A survey of condom use among female sex workers in Northern Sydney; declining condom use for fellatio

Abstract

Condom use among female sex workers (FSWs) is dynamic. We conducted a survey, by anonymous questionnaire, of condom use among FSWs routinely attending our clinical service in Northern Sydney. Logistic regression models determined associations with inconsistent condom use. All 201 women approached completed a questionnaire. Chinese-born women comprised 67% of participants. The median age was 35 years. Clients requesting unprotected fellatio was reported by 95% of participants, and approximately two-thirds felt pressure to have unprotected fellatio and vaginal sex (VSI). Inconsistent condom use at work was reported by 74% for fellatio and by 24% for VSI. The strongest adjusted association with inconsistent condom use for fellatio was monetary inducement by clients (aOR = 40.7, 95% CI 4.87–340, p = 0.001). The only other significant adjusted association was age ≥ 30 years ( p = 0.02). The strongest adjusted association with inconsistent condom use for VSI was also monetary inducement by clients (aOR = 56.1, 95% CI 9.26–340, p < 0.001). Other significant adjusted associations were Chinese-speaking participants ( p = 0.03) and clients requesting unprotected VSI ( p = 0.02). We report high levels of inconsistent condom use. Health promotion should assist FSWs, particularly those of Chinese ethnicity, develop skills in dealing with pressure for unprotected sex, particularly fellatio.

Increasing prevalence of gonorrhoea and chlamydia among female sex workers in northern Sydney, 2005–2019

“…The rising infection rates described here, particularly among FSWs born in China, agree with reports of lower condom use for oral sex among FSWs in Australia, 10,12,13,20 and the influence of monetary pressure from clients for unprotected oral and vaginal sex. 10 While dedicated outreach and clinical services have been effective so far in protecting the sexual health of FSWs in Australia, additional mechanisms are needed to address the financial pressure for condomless sex.…”

“…9 A recent survey of condom use among FSWs at our service found only 26% used condoms consistently for fellatio, while 76% used condoms consistently for vaginal sex, and that FSWs born in China were less likely to use condoms due to financial incentives from clients. 10 Several other surveys have found a similar trend. [11][12][13] A recent national study among FSWs in Australia reported a rising incidence of chlamydia and gonorrhoea, particularly pharyngeal.…”

HIV seroconversion among female sex workers: retrospective cohort study from a large-scale HIV prevention and sexual and reproductive health program in Tanzania

“…Other contributors could include a diminished ability of older sex workers to negotiate condom use with clients, heightening their vulnerability to HIV. Older FSWs might encounter more challenges in enforcing condom use, particularly when compared to their younger counterparts ( 33 – 35 ).…”

Determinants of intention to use pre-exposure prophylaxis and condom use among cisgender female sex workers in Madrid, Spain

“…(Tomko et al 2019), to which participants replied using a 5-category Likert scale: never, almost never, occasionally, almost every day, every day. The decision to not include condomless oral sex was made on the basis of it being a widespread practice (Lee et al 2021) and having a low risk of associated HIV infection ("HIV/AIDS" n.d.).…”