130.001 Condom Distribution Non-Contracting Prevention Sites

Policy Number 130.001
Effective Date December 16, 1994
Revision Date June 21, 2006
Subject Matter Expert Field Operations Consultant
Approval Authority Branch Managers
Signed by Felipe Rocha, M.S.S.W., L.M.S.W. and Sharon K. Melville, M.D., M.P.H.

1.0 Purpose

The Department of State Health Services (DSHS) supplies, upon request, prophylactics (condoms) free of charge to eligible public or non-profit community-based organizations (CBO’s) who contract for funds with the DSHS to provide HIV counseling, testing, referral, and partner notification (PREVENTION) activities, as well as to local health departments actively providing human immunodeficiency virus (HIV) and sexually transmitted disease (STD) outreach. Non-contracting CBO's providing PREVENTION activities and other local health departments may also request to receive condoms free of charge from the HIV/STD Comprehensive Services Branch by submitting a formal written request to the Branch which meets the criteria detailed in this procedure.

2.0 Procedure

2.1 How to Request

A non-contracting CBO providing PREVENTION activities, and local health departments not actively providing HIV/STD outreach, may submit a formal written request in the Branch approved format (form 130.001A) to place an order for condoms. Requesting non-contracting CBO's must submit a completed form to the Branch along with a concurrence memo from the designated HIV Regional Coordinator. Requests received without the HIV Regional Coordinators' concurrence memo will not be considered until such memo is obtained. A list of the HIV Regional Coordinators may be obtained from the Branch upon request.

Requesting local health departments must complete form 130.001A, but need not submit a concurrence memo from the designated HIV Regional Coordinator. The Branch reserves the right for final approval of all requests.

2.2 Criteria for Request

All condom order requests must be submitted in writing using form 130.001A. Verbal requests will not be considered. The Branch will grant approval of order requests to agencies that successfully meet the following criteria:

  1. Submit a letter of request (email is acceptable);

  2. Complete form 130.001A:

    • Be a public or non-profit CBO or a local health department,

    • Be willing to use and submit the Division's PREVENTION scan forms,

    • Currently use the DSHS Laboratory for all HIV testing or identify the laboratory being used,

    • Disclose all other funding resources available to purchase condoms to ensure that approval of request will not supplant other funding sources,

    • Provide assurances that condom distribution will be used in conjunction with an existing HIV/STD counseling program,


    • Accurately describe the high risk target audience to whom condoms will be distributed, and

    • Comply with the AIDS and HIV infection reporting requirements as specified in the Communicable Disease Prevention and Control Act, Chapter 81;

  3. Submit memo of concurrence from the designated HIV Regional Coordinator (does not apply to local health departments).

3.0 Criteria for Distribution

All agencies receiving state purchased condoms must adhere to the following condom distribution guidelines:

  • Distribution in elementary or secondary school environments is strictly prohibited,

  • Distribution will be made available only to identified high risk groups and not to the general public,

  • Distribution must be accompanied by safer sex messages that explain how to use condoms properly and consistently. Such messages may be delivered through counseling sessions or safer sex sessions,

  • Distribution of education packets to at-risk individuals must not contain more than six (6) condoms per packet,

  • Distribution at health fairs/exhibits is prohibited,

  • Self-serve distribution containers are prohibited,

  • Condoms should not be included in packets/folders for health care professionals during workshops or courses, and

  • Condoms supplied by the DSHS cannot be used for resale purposes.

The Branch reserves the right to investigate all alleged violations of this policy that may involve state purchased condoms. The Branch will formally request the return of all condoms distributed under this policy from any agency for which the alleged violations may be substantiated. An agency found to be in violation of this policy may request to be reinstated in the program following completion of a probationary period as determined by the Branch.

4.0 Review Process

The Branch will review order requests on an individual basis and will have final authority to grant the order request based on the criteria for request and the availability of condoms. The Branch will notify the requesting agency of the Branch’s decision within twenty (20) days of the date that all required elements are received. Successful applicants will receive no less than one case per approved application.

5.0 Additional Resources

Form 130.001A - Condom Order Request Non-Contracting Prevention Counseling and Testing Sites


6.0 Revision History

Date Action Section
9/25/2014 Converted format (Word to HTML)  -
6/21/2006 Converted format (WordPerfect to Word) -