, with the majority conducted in the United States of

America. We judged most studies to have medium risk of

bias. Most studies showed that school-based CAPs increased

the odds of students obtaining condoms (odds ratios (ORs)

for individual studies ranged between 1.81 and 20.28), and

reporting condom use (OR 1.36–3.2). Three studies showed

that school-based CAPs positively influenced sexual

behavior, while no studies reported increase in sexual

activity. Findings suggest that school-based CAPs may be an

effective strategy for improving condom coverage and pro-

moting positive sexual behaviors.

Keywords School health � Condom use � Sexual behavior � Adolescent


Globally, adolescents and young adults (15–24 years)

account for approximately 60% of incident sexually

transmitted infections (STIs) [1]. According to recent

UNAIDS estimates, in 2015 female and males aged

15–24 years accounted for approximately 20 and 14% of

new HIV-infections among adults ([15 years), respec- tively [2]. Annually, an estimated 16 million adolescents

(15–19 years) give birth in low- and middle-income

countries, with complications from childbirth being the

leading cause of mortality among adolescent females [3].

Several key studies and reports have highlighted the lim-

ited access that adolescents have to basic sexual repro-

ductive health services (i.e. STIs and pregnancy prevention

services) in high-, middle- and low- income countries

[4–6]. Due to the burden of these sexual and reproductive

health conditions (i.e. HIV and STI acquisition, pregnancy

complications) among this population, there is a need to

implement strategies that can increase access to and uti-

lization of STI and pregnancy prevention methods. Given

that approximately 75% of individuals in the school-going

age for secondary education globally are enrolled in sec-

ondary school [7], schools may serve as an ideal platform

to extend coverage for these services.