Promoting female condoms in the sex industry in 4 towns of Southern China: context matters

Abstract

Background: The female condom (FC) is an effective tool for dual protection, but it remains underused. Individual and contextual reasons need to be explored.

Objective: The aim of this study was to compare individual and contextual characteristics of FC multitime users, 1-time users, and nonusers among women in the sex industry of 4 study sites in China.

Methods: A standardized 1-year FC intervention along with male condoms was implemented through outreach to sex establishments. Three serial cross-sectional surveys were conducted at baseline and after each of two 6-month intervention phases.

Results: A total of 445, 437, and 290 eligible women were interviewed at 3 cross-sectional surveys, respectively. At the first and second postintervention surveys, 83.3% and 81.7% of women reported knowing about FC, and 28.8% and 36.6% had used FC at least once. Women who used FC multiple times reported less unprotected sex than nonusers in the last 30 days (3.0% vs. 17.2% at first and 3.2% vs. 16.8% at second postintervention survey, P < 0.01). Polytomous logistic regression showed that both 1-time and multitime users were more likely to come from one particular site (approximately 3 times more than the reference site). Higher intervention scores (adjusted odds ratio, 1.8-4.0) and working in boarding houses (adjusted odds ratio, 3.4) were associated with FC use.

Conclusions: Adding FC into male-condom-only intervention may reduce unprotected sex among women in sex establishments in rural and small urban areas of China. Adoption of FC may be related not only to intervention exposure but also to contextual factors associated with study site and type of sex establishments.