The S'Khokho 'bushcan' initiative: Kick a bush and condoms fall out.

BACKGROUND People living in rural areas have limited access to condoms owing to distance, cost and time involved in travelling to public health facilities, around which most condom distribution efforts are centralised. OBJECTIVE In an effort to increase access to condoms in these areas, we explored the feasibility and efficacy of condom distribution by placing 'condocans' on trees along informal footpaths used by residents. METHODS From October 2012, steel condocans, typically seen in clinic settings, were erected on trees along pathways in bushy areas with high levels of foot traffic at several rural locations in the Umgungundlovu district of KwaZulu-Natal Province, South Africa (SA). Because of their location, the condocans were referred to as 'bushcans'. Condom uptake was closely monitored, and the bushcans were restocked when necessary. RESULTS Following the introduction of the bushcans, male condom distribution increased by 237% from October 2012 to December 2012. Condom distribution in these areas increased on average by 187% from October 2012 to October 2015, with more than 408 000 condoms distributed over the 3-year period using the bushcans alone. Discussions with residents revealed that they were pleased about the increased access to condoms via the bushcans, and they recommended other areas for potential implementation of this initiative. CONCLUSIONS The bushcan initiative highlighted the fact that condoms are not as easily accessible to all South Africans as is often thought. By providing access to condoms in a discreet and convenient manner, the bushcans have the potential to increase access to condoms in other rural and periurban areas in SA where communities face similar barriers to access.