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Promoting Female Condoms in the Sex Industry in 4 Towns of Southern China: Context Matters

Nie, Li MS*; Liao, Susu MD, PhD*; Weeks, Margaret R. PhD; Wang, Yanhong PhD*; Jiang, Jingmei PhD*; Zhang, Qingning PhD*; Zhou, Yuejiao; He, Bin MPH§; Li, Jianghong MD, MS; Dunn, Jennifer MA

Sexually Transmitted Diseases: March 2013 - Volume 40 - Issue 3 - p 264–270
doi: 10.1097/OLQ.0b013e31827c58c9
Original Study

Background The female condom (FC) is an effective tool for dual protection, but it remains underused. Individual and contextual reasons need to be explored.

Objective The aim of this study was to compare individual and contextual characteristics of FC multitime users, 1-time users, and nonusers among women in the sex industry of 4 study sites in China.

Methods A standardized 1-year FC intervention along with male condoms was implemented through outreach to sex establishments. Three serial cross-sectional surveys were conducted at baseline and after each of two 6-month intervention phases.

Results A total of 445, 437, and 290 eligible women were interviewed at 3 cross-sectional surveys, respectively. At the first and second postintervention surveys, 83.3% and 81.7% of women reported knowing about FC, and 28.8% and 36.6% had used FC at least once. Women who used FC multiple times reported less unprotected sex than nonusers in the last 30 days (3.0% vs. 17.2% at first and 3.2% vs. 16.8% at second postintervention survey, P < 0.01). Polytomous logistic regression showed that both 1-time and multitime users were more likely to come from one particular site (approximately 3 times more than the reference site). Higher intervention scores (adjusted odds ratio, 1.8–4.0) and working in boarding houses (adjusted odds ratio, 3.4) were associated with FC use.

Conclusions Adding FC into male-condom-only intervention may reduce unprotected sex among women in sex establishments in rural and small urban areas of China. Adoption of FC may be related not only to intervention exposure but also to contextual factors associated with study site and type of sex establishments.

A female condom intervention study in the sex industry in 4 towns of southern China found that outreach to establishments enhanced female condom adoption and reduced unprotected sex. Female condom adoption was related to intervention exposure, study site, and type of venues.

From the *Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China; †Institute for Community Research, Hartford, CT; ‡Guangxi Center for Disease Prevention and Control, Nanning, Guangxi, China; and §Hainan Center for Disease Prevention and Control, Haikou, Hainan, China

We thank all staff from the Hainan and Guangxi Centers for Disease Control and Prevention and from the local county and townships who contributed significantly to this study and made it possible.

Supported by Award No. R01MH077541 from the US National Institute of Mental Health.

Conflicts of interest: No conflicts of interests are involved in this study.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Correspondence: Susu Liao, MD, PhD, Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/Peking Union Medical College, 5 Dong Dan San Tiao, Beijing, China. E-mail: susuliao@mx.cei.gov.cn.

Received for publication July 9, 2012, and accepted November 2, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association