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Why India’s free online condom store is succeeding when the government’s distribution system is not

Repeated condom stock outs and faulty distribution make it difficult for people to get condoms through the public health system.

When the international non-profit organisation AIDS Healthcare Foundation started a free online condom store in India this April, they were surprised by the response that it got. In less than three months, the store’s stock of nearly 10 lakh condoms was shipped out to customers.

The foundation had expected its initial stocks to last till the end of the year but has now ordered another 20 lakh condoms that are expected to arrive this month.

The foundation started the free online condom store to fill gaps in the National Aids Control Organisation’s condom distribution programme. Promoting the use of condoms is one of the cornerstones of the HIV prevention and control programme. NACO distributes condoms to groups of people at high risk of contracting HIV like sex workers, transgender people and gay men. NACO workers also distribute condoms at antiretroviral treatment centres at government hospitals. Besides, NACO also gives condoms to non-traditional outlets such as kirana shops and barber shops, where condoms are either given away for free or sold at a low prices. NACO has installed condom vending machines in major cities and towns so that people can pick up condoms discreetly.

Despite all these measures, the number of condoms that NACO has been able to distribute among people at a high risk of contracting HIV has fallen drastically in recent years. In its mid-term appraisal report published in August 2016, NACO said that while it has distributed 88 crore condoms in 2014-’15, it managed to distribute only 20.90 crore condoms in 2015-’16.

“The fall in the condom distribution was a very glaring gap,’ said Dr V Sam Prasad, the AIDS Healthcare Foundation’s India programme director. “We hear of stock outs every now and then.”

Akhila Sivadas, executive director at the Centre for Advocacy and Research that works with people living with HIV, said that NACO’s supply of condoms has been particularly erratic in the past year, because of stock outs. Outreach workers with the Centre for Advocacy and Research in Ajmer had to get condom supplies from the government’s Family Planning Programme in Jaipur to make up for the shortfall of condoms from NACO.

Dr S Venkatesh, the deputy director general of NACO, did not reply to Scroll.in’s queries about gaps in supply.

NACO and the Family Planning programme are the two public health channels through which condoms are distributed. The Family Planning programme distributes condoms at government health centres and directly to people through Accredited Social Health Workers or ASHAs.The National Family Health Survey shows that the use of condoms among married women has increased only marginally from 5.2% in 2005-’06 to 5.6% in 2015-’16.

Poonam Muttreja, executive director of the Population Foundation of India, believes that asking ASHAs to distribute condoms is a flaw in the programme’s delivery.

“How can ASHA convince a man to use condoms?” she asked. “People are shy to go to the village ASHA for condoms. She lives in the same community. This is a management failure and a distribution failure.”

Bypassing stigma

Given that in India there is still a lot of secretiveness about sex and stigma around contraception, the AIDS Healthcare Foundation wants to give more people access to condoms discreetly and a free online store seemed to be the best idea.

“The objective is to showcase how condoms can be distributed online,” said Prasad. “The stigma is so high. There is a lot of discomfort when a person goes to buy condoms. Having a free condom store ensures that the person’s identity is confidential.”

In their campaign about the online store, the foundation asked people to call on a toll free number or write and email to them asking for condoms. The store sends boxes of 144 condoms each to people calling and writing in. The store also checks that the person ordering condoms will use the condoms and not sell them.

It is uncertain whether this early success of the online condom store is filling the gaps in NACO’s and the Family Planning programme’s condom distribution. Most of queries for condoms have come from men in urban areas, said Prasad. This shows that people in villages who health workers find it difficult to reach are not using the online store yet. However, the foundation hopes that word of the store will spread enough for queries to come from rural areas too.

Some organisations that distribute condoms are also using the online store to bolster their supply. For example, a targeted intervention programme in Tamil Nadu associated with NACO asked for a lakh condoms.

In all, the foundation sent 2,820 consignments of condoms to individual clients, while about 18 larger consignments were sent to non-profit organisations.

Muttreja said that online delivery of condoms was a fabulous idea. “We should try do everything to promote condoms, which is the only contraceptive with no side effects,” she said. “Even one unwanted pregnancy is one too many.”

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