CAPs: In Brief
School-based condom availability programs (CAPs) began in the early 1990s in U.S. high schools as one possible way to reduce HIV, other sexually transmitted diseases (STDs), and teen pregnancy. By 1995, CAPs existed in more than 50 school districts across 21 states, including high schools in large, urban school districts.1
As CAPs were implemented over time, some communities have raised questions about their effectiveness in reducing HIV, STDs, and teen pregnancy, and possible unintended impact on teens’ sexual behavior.2-4 Researchers now have many years of evidence to help answer these questions.
CDC researchers systematically reviewed scientific papers that evaluated school-based CAPs in the U.S.5 and found that no programs reported any increase in sexual activity, number of sex partners, frequency of sex, or other sexual risk behaviors.4, 6-9 Two school districts actually showed lower levels of sexual risk among their students in schools with CAPs, perhaps because of educational materials or messages handed out with condoms.6,7
Of the 8 high school CAPs evaluated in 12 different studies, data showed that CAPs can lead to increased condom use among students. As many as 74% of sexually active students reported using a condom they received from a CAP.6, 10 CAPs may be particularly impactful for adolescents at greater risk for negative sexual health outcomes. For instance, one study found that students who started having sex at a younger age, had sex frequently, and had more sex partners were all more likely to have used a condom from a CAP than students with fewer risk behaviors.6
Finally, the research also shows that CAPs are widely accepted among students, and teens say CAPs are needed.10, 11 Awareness of CAPs was high in all studies, with one study finding 90% of students supported their high school’s CAP.11 However, some students said they would be embarrassed to use CAPs and had concerns about confidentiality.11, 12
The review of scientific papers also identified several key program components that were characteristic of a successful CAP. Schools and districts should consider incorporating these elements into their program:
- An oversight committee
- Trained condom distributers
- A designated program lead to order and store condoms and informational material
- Promotion materials or activities (e.g., through teachers/nurses/peers in classes including health education lessons)
- Procedures for appropriate parental/caregiver notification
- Coordination with a school-based health clinic on campus or other school programs (e.g., school-based Chlamydia screening event)
- Ensuring condoms are available in a private and confidential setting where students are comfortable accessing or obtaining them
- Kirby DB, Brown NL. Condom availability programs in U.S. schools. Fam Plan Perspect. 1996;28(5):196-202.
- Guttmacher S. Parents’ attitudes and beliefs about HIV/AIDS prevention with condom availability in New York City public high schools. J Sch Health. 1995:101-106.
- Kirby D, Coyle K. School-based programs to reduce sexual risk-taking behavior. Child Youth Serv Rev. 1997;19(5-6):415-436.
- Guttmacher S, Lieberman L, Ward D, Freudenberg N, Radosh A, Jarlais DD. Condom availability in New York City public high schools: Relationships to condom use and sexual behavior. Am J Public Health. 1997;87(9):1427-1433.
- Andrzejewski J, Liddon N, Leonard S. Condom availability programs in schools: A review of the literature. Am J Health Promotion. 2019;33(3):457-467.
- Kirby D, Brener ND, Brown NL, Peterfreund N, Hillard P, Harrist R. The impact of condom distribution in Seattle schools on sexual behavior and condom use. Am J Public Health. 1999;89(2):182-187.
- Blake SM, Ledsky R, Goodenow C, Sawyer R, Lohrmann D, Windsor R. Condom availability programs in Massachusetts high schools: Relationships with condom use and sexual behavior. Am J Public Health. 2003;93(6):955-962.
- Guttmacher S, Lieberman L, Ward D. Does access to condoms influence adolescent sexual behavior? AIDS Reader. 1998;8(4):201-205+209.
- Schuster MA, Bell RM, Berry SH, Kanouse DE. Impact of a high school condom availability program on sexual attitudes and behaviors. Fam Plan Perspect. 1998;30(2):67-72.
- Schuster MA, Bell RM, Berry SH, Kanouse DE. Students’ acquisition and use of school condoms in a high school condom availability program. Pediatrics. 1997;100(4):689-694.
- Brown NL, Pennylegion MT, Hillard P. A process evaluation of condom availability in the Seattle, Washington public schools. J Sch Health. 1997;67(8):336-340.
- Rafferty Y, Radosh A. AIDS prevention and condom availability in an urban school system: Facilitating factors and programme challenges. Health Educ J. 2000;59(1):50-68.