Condom use negotiation among sex workers in Singapore: findings from qualitative research

Abstract

Following an earlier study of 806 sex workers in Singapore in which they were found to succeed only half the time in getting clients to use condoms, a qualitative investigation was conducted on 40 sex workers to explore their perceived barriers and approaches in negotiating condom use with clients. Five different patterns of condom use were identified: successful, unsuccessful, misinformed, passive and uninterested. The successful negotiators used several practical approaches to secure clients' compliance. Unsuccessful negotiators experienced problems such as inability to resist clients' pressure or respond to their queries. The misinformed group believed that regular clients were safe. The passive group did not negotiate condom use due to their perceptions of lack of support from peers and brothel keepers, and the uninterested group was apathetic with fatalistic perceptions of AIDS. The in-depth interviews with successful negotiators provided relevant, specific and practical information which could be disseminated to their peers to develop their negotiation skills. This qualitative study also provided useful insights on condom use negotiation and highlighted the need for comprehensive interventions which should not only aim at developing sex workers' negotiation skills but also at gathering support from brothel keepers to facilitate behaviour change, and public education directed at clients to increase condom use.

Correlates of Condom Use among Sex Workers and Their Boyfriends in Three West African Countries

“…Likewise, the perception of vulnerability to AIDS and STD, as well as beliefs in the efficiency of condoms in preventing these diseases, were also determinants of condom use by clients of SW in Bali (Ford et al 2002). On the other hand, Wong et al (1994) noted that it was not a lack of knowledge that caused SW in Singapore not to use condoms, but rather the obstacles to negotiating condom use. Several authors maintain that programs based on conceptual frameworks have the potential to improve behavior with respect to the use and maintenance of safe practices (Coleman and Ford 1996;Fishbein et al 1996;Holtgrave et al 1995;Kok et al 1997).…”

Condom negotiation across different relationship types by young women engaged in sex work in Phnom Penh, Cambodia

“…Women repeatedly described drawing on their superior knowledge of HIV and STIs, gained through sex work, in the negotiation of condom use. This strategy has been reported among FSWs in other parts of Asia (Wong et al 1994, Basuki et al 2002, Marten 2005): I said that though body is fat but we cannot see it [HIV] so he must use condom. I further said that I am not sure if you or me who have it, so it is better to use condom so that we can be happy today and forever.…”

“…Consoling or sweet talk has been reported by FSWs in Cambodia (Marten 2005) and other parts of Asia (Wong et al 1994): We need to console him. To console him with sweet word.…”

Sex Workers’ Perspectives on Condom Use for Oral Sex with Clients: A Qualitative Study

“…The o ret i cal frame works from past research on con dom use, such as GREENS PRECEDE PROCEED frame work, 33 the health belief model, 34 and our pre vi ous research on con dom use, 27,32 were used in the con struc tion of the inter view guide to explore fac tors influ enc ing con sis tent con dom use for oral sex. GREEN's frame work inte grates many dif fer ent health behav ior change mod els into one and clas si fies fac tors influ enc ing behav ior into the fol low ing three cat e go ries: (1) pre dis pos ing fac tors such as knowl edge, self-per cep tion, and atti tudes that moti vate the per son to change behav ior; (2) enabling fac tors refer ring to skills, time, or envi ron ment that enable the sex work ers to change behav ior; and (3) rein forc ing fac tors refer ring to encour age ment and sup port from sig nifi cant oth ers such as fam ily mem bers or peers.…”