"There was no condom to fit the guy's penis": Sex Workers' Perceptions of Male Condom Size in Cape Town, South Africa Open Access

Miranda, Danielle (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/nz806000f?locale=en


Background: South Africa bears one of highest rates of HIV in the world, with 18.8% of South African adults between the ages of 15 and 49 reported as being HIV positive. Sex workers are considered an at-risk, vulnerable population who continue to bear a high burden of HIV in South Africa. Female, male and transgender sex workers engaged in the sex industry continue to face barriers to increased condom use in sexual encounters with clients.

Objectives: To understand condom use practices amongst female, male, and transgender sex workers and their clients, this study explored condom use amongst sex workers through the perspective of sex workers in Cape Town, South Africa. The study further examined sex workers' perceptions on the need for expanded condom size options to increase condom use in the sex work industry and whether expanding condom size options might increase condom use amongst sex workers and clients.

Methods: In-depth interviews were conducted amongst 20 female, male, and transgender sex workers affiliated with SWEAT as peer educators who identified as sex workers or former sex workers.

Results: Irrespective of gender, sex workers reported experiencing issues with limited condom sizes that fail to fit the wide variation of penis sizes on the part of clients. Sex workers reported that condom size serves as a barrier to consistent condom use with clients, and indicated that this puts them at increased risk of negative health outcomes including disease acquisition and unintended pregnancy. Condom failure is a common occurrence amongst sex workers. Sex workers expressed interest in the diversification of condom sizes and believe that increasing the variation in male condom sizes would encourage clients to reevaluate their decisions to use condoms.

Discussion: Condom size is a barrier to increased condom use amongst sex workers and clients. Experiences of condom failure expose sex workers and clients to adverse health risk, often resulting in inconsistent use or aversion to condoms on the part of clients. There is a need for continued research on how condom size diversification could alter the way people perceive condoms and the consistent utilization of condoms within the context of sex worker-client relationships.

Table of Contents

Table of Contents

Chapter One: Introduction 1

The Global Sex Work Industry

Sex Work in South Africa

Condom Size as a Barrier to Condom Use

Custom-Fitted Male Condoms

Research Question

Study Purpose

Chapter Two: Comprehensive Literature Review 8


Barriers to Condom Use amongst Sex Workers and Partners

Loss of Pleasure, Condom Discomfort, Condom Failure

Condom Failure Amongst Vulnerable Populations

Commercial Sex and Condom Use in South Africa

Gaps in the Literature

Chapter Three: Manuscript 26

Title Page

Contribution of Student








Chapter Four: Conclusion & Public Health Implications 60


Public Health Implications

References 68

Appendices 71

Appendix A: Interview Guide for Interviews with Sex Workers

Appendix B: Information Sheet for Interviews with Sex Workers

Appendix C: Informed Consent Sheet for Interviews with Sex Workers

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