Actions taken by female sex workers (FSWs) after condom failure in semi urban Blantyre, Malawi

Abstract

Background Little is known about actions taken by female sex workers (FSWs) after male condom failure during male–female sexual intercourse. The objective of this study was to investigate the actions taken by FSWs after condom failure among FSWs in semi-urban, Blantyre in Malawi. Methods A cross sectional, qualitative study was conducted among FSWs in Blantyre, Malawi between May and July 2019. Snowballing technique was used to recruit study participants in four purposively selected study sites. Focus group discussions and in-depth interviews were conducted by trained research assistants among 40 FSWs. Data were analyzed using thematic content analysis. Results Study participants reported having taken different actions after condom failure. Out of 18 FSWs who experienced condom failure, 10 reported to have stopped sex immediately and changed the condom and then resumed afterwards. They reported to have douched, urinated, and/or squatted to prevent pregnancy, sexually transmitted infections (STIs) and HIV acquisition. Five study participants reported to have asked for extra pay from the client; 10 FSWs didn’t seek medical care. They thought the actions taken were enough for HIV and pregnancy prevention. Out of the 18 FSWs, only 3 stopped sexual intercourse completely and sought medical care which included post-exposure prophylaxis for HIV, STI treatment, and emergency contraceptives. Another 3 reported that they did not stop the sexual intercourse but only squatted and/or douched after sexual intercourse. The remaining 2 FSWs reported not to have stopped sexual intercourse and no any other actions were taken after the condom failure. Conclusion We report some inadequate behaviors among FSWs after condom failure. Health programs should develop interventions and support the performance of safer sex and actions after condom failure among FSWs to prevent STIs including HIV, and unplanned pregnancies. Interpersonal, structural and policy factors hindering FSWs’ access to perform effective interventions need to be addressed.

Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion

“…Fourteen of the studies were conducted in Kenya [ 10 – 23 ], eight in South Africa [ 13 , 14 , 24 – 29 ], eight in Uganda [ 30 – 37 ], six in Mozambique [ 13 , 14 , 38 – 40 ], five in Tanzania [ 41 – 45 ], three in Eswatini [ 46 – 48 ] and in Malawi [ 49 – 51 ], two in Ethiopia [ 52 , 53 ], in Zambia [ 54 , 55 ], and in Zimbabwe [ 56 , 57 ] and one each in Democratic Republic of Congo [ 58 ], Lesotho [ 59 ], Rwanda [ 60 ], and online (Australia, Brazil, El Salvador, France, Kenya, Malawi, Russia, South Korea, Spain, Tanzania, the United States of America, and Zimbabwe) [ 56 ]. Thus, knowledge production concerning WSS in relation to non-barrier contraception, pregnancy and abortion is dominated by studies conducted in Kenya.…”

“…We therefore list all found (noting that some may not apply in certain areas, while others may apply but were not included in the study). Variables include: personal factors – fear of side effects [ 10 , 51 ]. desire for (more) children [ 11 ], being nulliparous [ 46 ], history of incarceration or arrest [ 55 ], intoxication [ 42 ], and being older than 35 [ 31 ]; interpersonal factors—male partners’ or clients’ disapproval [ 10 ], physical or sexual abuse [9, 16], having a steady partner [ 51 ]; and systemic issues—poor clinic access [ 10 , 42 ], negative healthcare provider attitudes [ 10 ], and condom availability at work [ 55 ].…”

“…Variables include: personal factors – fear of side effects [ 10 , 51 ]. desire for (more) children [ 11 ], being nulliparous [ 46 ], history of incarceration or arrest [ 55 ], intoxication [ 42 ], and being older than 35 [ 31 ]; interpersonal factors—male partners’ or clients’ disapproval [ 10 ], physical or sexual abuse [9, 16], having a steady partner [ 51 ]; and systemic issues—poor clinic access [ 10 , 42 ], negative healthcare provider attitudes [ 10 ], and condom availability at work [ 55 ]. Use of non-barrier contraception was found in to be associated with ease of access, positive healthcare provider attitudes, conducive clinic schedules, fewer side effects [ 56 ], previous pregnancy, positive attitude to and knowledge of family planning, younger age, and lower education [ 18 ].…”

Assessment of Awareness, Willingness, and Practice of Human Immunodeficiency Virus Pre-Exposure Prophylaxis Among Female Sex Workers in Uyo, Akwa Ibom, Nigeria

“…For example, firstly, behavioral interventions such as the appropriate and consistent use of male or female condoms have been shown to reduce HIV transmission and decline HIV incidence rates across the world [13, 14, 15 16]. However, concerns have been raised that, sometimes condoms may not be used for several reasons, such as in rape cases, personal choice, or condom breakage [17,18,19]. In such situations, the probability of HIV transmission may be reduced if the FSW is on PrEP.…”

“…The use of PrEP among FSW would be a game changer as they can control its use by taking it before they have contact with their clients. Several studies have reported that FSWs who had a condom burst or been engaged in unprotected sexual exposure with clients with unknown HIV status didn't use post-exposure prophylaxis (PEP) and were not on PrEP to prevent HIV infection [17,18,19].…”