How long-term benefits override upfront costs: using research and evaluation to justify a female condom intervention

In a time where economic interests override public health concerns, a new study published in AIDS and Behavior shows that public health spending can reduce costs in the long run. In general, female condoms are more expensive than male condoms. However, after cost-analyzing an initiative that distributed 200,000 condoms to women in a neighborhood with high rates of HIV-diagnosis in Washington D.C., the authors found that for every $1 spent, $15 was saved.

D.C. has the highest prevalence of HIV in the United States. 1 in every 33 residents is infected with the virus, and 1 in 14 residents in their 40’s have tested positive. The sexual health initiative began two years ago after a report noted these high levels of HIV/AIDS diagnoses.

The campaign, called D.C.’s Doin’ It!, chose to target sub neighborhoods with high HIV-diagnosis rates. Officials justified the distribution using study findings that showed large numbers of African American heterosexuals in the District engaging in risky sexual behaviors: (Something to consider: 92.3% of study’s participants self-identified as black. Is it possible to compare this to the other 7% of the study and make these same conclusions?)

The report also found that women had a higher HIV prevalence than men (6.3% versus 3.9% respectively). To empower and increase women’s autonomy, officials chose female condoms as the intervention. Female condoms give women the power to make healthy choices, even when a partner does not give them this choice.

The campaign dispensed these at convenience stores, beauty salons and community clinics and trained community members to discuss sexual health with peers in informal settings (UMN professor also used this approach, calling it “Barbershop Conversations”- check it out! The initiative plans to continue the project, by distributing between 250,000-300,000 female condoms a year.

Playing with issues of women empowerment, race, socioeconomic status, and class, critics argue that the intervention targeted a subgroup of D.C.  residents. Is this justified/ethical? Can public health interventions target subpopulations, rather than a community at large? Are there any other issues to consider when implementing a similar campaign?

Although there are concerns with the study and intervention, public health should not disregard evaluation results. Upstream care can and should be utilized to promote population health, including within the reproductive health sphere.