The effects of free condom distribution on HIV and other sexually transmitted infections in men who have sex with men

HIV and other sexually transmitted infections remain a burden on men who have sex with men in the era of effective combination antiretroviral therapy. New prevention efforts are therefore needed. One of these approaches is the current country-wide free condom distribution at gay bars with darkrooms and gay saunas in the Netherlands. This study assessed the effects of free condom distribution on incidence and burden of disease of HIV and other sexually transmitted infections.A model was constructed to calculate the impact of free condom distribution on HIV, hepatitis C, chlamydia, gonorrhoea, and syphilis among men who have sex with men visiting these venues. Outcomes included new infections averted and disability-adjusted life years averted. Scenario studies were performed to predict the effects of a further increase of condom use, condom effectiveness and coverage. Lastly, cost-effectiveness and sensitivity analyses were performed.Condom use at public sex venues increased after the intervention. Our model showed decreases in annual incidence risk, ranging from 5.73% for gonorrhoea to 7.62% for HIV. The annual number of new infections averted was largest for chlamydia and gonorrhoea (261 and 394 infections, respectively), but 42 new HIV infections were averted as well. Over 98% of the decrease in burden of disease was due to HIV. In scenarios where condom use and condom effectiveness were further increased, this reduction became more extensive. The intervention was cost-effective and cost-saving (for every €1 spent on condom distribution, €5.51 was saved) and remained this in all sensitivity analyses.Free condoms at public sex venues can reduce the transmission of HIV and other sexually transmitted infections. Condom distribution is an affordable and easily implemented intervention that can reduce the burden of disease in men who have sex with men substantially.