Exploring custom-fitted male condoms as a sexual health intervention in Cape Town, South Africa

Between June and August of 2013, graduate students from Emory University in Atlanta, Georgia conducted a mixed methods study in Cape Town, South Africa that explored the demand for, and feasibility of, incorporating custom-fitted male condoms into current sexual health interventions. In collaboration with the Human Sciences Research Council (HSRC) and other community-based and government agencies in Cape Town, the project surveyed 133 heterosexual men to explore experiences and attitudes regarding standard male condoms, and interest in non-standard sized male condoms. Team members also conducted 6 in-depth interviews with condom distribution and education staff at clinics and sexual health organizations to determine the feasibility of incorporating custom-fitted male condoms into existing interventions and practices, and 20 in-depth interviews with sex workers to examine interest in custom-fitted male condoms. Of the heterosexual men surveyed, nearly one-third (32%) had not used a condom during last sex. Two-thirds (67%) experienced condom fit problems including breakage or slippage, and 72% reported they would be more likely to use male condoms if they were custom-fitted. Findings from the qualitative interviews with condom distribution and education staff showed interest in greater condom size variety, with a preference for having a small number of different sizes, a well-organized supply chain, affordable pricing, and long-term supply availability. Most sex workers interviewed indicated that they had experienced condom failure during intercourse with clients, and the majority believed that the availability of more condom sizes would improve clients' willingness to use condoms. Sex workers felt that having several sizes (small, medium and large) would be most beneficial and feasible. Further, respondents indicated that size alone would not encourage increased condom use; clients prefer condoms that are colored, flavored, and textured. They also emphasized an aversion to using government-branded condoms. All of the different populations studied showed substantial interest in an expanded array of condom sizes. Further, the data highlight important considerations regarding the feasibility and logistics of introducing custom-fitted condoms as a sexual health intervention in Cape Town, South Africa.