Short-term acceptability of female condom use among low-fee female sex workers in China: a follow-up study

Abstract

Background Low-fee female sex workers (FSW) lack power to effectively negotiate male condom use with clients. Female condoms (FCs) may provide an alternative strategy. This study was conducted to assess the acceptability of FC use among low-fee FSWs, and to identify appropriate candidates for future FC promotion. Methods A one-month follow-up study was conducted. At entry into the study, eligible participants completed a baseline questionnaire and were given 10 FCs. At the one-month follow up encounter, the number of used FC packages were counted and each participant completed a follow-up questionnaire. Logistic regression was used to identify variables associated with more frequent use of FCs (> 2 times). Results A total of 312 low-fee FSWs were enrolled at baseline and all participants completed the follow-up evaluation. Among them, 123 (39.4%) participants had used more than two FCs. Participants who were illiterate or had completed at most primary school education (OR: 2.4, 95% CI: 1.4–7.2), charged ≤30 RMB per client (≤30 vs. 51–80 RMB, OR: 3.8, 95% CI: 1.9–7.6), or had consistently used condoms with regular clients in the past month (OR: 2.4, 95%CI: 1.4–4.2) were more likely to use FCs. Conclusion Low-fee FSWs charging ≤30 RMB per client, and those who are less educated may be appropriate initial candidates for FC promotion in China. Strategies to consider include teaching FSWs tactics for negotiation of FC use that can initially be applied with regular clients, and providing education to maximize ease-of use, and minimize discomfort with FC usage. Electronic supplementary material The online version of this article (10.1186/s12905-019-0773-7) contains supplementary material, which is available to authorized users.

Barriers and Enablers Influencing Women's Adoption and Continuation of Vaginally Inserted Contraceptive Methods: A Literature Review

“…2016; Naidu 2013; Zhou et al. 2019), and partner's sexual satisfaction (POW PDP 2015; Wang, Liu, and Cheng 2016)—were similar to the other methods listed in Table 2. The size of the product was a barrier for some female condoms, with a common complaint being that the condom and its inner ring (e.g., with FC2) were too large (Schuyler et al.…”

Barriers and Facilitators to Acceptability of the Female Condom in Low- and Middle-Income Countries: A Systematic Review

“…Many of the studies demonstrate that once potential users have tried the FC, they feel positively about it, and report willingness to use it again. This was especially true for older female sex workers, as well as sex workers with older clients [22,32,33]. In a study in China [22], low-fee female sex workers were more likely to accept the device, and these workers tend to have older clients with a higher prevalence of erectile dysfunction.…”

“…This was especially true for older female sex workers, as well as sex workers with older clients [22,32,33]. In a study in China [22], low-fee female sex workers were more likely to accept the device, and these workers tend to have older clients with a higher prevalence of erectile dysfunction. Unlike the male condom, the FC does not require an erect penis to function.…”

“…Across various studies set in different LMICs, we see how low or absent partner acceptability serves as a barrier to FC acceptability and use. Zhou et al conducted a follow-up study over one month to assess the acceptability of the FC among female sex workers in China [22]. Over the course of the study, and of a total 312 female sex workers that were enrolled in the study, only 273 reported using FCs, and 50.3% (n = 157) reported that they would not use the FC in the future.…”

Characteristics of low-tier female sex workers who engage in commercial sex with old male clients in Zhejiang province, China: a cross-sectional study

“…Low-tier FSWs are defined as those who work in smaller and hidden venues, such as hair salons, rental accommodations, small hotels and so on, or on the street. [5][6][7][8][9] Low-tier FSWs typically have lower living standards and are older, less educated, and married, separated or divorced. 9 10 These sociodemographic characteristics may be related to a higher rate of condomless sex 9 10 and lower use of HIV prevention services.…”