Predictors of Non-Condom Use Among Female Sex Workers in Zambia Open Access

Abstract

This study examined factors that influence female sex workers decision to not use condoms with clients to prevent HIV transmission in Zambia. Specifically, personal and environmental factors were explored for associations with not using condoms with non-repeat partners. In Sub-Saharan Africa, female sex workers are 13.5 times more likely to become infected with HIV than women in the general population as a result of engaging in risk-taking behaviors. Research has identified inconsistent condom use with clients as a primary risk factor for contracting HIV. Lack of condom use can be attributed to barriers in access, low self-efficacy, and most importantly partner influence. The current study analyzed a secondary data set from the Zambia Emory HIV Research Group. A cross-sectional survey questionnaire was used to collect data on socio-demographic information, lifetime sexual history, and condom use influences among 147 female sex workers in Lusaka and Ndola, Zambia. The social cognitive theory was used to select relevant survey items as predictors of non-condom use with non-repeat partners. Results of a multivariate logistic regression revealed that female sex workers were more likely to not use a condom in the past month if the client reports being HIV-negative (AOR=0.111; p=.002; 95% CI=.028 - .438). In addition, women most commonly did not use a condom with their non-repeat partner because of higher payments and client refusal. These findings support existing literature on the powerful influence clients have over female sex workers in deciding to not use condoms. Results such as these demonstrate why female sex worker empowerment and mobilization are needed to provide supportive services and improve their ability to negotiate condom use.

Table of Contents

Introduction 1

Problem Justification 2

Theoretical Framework 4

Formal Statement of Problem 6

Literature Review 8

HIV Knowledge among FSW 8

Condom Use/Self-efficacy among FSW 9

Partner Influence on condom use 10

Physical Environment influence on condom use 14

Methods 18

Recruitment 18

Enrollment 19

Survey Measure 20

Outcome Variable 21

Analysis 21

Results 23

Bivariate 26

Multivariate 27

Discussion 30

Strengths and Limitations 32

Implications and Recommendations 34

References 35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	sex work Zambia HIV/AIDS condoms
Committee Chair / Thesis Advisor	Lang, Delia L, Emory University Allen, Susan A, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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