Massachusetts teenagers who attend schools where condoms are distributed are less likely than those whose schools do not make condoms available ever to have had intercourse and to have done so recently; moreover, if youth are sexually experienced, those in schools that provide condoms are more likely than those whose schools do not make condoms available to use condoms.¹ Students in schools with condom distribution programs receive instruction about more HIV-related topics than those whose schools do not provide condoms; they also have elevated odds of learning about how to use a condom or to prevent HIV. These are some highlights of an analysis of 1995 data for the state, which has what the analysts label "one of the most progressive and far-reaching...HIV/AIDS education policies in the country."

The data came from the Massachusetts Youth Risk Behavior Survey, which was conducted among a representative sample of high school students. At the time of the survey, the state had a four-year-old policy recommending that local school districts consider adopting policies regarding the provision of condoms and instruction for their use in high schools. In most districts with condom availability programs, school personnel distributed condoms, and students did not need parental consent to obtain them.

One-fifth of the 4,166 survey respondents attended schools with condom distribution programs. Compared with respondents from other schools, these youth were slightly younger (mean age, 16.0 vs. 16.1 years), were more likely to be in lower grades (59% and 53%, respectively, were in grades 9-10) and were more likely to be members of racial or ethnic minority groups (49% vs. 20%). The researchers used analyses of covariance and logistic regression to examine differences in HIV-related education and high-risk behavior between these two groups, controlling for student and community characteristics.

Nine in 10 youth surveyed had had any instruction about HIV in school, and the same proportion had learned about how to prevent HIV; students in schools with condom distribution programs were more likely than those in other schools to have received such instruction (odds ratios, 1.5-1.6). Overall, 50% had seen a presentation by a person with AIDS or been taught how to use a condom; the likelihood of these experiences, too, was elevated among respondents whose schools made condoms available (2.6 and 1.7, respectively). These students also reported having learned about a significantly larger number of HIV-related topics than those in schools that did not distribute condoms (2.2 vs. 1.8).

Half of respondents were sexually experienced, and one-third had had intercourse within the three months preceding the survey; odds of both lifetime and recent sexual experience were reduced among youth attending schools with condom distribution programs (odds ratio, 0.8 for each). Slightly more than half of those with sexual experience said they had used a condom at last intercourse or had used a condom for pregnancy prevention at that time; in both cases, the odds of use were doubled (2.1) for students at schools where condoms were available. Three-quarters of sexually experienced respondents had used any contraceptive at last intercourse, and one in four had used a method other than condoms; students in schools with condom distribution programs had reduced odds of giving these responses (0.5-0.6). Notably, the two groups did not differ with respect to age at first intercourse, number of lifetime or recent partners, or pregnancy involvement.

Another striking finding was that the two groups of youth were similar in their views about the accessibility of condoms and where they were most likely to obtain them: Although the great majority (89% both overall and among those with sexual experience) considered condoms easy to obtain, fewer than half said that they would most likely get them in school. The analysts suggest that these findings reflect the ease with which young people can obtain condoms in the community and students' potential reluctance to seek them from school personnel.

The researchers acknowledge that studies comparing condom use before and after schools implement a condom distribution program would be more "compelling" than their cross-sectional analyses. They further point out that unmeasured community and student characteristics may have influenced the results. Nevertheless, they contend that given their large, statewide representative sample of students, the findings suggest that school-based condom distribution programs "may improve HIV prevention practices."--D. Hollander

REFERENCE

1. Blake SM et al., Condom availability programs in Massachusetts high schools: relationships with condom use and sexual behavior, American Journal of Public Health, 2003, 93(6):955-962.