Views of Cameroonian sex workers on a woman-controlled method of contraception and disease protection

Abstract

Five hundred and twenty female Cameroonian sex workers participating in a clinical trial of the effectiveness of nonoxynol-9 (N-9) contraceptive film to prevent HIV infection were interviewed to determine their experience with this woman-controlled method. The sex workers liked the film, with over 80% stating they would continue to use it if it were shown to be effective against HIV and were to become widely available. However, they were much more likely to use condoms and films simultaneously with their clients (40%) than with their regular partners (16%). The advantages ascribed to the film were that its use was under the woman's control; it could be used without the partner's knowledge; it allowed direct contact between partners; and it provided back-up protection in case of condom breakage. Data from this small study suggest that development of an effective, woman-controlled method of pregnancy and disease protection would be welcomed by these women.

PIP: Nonoxynol-9 (N-9) vaginal contraceptive film, a square that dissolves quickly and easily in the vagina and may be used without the partner's knowledge, represents a potential woman-controlled method of contraception and sexually transmitted disease (STD) prevention. 520 of 1292 Cameroonian sex workers, enrolled in a clinical trial of the capability of N-9 contraceptive film to prevent HIV transmission, were interviewed about their experiences with this method. The clinical trial failed to demonstrate an additional protective effect of N-9 film against HIV or other STDs when used with a condom. During the study period, 50% of participants reported they always used a condom and 45% always used the film. 59% of those who did not always use a condom claimed it was because clients or partners objected. In contrast, only 15% of women who sometimes did not use the film cited partner objection. Over 80% of sex workers indicated they would use N-9 film with both clients and regular partners if it were shown to be effective and were available. With a regular partner, 66.5% would use the film alone and 15.6% would also use a condom. With clients, 46.5% would use the film alone and 39.8% the film and condom together. Sex workers liked the fact that the method was under the woman's control, could be used without the male partner's knowledge or agreement, allows direct contact between partners, and provides back-up protection in the event of condom breakage. These findings suggest a woman-controlled method, such as a vaginal film, with demonstrated safety and effectiveness, would be readily accepted by sex workers in Cameroon.