Female sex workers are a marginalized and highly vulnerable population who are at risk of HIV and other sexually transmitted diseases, harassment, and unplanned pregnancies. Various female condoms are available to mitigate the severity of the consequences of their work. However, little is known about the acceptability and usage of female condoms and contraceptives among sex workers in small South African towns. This descriptive cross-sectional study of conveniently selected sex workers explored the acceptability and usage of female condoms and contraceptives among sex workers in South Africa using validated questionnaires. The data were analyzed using STATA 14.1. The 95% confidence interval is used for precision, and a p-value ≤ 0.05 is considered significant. Out of 69 female-only participants, 49.3% were unemployed, 53.6% were cohabiting, and 30.4% were HIV positive. The median age of entry into sex work was 16 years old. Participants reported use of condoms in their last 3 sexual encounters (62.3%), preference of Implanon for contraception (52.2%), barriers to condom use (81.2%), condoms not being accepted by clients (63.8%), being difficult to insert (37.7%), and being unattractive (18.8%). Participants who reported barriers to condom use were 90% more likely to have adequate knowledge than those who did not (PR = 1.9; p-value < 0.0001). Knowledge of condom use was an important factor in determining knowledge of barriers to their use. Reasons for sex work, sex workers’ perceptions, and clients’ preferences negatively affect the rate of condom use. Sex worker empowerment, community education, and effective marketing of female condoms require strengthening.

Background: Female sex workers are a marginalised and highly vulnerable population who are at risk of HIV and other sexually transmitted diseases, harassment and unplanned pregnancies. However, little is known about the acceptability and usage of female condoms and contraceptives among sex workers in small South African towns like Brits, Rustenburg and Grahamstown. Methods: This study is a quantitative study design with both descriptive and analytical components, undertaken in September 2018. A validated, researcher-administered questionnaire adapted from the South African Youth Risk Behaviour Survey was used. Data were analysed using STATA 14.1. Normally distributed numerical data are summarised using the mean, standard deviation and range. Numerical data that were not normally distributed are summarised using the median and interquartile range. Simple linear regression is used to compare two numerical variables. The prevalence ratio (PR) is used to determine the association of two categorical variables. The level of significance is p-value<0.05.Results: Sixty-nine (69) participants are reported on in this study which recorded an HIV prevalence of 30.4% (n=21/69). A high number of participants had completed high school (60.9%); the median age of entry into sex work was 16 and the median sexual debut was 15 years. More than half of the participants (37/69 or 53.6%) were cohabiting. In general, condom use during transactional sex was not consistent as it affected their income. Participants who reported barriers to condom use were 90% more likely to have adequate knowledge than those who did not and this was statistically significant (PR=1.9; p-value<0.0001).Conclusion: Sex workers, like all members of society have a right to access to promotive, preventive and curative healthcare and should thus have their health needs known and addressed. This study is one of few such efforts for small rural towns in South Africa.