Background:  In Kenya, while HIV prevalence is high (7.4%), condom use is low. This study investigates the role of geographic/financial and social factors in determining condom access and use among the sexually active general population. It was hypothesised that individuals with higher levels of geographic/financial and social access would have higher levels of condom uptake and consistency in use.

Methods:  Using an urban (Kilifi Town) and rural (Sokoke) site in the Demographic Surveillance Area in Kilifi district, Kenya:  all potential condom outlets (n = 278) were mapped; questionnaires on condom access and use were administered to a random sample of individuals, male or female, 15 to 49 years old (n = 630, 322 urban, 308 rural). Geographical data were processed using ArcMap 9.2, and STATA 9 was used for statistical analysis (c² test, t test, and logistic regression).

Results:  Levels of condom use were higher among the urban respondents than the rural respondents; levels of “high-risk” sex (with a non-marital/non-cohabiting partner) were similar across both sites (Table 1). Table 2 shows the definition and prevalence of individuals with “no geographic/financial barriers,” “no social barriers,” and “neither type of barrier.” Overall, only 7% had neither type of barrier. Controlling for factors associated with condom use (gender, age, education, and high-risk sex), individuals with no geographic/financial/social barriers were more likely to have reported condom use “ever,” “over the past 12 months,” and “most of the time.” This likelihood reached 13-fold (condom use over the past 12 months) among individuals with neither type of barrier (Table 3).

Table 1. Level of condom use, urban versus rural site

Table 2. Prevalence of geographic/financial and social barriers

Table 3. Effect of geographic/financial and social factors on condom use,
     among the sexually active

Conclusions:  In both the urban and rural study sites, condom use was low, and full geographic/financial and social access to condoms lacking. Controlling for socio-demographic factors and high-risk sex, individuals with higher levels of condom access had higher levels of uptake and consistency in use. These results point to the key role of efforts aimed at improving geographic/financial and social access to condoms in resource-limited settings. With fewer than a third of respondents using condoms “most of the time” during high-risk sex, efforts must also include messages emphasising consistency.