Structural Barriers to Condom Adoption: Insights from India

Background: Condoms remain the only widely available multipurpose prevention technology that simultaneously protects against HIV, other sexually transmitted infections (STIs), and unintended pregnancies. Despite promotion efforts and free and subsidised availability, condom uptake in India remains low, contributing to a high prevalence of HIV and STIs and continued population growth. While previous studies have identified some barriers to condom use, comprehensive research examining structural barriers and how they impede adoption remains limited. Drawing on institutional theory, this study explores how structural barriers influence condom adoption in India. Methods: We employed a qualitative, exploratory approach using purposive sampling to recruit system level actors such as managers and leaders from organisations that design and implement condom promotion and behaviour change initiatives. In-depth interviews were conducted with these actors from government agencies, NGOs, and social marketing organisations in New Delhi who possess a system level understanding of barriers gained through engagement with communities, regulators, and supply chains. Data were analysed using thematic analysis. Results Three categories of structural barriers emerged, aligned with institutional pillars: regulative, normative, and socio-cultural. The regulative barriers highlight how rules, regulations, and bureaucratic procedures impede behaviour change. Normative barriers reflect the influence of prevailing norms and beliefs that discourage condom use. Socio-cultural barriers capture the meanings, symbols, and associations surrounding condoms that hinder adoption. Conclusion This study demonstrates that structural barriers, shaped by regulative, normative, and socio-cultural institutions, significantly hinder condom adoption in India.