Central American Sex Workers' Introduction of the Female Condom to Different Types of Sexual Partners

Abstract

Formative research was conducted in El Salvador and Nicaragua to inform promotion of female condoms to sex workers. Two rounds of focus groups with sex workers were conducted, with female condom training and supplies provided. Structured interviews with sex workers and direct observations of health educators were conducted. One third of sex acts were protected with female condoms in the previous 7 days. Women recommended nonpaying partners as "first try" partners but most frequently reported trying female condoms with clients. With clients, women preferred female condoms over male condoms but expressed no preference with nonpaying partners. Lack of exposure to female condoms among men and women was cited as a key barrier to female condom use. Strategies for persuading all partner types to try the female condom are suggested, and we provided promotional messages, based on results, to assist sex workers in introducing female condoms to different partners.

Knowledge, attitudes, practices and behaviors associated with female condoms in developing countries: a scoping review

“…Some studies reported that stigmatized notions of the FC impeded initial use and were widely expressed by men, women, and health care providers, 52 , 54 , 73 , 78 , 79 linking the device with infidelity and commercial sex work, even when marketed as a contraceptive for stable couples. 54 , 61 , 66 , 68 , 78 – 81 For example, a quarter of female participants in a Kenyan study felt that using or carrying an FC was synonymous with unfaithfulness. 61 Researchers in Zimbabwe commented that “just like the male condom, the [FC] was seen as a threat to intimacy and commitment, in that requesting them would introduce an element of distrust and suspicion of infidelity and promiscuity”.…”

“… 48 FSWs in Brazil and El Salvador reported using FCs more often with regular clients than with new/occasional clients or boyfriends. 67 , 68 Conversely, despite both sexes generally perceiving dual protection as an advantage, women in Swaziland, Zimbabwe, Cote d’Ivoire, and India reported discomfort discussing disease prevention with long-term partners. 69 , 70 , 119 , 120…”

“… 126 , 127 In South Africa, reduced partner awareness, often when partners were drunk or high, was more important to women than absolute covert use. 80 Covert use may facilitate higher sex work earnings from clients willing to pay more for sex without a condom, 68 whilst increasing a woman’s chance of protection: [I]f you have the female condom, you can go to the bath-room and put it in and the client thinks they are not using a condom. But because you are wearing it, there is no risk that he can give you an infection (FSW, El Salvador).…”

“…But because you are wearing it, there is no risk that he can give you an infection (FSW, El Salvador). 68 …”

Who Are the Preferential Targets for Intervention Programs Related to the Female Condom Among Sex Workers in Southern China?

“…Since FC was first introduced, studies of acceptability and usage have been widely conducted among sex workers (Witte, El-Bassel, Wada, Gray, & Wallace, 1999; Jivasak-Apimas et al, 2001; Cheng et al, 2002; Zachariah, Harries, Buhendwa, Spielman, Chantulo, & Bakali, 2003; Thomsen et al, 2006; Hoke et al, 2007; Lara, Grossman, Munoz, Rosario, Gomez, & Garcia, 2009; Mack, Grey, Amsterdam, Matta, & Williamson, 2010; Liao et al, 2011a; Liao et al, 2011b), couples (Musaba, Morrison, Sunkutu, & Wong, 1998; Lawson et al, 2003; Smita et al, 2005; Lameiras Fernandez, Failde Garrido, Castro, Nunez Mangana, Carrera Fernandez, & Foltz, 2008), patients from clinics (Artz et al, 2000; Hoffman, Exner, Leu, Ehrhardt, & Stein, 2003; Kulczycki, Kim, Duerr, Jamieson, & Macaluso, 2004), and volunteers (Barbosa, Kalckmann, Berquo, & Stein, 2007). Despite numerous studies demonstrating high acceptability of FC among various populations, its use remains low and a large proportion of women who initially tried it did not sustain its use (Hoffman et al, 2004; Gallo, Kilbourne-Brook, & Coffey, 2012).…”