Academic journal article International Perspectives on Sexual and Reproductive Health

Use of Dual Protection among Female Sex Workers in Swaziland

Academic journal article International Perspectives on Sexual and Reproductive Health

Use of Dual Protection among Female Sex Workers in Swaziland

Article excerpt

CONTEXT: Female sex workers are at heightened risk of both HIV infection and unwanted pregnancy. Nonbarrier modern contraceptives are highly effective at preventing pregnancy, but offer no HIV protection. A better understanding of sex workers' use of condoms and nonbarrier methods is needed to help them meet their contraceptive and STI Protection needs.

METHODS: A 2011 respondent-driven sampling survey collected reproductive health and contraceptive use data from 325 female sex workers in Swaziland. Multinomial logistic regression analysis was used to identify associations between selected characteristics and four outcomes of contraceptive use over the past month: consistent condom use alone; nonbarrier modern contraceptive use (either alone or with inconsistent condom use); dual method use; and inconsistent condom use, other method use or nonuse. Adjusted predicted probabilities were also calculated to determine patterns of association.

RESULTS: After adjustments were made for background and behavioral factors, 16% of female sex workers were found to be consistent users of condoms alone; 39% used nonbarrier modern methods (without consistent condom use); 8% were dual method users; and 38% were inconsistent condom users or used other methods or none. Women who reported recent condom failure were less likely than others to be consistent condom users (6% vs. 22%). Consistent use of condoms alone was more common among women who had had no noncommercial partners in the past month than among those who reported two or more such partners (39% vs. 3%). In addition, respondents who had children were more likely than their nulliparous counterparts to report use of nonbarrier methods alone (65% vs. 14%).

CONCLUSIONS: Inconsistent or no condom use among nonbarrier contraceptive users underscores the need to incorporate HIV prevention into family planning interventions, particularly among female sex workers who have children and noncommercial partners.

International Perspectives on Sexual and Reproductive Health, 2013, 39(2):69-78, doi: 10.7363/3906913

Female sex workers are at high risk of both HIV infection and unintended pregnancy. Although programs and policies targeting female sex workers emphasize HIV prevention and condom promotion, they typically pay limited attention to the family planning needs of these women.

Correct and consistent condom use is highly effective at preventing HIV and other STIs, but condoms are not the most effective contraceptive method. (1) In contrast, nonbarrier modern contraceptive methods (such as oral contraceptives, injectables and sterilization) are highly effective at preventing pregnancy, but confer no protection against STIs. For protection against both unwanted pregnancy and STLs, one option is a dual method approach: consistent use of condoms in conjunction with a more effective nonbarrier method. However, for many women--particularly female sex workers, who have frequent sex with multiple partners--the use of two methods for every sex act may be burdensome and unrealistic. For these women, a more feasible dual protection strategy might be a singlemethod approach: consistent condom use alone.

Most dual protection research has taken place in developed countries, where contraceptive prevalence is relatively high. The reported prevalence of dual method use among American women ranges from 7% to 38%. (2-7) A handful of studies on dual protection have been conducted in Sub-Saharan Africa, where both HIV and unwanted pregnancy are critical public health challenges. In South Africa and Botswana studies, dual method use at last sex ranged from 4% to 28%. (8-11) However, a limitation of most research on dual protection is the focus on method use at last sex, rather than consistency of simultaneous condom and other contraceptive use at each coital act. These "last sex" measures of dual method use may not reflect optimal dual protection against both pregnancy and disease. …

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