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Boering P, Seeley J, Buule J, Kamacooko O, King R. A Comparison of Self-reported Condomless Sex and Yc-DNA Biomarker Data from Young Women Engaged in High Risk Sexual Activity in Kampala, Uganda. AIDS Behav 2024; 28:320-331. [PMID: 37751111 PMCID: PMC10803388 DOI: 10.1007/s10461-023-04177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
Reporting of condom-use can limit researchers' understanding of high-risk sexual behaviours. We compared self-reported condom-use with the Yc-DNA biomarker data and investigated potential factors influencing participation in, and reporting of, sexual behaviours. Self-reported data were collected using Audio Computer Assisted Self Interviews (ACASI) and samples for Yc-DNA biomarker were collected using self-administered and health worker-collected vaginal swabs from 644 women (aged 15-24 years) who were not living with HIV. Yc-DNA results and interview data were compared using McNemar-Bowker Analysis and Cohen's Kappa. Test statistics for Yc-DNA biomarker were calculated. Log Binomial models for Yc-DNA and self-reported results were conducted to assess for association. We found strong evidence (p < 0.001) for a difference between Yc-DNA and self-reported results. 13.7% of participants reported consistent condom-use with all partners, regardless of HIV status. Self-reported condom-use was discordant in 50.0% (n = 206) of cases, when compared to Yc-DNA results. Positive Yc-DNA results were found to be associated with older age (RR 1.36; 95%CI 1.04, 1.76 p = 0.023). Self-reported condom-use with partners with unknown HIV status was associated with higher education (RR 0.76; 95%CI 0.58,0.99 p = 0.043). Sensitivity analysis did not determine difference between methods for controlling for missing data. We found significant under-reporting of condomless sex in the self-reported data when compared to Yc-DNA results.
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Affiliation(s)
- Pippa Boering
- London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK.
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
| | - Joshua Buule
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Rachel King
- University of California, San Francisco, CA, USA
- INSERM, 60 Rue de Navacelles, 34090, Montpellier, France
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Gebresilassie F, Ayele B, Hadgu T, Gebretnsae H, Negash D, Demoz Ghebremdhin K, Gebru KT, Wubayehu T, Ricceri F. Predictors of Condom Use Among Youth of the Rural Tigray, Northern Ethiopia: Community-Based Cross-Sectional Study. HIV AIDS (Auckl) 2023; 15:377-385. [PMID: 37377455 PMCID: PMC10292206 DOI: 10.2147/hiv.s412337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Background Condom is one of the most commonly used and cost-effective HIV preventive measures, particularly in low-income countries. Despite the proven effect of condoms for STI/HIV prevention, there are limited data on its utilization. Hence, this community-based study aimed to assess the level and determinant factors of condom utilization among the youth of the rural Tigray. Methods This study was part of a large community-based cross-sectional study conducted to assess the utilization of adolescent and youth-friendly health services among randomly selected 631 youth aged 15-24 years from May 23 to June 30, 2018. We used 273 youth who reported having a history of sexual activity during the study period. The data were collected using an interviewer-administered structured questionnaire. Logistic regression analysis was used to determine the independent predictors of the outcome variable and the level of significance was declared at a P-value of <0.05. Results A total of 273 participants were included in the study. The mean age (+SD) of the respondents was 19.14 (±2.74) years. Only one-third (35.2%) of the respondents used a condom during their last sexual encounter and 51 (53.1%) of them used it consistently. Being married (AOR = 0.17; 95% CI: 0.04, 0.60), respondent's partner attained primary education (AOR = 0.14; 95% CI: 0.04, 0.50), and having multiple sexual partners (AOR = 6.97; 95% CI: 2.09, 23.20) were found to be the determinants of condom utilization. Conclusion The study participants had a low level of condom utilization. Social and sexual related factors were the major predictors of condom use among the youth. Therefore, focused interventions need to be designed specifically to strengthen condom promotion campaigns.
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Affiliation(s)
| | - Brhane Ayele
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Tsegay Hadgu
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Degnesh Negash
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | | | | | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Kampman CJG, Peters CMM, Koedijk FDH, Berkenbosch TS, Hautvast JLA, Hoebe CJPA. Sexual risk and STI testing behaviour among Dutch female and male self-employed sex workers; a cross-sectional study using an Internet based survey. BMC Public Health 2022; 22:1155. [PMID: 35681139 PMCID: PMC9185941 DOI: 10.1186/s12889-022-13582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Sex workers are men, women or transgender people who have sex in exchange for money or goods. Self-employed sex workers solicit clients independently from a third-party. Self-employed sex workers are at risk of acquiring sexually transmitted infections (STIs) through their work. We performed a cross-sectional study, using an Internet survey conducted in 2019–2020 aiming to establish sexual risk behaviour and STI testing behaviour among female and male self-employed sex workers. Results A total of 76 female self-employed sex workers (FSW) and 79 male self-employed sex workers (MSW) completed the survey. Both FSW and MSW more often had sex with partners of the opposite sex during work (65.8% FSW, 61.6% MSW) and in their private life (63.3% FSW; 64.5% MSW). During vaginal sex 35.7% of FSW and 29.6% of MSW did not always use a condom. Inconsistent condom use was observed in 35.7% of FSW and 29.6% of MSW during vaginal sex, 46.2% of FSW and 35.7% of MSW did not always use a condom during receptive anal sex. The majority of both FSW and MSW tested for STIs in the past year (67.1% FSW; 67.7% MSW) and 67.5% were aware of the possibility of low-threshold testing at an STI clinic. In the past year, 11.6% of FSW and 8.1% of MSW had an STI. Conclusion The reported STI positivity rate among self-employed sex workers was not very high. However, STI prevention efforts remain important considering the low compliance with condom use during sex work. Moreover, not testing for STIs in the past year was substantial with one-third of both FSW and MSW and one-third of both FSW and MSW being unaware of the possibility of low-threshold testing at an STI clinic, warranting efforts to increase testing uptake in this population.
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Affiliation(s)
- C J G Kampman
- Public Health Service Twente, Postbus 1400, JM, 7511, Enschede, The Netherlands.
| | - C M M Peters
- Public Health Service South Limburg, Heerlen, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Department of Social Medicine and Medical Microbiology, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
| | - F D H Koedijk
- Public Health Service Twente, Postbus 1400, JM, 7511, Enschede, The Netherlands
| | - T S Berkenbosch
- Public Health Service Twente, Postbus 1400, JM, 7511, Enschede, The Netherlands
| | - J L A Hautvast
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C J P A Hoebe
- Public Health Service South Limburg, Heerlen, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Department of Social Medicine and Medical Microbiology, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
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Trust as a Determinant Factor for Condom Use among Female Sex Workers in Bali, Indonesia. Trop Med Infect Dis 2020; 5:tropicalmed5030131. [PMID: 32824197 PMCID: PMC7558845 DOI: 10.3390/tropicalmed5030131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 01/09/2023] Open
Abstract
Female sex workers (FSWs) decision to use or not to use condoms depends on several issues, including the decision to trust their client or not, a matter given little attention in previous research. This paper explores the role of trust in consistent condom use among FSWs. We used a cross-sectional survey among FSWs in Bali, Indonesia. The outcome variable for this study was condom use, and independent variables included sociodemographic characteristics, psychosocial factors, social capital dimensions and HIV prevention practices. In total, 406 FSWs participated in the study. Of these, 48% of FSWs used condoms consistently with paying clients over the last month. The following FSWs were less likely to consistently use condoms with clients: FSWs who did not trust that their peer FSWs will use condoms (AOR = 9.3, 95% CI, 3.3–26.2), FSWs who did not feel valued by the people at their location (AOR = 3.9, 95% CI, 1.4–11.6), FSWs who did not graduate from primary or never went to school (AOR = 2.4, 95% CI, 1.03–5.6), and FSWs who have worked more than five years as FSWs (AOR = 5.8, 95% CI, 1.2–29.2). Our results highlight higher rates of inconsistent condom use related to lower trust and feelings of being valued between FSWs, identifying areas for policy and practice attention.
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Ahinkorah BO, Budu E, Seidu AA, Hagan JE, Agbaglo E, Hormenu T, Schack T, Yaya S. Consistent condom use among men who pay for sex in sub-Saharan Africa: Empirical evidence from Demographic and Health Surveys. PLoS One 2020; 15:e0236552. [PMID: 32776965 PMCID: PMC7416936 DOI: 10.1371/journal.pone.0236552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Paying for sex has often been associated with risky sexual behavior among heterosexual men, and men who pay for sex are considered as a bridging population for sexually transmitted infections. Consistent condom use during paid sex is essential for reducing sexually transmitted infections, including HIV/AIDS. In this study, we assessed the prevalence and predictors of consistent condom use among men who pay for sex in sub-Saharan Africa. MATERIALS AND METHODS We pooled data from 29 sub-Saharan African countries' Demographic and Health Surveys. A total of 3,353 men in sub-Saharan Africa who had paid for sex in the last 12 months preceding the surveys and had complete information on all the variables of interest were used in this study. The outcome variable for the study was consistent condom use for every paid sex in the last 12 months. Both bivariate and multivariable logistic regression analyses were carried out. Results were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Statistical significance was declared at p< 0.05. RESULTS Overall, the prevalence of consistent condom use during paid sex in sub-Saharan Africa was 83.96% (CI = 80.35-87.56), ranging from 48.70% in Benin to 98% in Burkina Faso. Men aged 35-44 [AOR, 1.39 CI = 1.04-1.49], men in the richest wealth quintile [AOR, 1.96 CI = 1.30-3.00], men with secondary level of education [AOR, 1.69 CI = 1.17-2.44], and men in Burkina Faso [AOR = 67.59, CI = 8.72-523.9] had higher odds of consistent condom use during paid sex, compared to men aged 15-19, those in the poorest wealth quintile, those with no formal education, and men in Benin respectively. Conversely, Muslim men had lower odds [AOR = 0.71, CI = 0.53-0.95] of using condom consistently during paid sex, compared to Christian men. CONCLUSION Empirical evidence from this study suggests that consistent condom use during paid sex encompasses complex social and demographic characteristics. The study also revealed that demographic characteristics such as age, wealth quintile, education, and religion were independently related to consistent condom use for paid sex among men. With sub-Saharan Africa having the highest sexual and reproductive health burden in the world, continuous application of evidence-based interventions (e.g., educational and entrepreneurial training) that account for behavioural and social vulnerabilities are required.
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Affiliation(s)
- Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Hormenu
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
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