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Association Between Condom Use and Use of Other Contraceptive Methods Among Female Sex Workers in Swaziland: A Relationship-Level Analysis of Condom and Contraceptive Use

Yam, Eileen A. PhD*; Mnisi, Zandile BSN; Sithole, Bheki MPhil; Kennedy, Caitlin PhD§; Kerrigan, Deanna L. PhD; Tsui, Amy O. PhD; Baral, Stefan MD**

Sexually Transmitted Diseases: May 2013 - Volume 40 - Issue 5 - p 406–412
doi: 10.1097/OLQ.0b013e318283c16d
Original Study

Objectives Nonbarrier modern contraceptive users often are less likely to use condoms, particularly with more intimate sex partners. We examine whether female sex workers (FSWs) in Swaziland who use nonbarrier contraception use condoms less consistently and whether this inverse association varies by relationship type.

Methods In 2011, we conducted a survey among 325 Swazi FSWs using respondent-driven sampling. Each woman reported on condom use during sexual activity in the past month with up to 3 partner types (new clients, regular clients, noncommercial partners). We used a generalized estimating equation model to conduct a relationship-level multivariate logistic regression analysis of correlates of consistent condom use in the past month. We tested whether relationship type modified the effect of nonbarrier modern contraception on condom use.

Results Each participant reported up to 3 observations, for a total of 892 measures of condom use in the past month. Compared with sexual activity with new clients, sex with regular clients and noncommercial partners was less likely to be protected by consistent condom use (adjusted odds ratio, 0.30 [95% confidence interval, 0.19–0.47] for regular clients; adjusted odds ratio, 0.15 [95% confidence interval, 0.09–0.24] for noncommercial partners). There was no significant association between condom use and nonbarrier modern contraceptive use.

Conclusions These data highlight the need to provide condoms and condom-compatible lubricants and targeted education programs for FSWs and their male sex partners to encourage the consistent use of these commodities with all sex partners, irrespective of the use of other contraceptive methods.

Swazi female sex workers used condoms less consistently with more intimate partners. Nonbarrier contraceptive use was not associated with less consistent condom use.

From the *Population Council, Washington, DC; †Swaziland National AIDS Programme, Ministry of Health, Mbabane, Swaziland; ‡House of Hope, Mbabane, Swaziland; and Departments of §International Health, ¶Health, Behavior and Society, ∥Population, Family and Reproductive Health, and **Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

The authors thank the community of female sex workers who embraced this research project and chose to participate in this study and all the members of the Swaziland Most-at-Risk Populations technical working group, the Swaziland Ministry of Health, and other Swazi government agencies who provided valuable guidance and helped ensure the success of this study. The authors acknowledge Rebecca Miller and Darrin Adams for their leadership in the implementation of this project and Virginia Tedrow and Mark Berry for also supporting the implementation, as well as Babazile Dlamini, Edward Okoth, and Jessica Greene of Population Services International/Swaziland for their leadership in operationalizing this study.

Supported by USAID/Project SEARCH, Task Order No. 2, funded by the US Agency for International Development under Contract No. GHH-I-00-07-00032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief.

Conflict of interest: None declared.

Correspondence: Eileen A. Yam, PhD, Population Council, 4301 Connecticut Avenue NW, Suite 280, Washington, DC 20008.

Received for publication September 6, 2012, and accepted December 18, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association