In addition to Japan and the US, countries that produce large numbers of condoms include India, Malaysia, and South Korea (209). China has been producing 1.2 billion condoms a year for domestic use (442). Condoms also are produced in many other countries (213, 434, 590).

In many countries condoms have become more available in the past decade (12, 54, 172, 218, 541, 545). Still, condoms are not always available to all who need and want them. In some countries it may actually be more difficult than in the past to meet demand because demand has grown (475). In Africa shortages of condoms have been reported in many countries, including Algeria, Botswana, Uganda, and Zimbabwe (42, 107, 389, 584). Uganda, for example, faced an acute shortage of condoms in late 1998. The projected annual need for condoms was 10 million based on 1994 levels of demand, but annual demand has risen to 30 million, according to a national AIDS program official (290).

Asian countries also have faced shortages of condoms. In India the National AIDS Control Organization reports that domestic production of condoms is sufficient to meet increasing demand (528). Even so, a survey in Agra District, Uttar Pradesh, found that only 29% of ever-married women who currently used condoms had a regular source of supplies during the previous three months; 59% had an irregular supply; and 12% received no condoms (364). In China some rural areas have not been receiving adequate supplies from the government (329). In Bangladesh shortages hampered condom distribution in 1995 (264).

While condoms are now produced in developing countries (207), most developing countries rely on donor organizations as the primary funding source for condoms, as for other contraceptives, and donors have responded to rising demand in the past. From 1994 to 1997 donor support of contraceptive commodities increased more than 50% compared with the previous 4-year period (546). But will donors be able to or wish to continue in this role if future demand rises rapidly?

The biggest supplier of condoms to developing countries, the United States Agency for International Development (USAID), reduced its purchases and provision of condoms from nearly 800 million a year in 1990 and 1991 to under 300 million in 1997; procurement then rose again to just under 500 million in 1998. USAID reductions have been due partly to budget constraints (flat budgets despite an expanding mandate), partly due to a changing mix of countries receiving USAID assistance, and partly to other donors contributing more (124). Although USAID procurement programs for individual countries may change for various reasons, USAID reports having no plan to end its condom procurement and supply programs (125).

There appears to be little room for most donors to get more condoms for their money. To keep costs low, donor agencies already try to buy condoms as inexpensively as possible while maintaining quality. The current lowest price paid by the United Nations Population Fund (UNFPA) is approximately US$3.30 per gross (including sampling and testing), or approximately 2.3 US cents per condom (200). USAID, however, is required to buy from US manufacturers, at a price currently estimated at about 5 US cents per condom (125).

Some donors have been urging developing-country programs to generate enough income from sales of contraceptives to continue on their own without donated or subsidized commodities (475). Such policies necessarily imply a de-emphasis on the provision of donated condoms (125). Few developing-country programs will soon be able to charge users the full cost of condoms, however (497). Thus programs will need to continue relying on external assistance to ensure that condoms are accessible to even the poorest people (124).