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Environmental-structural factors significantly associated with consistent condom use among female sex workers in the Dominican Republic

Kerrigan, Deannaa; Ellen, Jonathan Mb; Moreno, Luisc; Rosario, Santoc; Katz, Joannea; Celentano, David Da; Sweat, Michaela

Epidemiology & Social

Objective: To examine the influence of environmental-structural factors in promoting consistent condom use (CCU) among female sex workers (FSW) and their regular paying partners in the Dominican Republic.

Methods: A cross-sectional survey was conducted with 288 FSW recruited from 41 sex establishments in Santo Domingo from March to June 1998. Sex workers were asked about their sexual behavior, self-efficacy at negotiating safe sex, perceived intimacy with their most recent regular paying partner, and the physical, social and policy environment of the establishment where they worked. Factor and reliability analysis were utilized to develop aggregate measures for self-efficacy (Cronbach's Alpha 0.60), intimacy (Cronbach's Alpha 0.80), and environmental-structural support (Cronbach's Alpha 0.72).

Results: Controlling for sociodemographic characteristics of participants in multivariate analyses, environmental-structural support for condom use and HIV/sexually transmitted infection (STI) prevention was a significant predictor of CCU (OR 2.16; CI 1.18–3.97) among FSW and their regular paying partners. Safe sex self-efficacy (OR 2.80; CI 1.31–5.97) and low perceived intimacy with the most recent regular paying partner (OR 7.20; CI 3.49–14.83) were also significantly associated with CCU in multivariate analysis.

Conclusion: Environmental-structural support for condom use and HIV/STI prevention is a significant predictor of CCU among FSW in the context of regular paying partnerships. Environmental-structural factors, in addition to relational and individual cognitive factors, should be assessed and addressed by behaviorally guided theory, research and interventions related to HIV/STI prevention and female sex work.

From the aJohns Hopkins School of Public Health, and bJohns Hopkins School of Medicine, Baltimore, MD, USA; and cCentro de Orientación e Investigación Integral, Santo Domingo, Dominican Republic

Correspondence to: Deanna Kerrigan, Assistant Research Professor, Johns Hopkins School of Public Health, 615 North Wolfe Street, Room E7141, Baltimore, MD 21205, USA. Tel: +1 410 614 0075; fax: +1 410 502 6733; e-mail:

Received: 4 April 2002; revised: 20 September 2002; accepted: 8 October 2002.

© 2003 Lippincott Williams & Wilkins, Inc.