Abstract
Objectives. This study examined correlates of condom use among 248 female sex workers (FSW) in The Gambia.Methods. Between July and August 2011, FSW in The Gambia who were older than 16 years of age, the age of consent in The Gambia, were recruited for the study using venue-based sampling and snowball sampling, beginning with seeds who were established clients with the Network of AIDS Services Organizations. To be eligible, FSW must have reported selling sex for money, favors, or goods in the past 12 months. Bivariate and multivariate logistic regressions were used to determine associations and the relative odds of the independent variables with condom use. Four different condom use dependent variables were used: consistent condom use in the past six months during vaginal or anal sex with all clients and partners; consistent condom use in the past month during vaginal sex with new clients; consistent condom use in the past month during vaginal sex with nonpaying partners (including boyfriends, husbands, or casual sexual partners); and condom use at last vaginal or anal sex with a nonpaying partner.Results. Many FSW (67.34%, n = 167) reported it was not at all difficult to negotiate condom use with clients in all applicable situations, and these FSW were more likely to report consistent condom use with all clients and partners in the past 6 months (aOR 3.47, 95% CI [1.70–7.07]) compared to those perceiving any difficulty in condom negotiation. In addition, FSW were more likely to report using condoms in the past month with new clients (aOR 8.04, 95% CI [2.11–30.65]) and in the past month with nonpaying partners (aOR 2.93, 95% CI [1.09–7.89]) if they had been tested for HIV in the past year. Women who bought all their condoms were less likely than those who received all of their condoms for free (aOR 0.38, 95% CI [0.15–0.97]) to have used a condom at last vaginal or anal sex with a nonpaying partner.Conclusions. HIV and sexually transmitted infection (STI) prevention interventions for FSW should aim to improve condom negotiation self-efficacy since women who report less difficulty negotiating condom use are more likely to use condoms with clients. Interventions should also be aimed at structural issues such as increasing access to free condoms and HIV testing since these were positively associated with condom use among FSW.
Highlights
In the small Western African country of The Gambia, approximately 14,000 people are living with HIV, including 7,700 women aged 15 and older
Population, and recruitment The study was conducted in The Gambia at a private voluntary counseling and testing (VCT) site managed by the Network of AIDS Services Organizations (NASO)
female sex workers (FSW) who lived with a sexual partner or boyfriend (OR:0.37, 95% CI [0.18–0.79]) and were afraid to seek healthcare (OR:0.33, 95% CI [0.14–0.77]) were less likely to consistently use condoms in the past six months with all clients and partners
Summary
In the small Western African country of The Gambia, approximately 14,000 people are living with HIV, including 7,700 women aged 15 and older. This results in an HIV prevalence of approximately 1.5% in the adult population (UNAIDS, 2011). One study found that approximately 25% of FSW in The Gambia reported ulcers, sores, or genital discharge characteristic of a sexually transmitted infection (STI) in the past year (Jallow, 2011). One study conducted in The Gambia from 1989–1990 found that there was no significant association between condom use and age, education level, marital status, country of origin, number of children, or whether or not the FSW had a regular partner (Pickering et al, 1993)
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