Identifying disparities in sexual health resources and their impact on sexually transmitted infections

In addition to their contribution to long-term sexual health complications, infection with sexually transmitted infections (STIs) increases the biological risk of HIV infection. Understanding the distribution of sexual health resources in a community can inform interventions aimed at preventing STIs. We developed an audit to assess condom availability and accessibility in St. Louis, Missouri and analyze their relationship to gonorrhea and chlamydia incidence rates from 2011. Google Earth “Street View” was utilized to simulate a driving audit, allowing for the identification and mapping of potential condom-selling vendors. Eligible businesses included gas stations, pharmacies, grocery/convenience stores, barbershops/beauty salons, and liquor stores/bars. Eligible businesses were called and completed a survey to assess condom availability (yes/no) and accessibility (cost of condoms, condom location, number of types). Spatio-statistical analysis of the businesses and STI rates was performed to identify the spatial relationship between condom accessibility and STI rates; while accounting for socioeconomic factors that may influence that relationship. Of the 1272 businesses contacted, 829 participated in the study. One-third of businesses sold condoms, with 177 of vendors storing the condoms behind the register. There was higher availability of condoms in ZIP codes with high incidence of gonorrhea and chlamydia; however, these regions had lower accessibility than low incidence areas.These findings suggest that condom accessibility is inversely related to STI rates, though high availability of condoms was associated with higher STI rates. These initial audit findings identify opportunities for future research and community-level interventions related accessibility of sexual health resources in high-incidence regions.