Background HIV and other sexually transmitted infections remain a burden on men who have sex with men in the era of effective combination antiretroviral therapy. New prevention efforts are therefore needed. One of these approaches is the current country-wide free condom distribution at gay bars with darkrooms and gay saunas in the Netherlands. This study assessed the effects of free condom distribution on incidence and burden of disease of HIV and other sexually transmitted infections. Methods A static model was constructed to calculate the impact of free condom distribution on HIV, hepatitis C, chlamydia, gonorrhoea, and syphilis among men who have sex with men visiting these venues. Outcomes included new infections averted and disability-adjusted life years averted. Scenario studies were performed to predict the effects of a further increase of condom use, condom effectiveness and coverage. Lastly, cost-effectiveness and sensitivity analyses were performed. Results Our model showed that condom use at public sex venues increased after the intervention. Annual incidence risk decreased, ranging from 5.73% for gonorrhoea to 7.62% for HIV. The annual number of new infections averted was largest for chlamydia and gonorrhoea (261 and 394 infections, respectively), but 42 new HIV infections were averted as well. In scenarios where condom use and condom effectiveness were further increased, the number of infections reduced more extensively. Over 99% of the decrease in burden of disease was due to HIV. The intervention was cost-effective and cost-saving (for every €1 spent on condom distribution, €5.51 was saved) and remained this in all sensitivity analyses. Conclusions Free condoms at public sex venues could reduce the transmission of HIV and other sexually transmitted infections. Condom distribution is an affordable and easily implemented intervention that could reduce the burden of disease in men who have sex with men substantially. Electronic supplementary material The online version of this article (10.1186/s12879-019-3839-0) contains supplementary material, which is available to authorized users.

HIV and other sexually transmitted infections remain a burden on men who have sex with men in the era of effective combination antiretroviral therapy. New prevention efforts are therefore needed. One of these approaches is the current country-wide free condom distribution at gay bars with darkrooms and gay saunas in the Netherlands. This study assessed the effects of free condom distribution on incidence and burden of disease of HIV and other sexually transmitted infections.A model was constructed to calculate the impact of free condom distribution on HIV, hepatitis C, chlamydia, gonorrhoea, and syphilis among men who have sex with men visiting these venues. Outcomes included new infections averted and disability-adjusted life years averted. Scenario studies were performed to predict the effects of a further increase of condom use, condom effectiveness and coverage. Lastly, cost-effectiveness and sensitivity analyses were performed.Condom use at public sex venues increased after the intervention. Our model showed decreases in annual incidence risk, ranging from 5.73% for gonorrhoea to 7.62% for HIV. The annual number of new infections averted was largest for chlamydia and gonorrhoea (261 and 394 infections, respectively), but 42 new HIV infections were averted as well. Over 98% of the decrease in burden of disease was due to HIV. In scenarios where condom use and condom effectiveness were further increased, this reduction became more extensive. The intervention was cost-effective and cost-saving (for every e1 spent on condom distribution, e5.51 was saved) and remained this in all sensitivity analyses.Free condoms at public sex venues can reduce the transmission of HIV and other sexually transmitted infections. Condom distribution is an affordable and easily implemented intervention that can reduce the burden of disease in men who have sex with men substantially. INTRODUCTIONPromoting condom use has been part of HIV prevention strategies since the beginning of the epidemic among men who have sex with men (MSM). 1 As the effectiveness of condoms in reducing HIV transmission became apparent during the 1980s, their use was actively promoted, which lead to a steady increase in condom uptake. 2 By the end of the decade, brands of condoms especially designed for anal intercourse were marketed to MSM. As the use of condoms and other safe sex practices became common, the incidence of HIV dropped sharply. 3 This lower incidence was maintained throughout the 1990s, until the introduction of effective combination antiretroviral therapy (cART) in 1996. New antiretroviral therapies greatly improved the quality of life and life exBom et al, PrePrint, March 2018 1Effects of free condoms on HIV and STI in MSM pectancy of those living with HIV, but also led to decreased sexual risk perception among MSM. 4-8 As a consequence, sexual risk behaviour, such as unprotected anal intercourse (UAI), has increased among MSM, and prevalences of various sexually transmitted infections (STIs) have risen; 9,10 also the incidence of HIV increas...