Between March and May 2007, three anonymous, unlinked surveys were administered to Brown undergraduates via various means to estimate the frequency of condom use to understand obstacles that affected the routine utilization of condoms among students. Based on student responses to these surveys, several key aspects of condom use at Brown became clear: 1.) students are only using condoms about 40% of the time, 10% less than national standards for their age group, 2.) students are primarily not using condoms because they feel they are not accessible when they need them, 3.) condoms are not accessible because the current distribution method using student residential counselors is a failure, and 4.) students would be interested in receiving free condoms and in fact believe that they would use condoms more frequently if they did.
Bandura’s models of sociocognitive learning might best explain what is at play in the Brown sexual health scenario: students know they are supposed to be protecting themselves from condoms, yet because their friends are encouraging risky sex by practicing it themselves and there is no visibility for STIs on campus, students feel safe modeling their behaviors based on the general campus consensus: don’t use a condom because there are no diseases to catch at Brown. While STI incidence rates indicate that this may be true, the fact remains that by learning unsafe behaviors in a relatively sterile environment, students are learning to lower their guard in a way which puts them at great risk for contracting an STI when they extend their social networks beyond the Brown campus.
Thus, Project CARES is designed to study the efficacy of steady, direct condom distribution and peer-based community support in increasing frequency of condom use among Brown undergraduates. Five condoms will be mailed to approximately 250 participants, both sexually active and inactive, in order to get the active students to challenge the reasons they really aren’t using condoms once accessibility becomes a non-issue and get inactive students to encourage their friends to practice safer sex by distributing the condoms to peers. The impact of this intervention will be measured by collecting monthly survey data from a randomly selected 100 participants and this impact will be compared to a control group receiving condoms through current distribution methods.
Project CARES is an evaluation of steady, direct condom distribution with a peer-based safer sex support network to Brown undergraduates as a viable means of increasing frequency of condom use over time among participants. The overall efficacy of this intervention will then be compared to those of existing on-campus condom distribution methods and used to improve undergraduate access to condoms during the subsequent school year.
During the spring semester of the 2007 school year, Project CARES will temporarily increase condom accessibility among 300 Brown undergraduate participants in order to measure its impact on frequency of condom use. Based on the preliminary assumption that Brown students only use condoms for 40% of their anal and/or vaginal sex partners, Project CARES aims to increase participants’ frequency of condom use to 60%. In order to achieve this goal, participants will be sought out using snowball recruitment techniques from early October until mid-December. Every recruit will be informed that they can participate in the Project CARES condom distribution program regardless of whether they wish to participate in the project. However, those recruits who do not wish to participate in the stud will still be asked to respond to the baseline questionnaire. Those recruits who choose to enroll in Project CARES will simultaneously be asked via e-mail to respond to a baseline survey in late January to assess relationship status, sexual practices, condom use, and interaction with existing sexual health and condom distribution outlets before the is implemented. Participants will then receive ten condoms every two weeks for the duration of the project and a randomly selected 100 participants will be asked to fill out three additional monthly follow-up surveys investigating the impact of the program on their sexual practices and changes in their views towards condom accessibility and practicality. During this period, ten participants will also be randomly selected from the experimental group to participate in a three monthly focus groups to gauge any changes in their attitudes and practices as the project progresses as well as to provide a forum to discuss any issues that the monthly questionnaires might not provide an adequate forum to address.
The purposes of this project are four-fold. The primary purpose of this project is to evaluate the viability of the Project CARES model as a feasible condom distribution method within Brown University and potentially, within other schools across the nation.
The secondary purpose of this project is to extensively evaluate the strengths and weaknesses of current condom distribution models in place at Brown University through comparison with the Project CARES model and then based on this information, improve the distribution pathways.
The third purpose of this project is to compare baseline sexual risk behavior data collected from subject participants to national statistics for the same age and ethnic groups to determine how closely students at Brown reflect national standards within their relative risk profiles. Hopefully, qualitative survey data and focus group data will provide some insights as to why Brown students lie where they do on the risk spectrum in relation to national standards.
The final aim of this project is to encourage an open social dialogue about safer sex among undergraduates. While existing condom distribution methods may successfully be providing condoms to undergraduates, they are not encouraging students to discuss safer sex outside of these establishments. Therefore, Project CARES will distribute condoms to both sexually active and sexually inactive students with the intention that sexually active students will be more likely to feel comfortable asking a friend or hallmate, even a sexually inactive one, for a condom than an authority figure. Thus, by encouraging students to discuss safer sex among themselves and become capable of asking one another for condoms, Project CARES is simultaneously providing students with the physical materials they need to protect themselves and creating an opportunity for the creation of a safe social institution in which safer sex and sexuality can be discussed without shame or stigma.