Inclusion of the female condom in a male condom-only intervention in the sex industry in China: A cross-sectional analysis of pre- and post-intervention surveys in three study sites

Abstract

SUMMARYObjectives-To describe female condom (FC) use, male condom (MC) use and overall levels of protected sex before, during and after FC education and promotion (using the original prototype FC) combined with MC promotion among female sex workers in three rural or small urban settings in southern China.Study design-The 1-year FC intervention was conducted by local health workers through outreach to establishments where sex work is conducted. Three serial cross-sectional surveys were conducted in each study town before, during and after the intervention along with process documentation throughout the intervention period.Methods-Cross-sectional data from pre-intervention (baseline) and 6-month and 12-month post-intervention surveys from three study sites are used in a descriptive comparison of the context of the sex industry, outreach in two phases of intervention, and FC adoption after the intensive intervention phase in each site.Results-Approximately 75-80% of eligible women working in sex establishments, varying from 74 to 155 participants for each survey, were recruited from three study sites. After introduction and promotion of the FC along with the MC during the community public health * Corresponding author. Tel.: +86 10 65296971; fax: +86 10 65225752. susuliao@mx.cei.gov.cn (S. Liao).Ethical approval Institutional Review Boards at the Institute for Community Research, Hartford, Connecticut, USA; the Peking Union Medical College/China Academy of Medical Sciences, Beijing, China; and the Guangxi Provincial Centres for Disease Prevention and Control in Nanning, Guangxi, China. All study participants provided informed consent. Competing interests None declaredPublisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. intervention, between one-fifth and one-half of the study participants had tried the FC in the three study sites by the time of the 6-month and 12-month cross-sectional surveys. Among them, 10-30% had used the FC more than once. FC awareness increased following the intervention with much less variation across the three study sites. At baseline, 31-54% of participants across the three sites reported 100% protected sex in the last 30 days with all types of partners. At one of the sites with relatively low MC use before the intervention, the proportion of women reporting 100% protected sex in the last 30 days increased by 15%, and the proportion reporting nil protected sex in the last 30 days decreased by 13% between baseline and 12-month post-intervention surveys. More complex profiles of FC and MC use and protected sex were shown at the other two study sites, where ...

Initial reactions to the Woman's Condom by potential user groups in Shanghai, China

“…Of particular note was the interest in the device by women working in the entertainment industry, both because of the ability of the device to provide dual protection and because it was female-initiated. This interest in, and willingness to use, the Woman's Condom by women working in the entertainment industry is consistent with reports of their interest and use of other female condom products 22–24…”

Multilevel Dynamic Systems Affecting Introduction of HIV/STI Prevention Innovations Among Chinese Women in Sex Work Establishments

“…The female condom (FC), a woman-initiated novel barrier method that is as effective as male condoms (MC) for both STI and pregnancy prevention (Kaler, 2004; Liao, Weeks, Wang, Nie, et al, 2011; Mantell et al, 2006; Weeks, Hilario, et al, 2010) is largely under-promoted for prevention worldwide. The different and awkward appearance of the FC and the typical initial difficulty of insertion (Choi, Gregorich, Anderson, Grinstead, & Gomez, 2003; Smit, Beksinska, Vijayakumar, & Mabude, 2006; Vijayakumar, Mabude, Smit, Beksinska, & Lurie, 2006) often lead potential new users to reject FC before trying it or after the first use, and induce health care providers and educators to dismiss it before giving sufficient effort to get potential users past the initial barriers (Mantell et al, 2011).…”

“…A multi-level ecological model, focused primarily on linear associations among factors in the contexts inside sex-work establishments, guided our intervention design and methodological approach. Analyses based on that approach, presented elsewhere (Liao, Weeks, Wang, Nie, et al, 2011; Liao, Weeks, Wang, Li, et al, 2011; Nie et al, in press; Weeks, Liao, et al, 2010), indicated some successes in reducing sexual risk in the target population of women working in sex-work establishments in the four study towns, and also demonstrated important differences across study sites in intervention processes and outcomes.…”

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).…”

“…In this study, about 94% of women in the intervention reported liking FC, and 97% expressed that they would use it in the future (Cheng et al, 2002; Cheng et al, 2003). Liao et al reported findings from cross-sectional surveys in three study sites in southern China conducted by our project team, in which about 25%–50% of the study participants reported using FC; of these, only 10%–30% used it more than once after FC intervention, but this varied by study site (Liao et al, 2011b). All of these studies indicated that, although FC provides dual protection from STI and unwanted pregnancy, it might not be considered an alternative option for all FSW in China.…”