Trend and Factors Associated with Condom Use Among Male Clients of Female Sex Workers in Hong Kong: Findings of 13 Serial Behavioural Surveillance Surveys

Condom use, symptoms of suggestive sexually transmitted infections, and health care seeking among female sex workers in Bangladesh

This article presents a mixed-method cross-sectional study reporting condom use, sexually transmitted infection (STI) symptoms, and care seeking of female sex workers (FSWs) in Dhaka, Bangladesh. A survey of 1228 FSWs, in-depth interviews (n = 24), and key informants' interviews (n = 26) were used for data collection. Among the 1228 FSWs included in this study, 50% of them were illiterate and 39.3% were married, and their mean age was 27.1 years. The consistent use of condoms was reported by 75.6% of the FSWs, 88.7% reported having STI symptoms in the last 6 months, while 91.8% visited one of the drop-in centers for services. FSWs without formal education had lower odds of using condoms consistently (AOR: 0.72; 95% CI: 0.55-0.95), and those working elsewhere than in the streets showed higher odds (AOR: 1.63; 95% CI: 1.23-2.15) to use condoms. Stigma to access health care services, poor knowledge about STI/HIV, and low perceived risk were mentioned as causes of having STI symptoms in the survey as well as in qualitative in-depth interviews. Self-reported condom use, STI symptoms, and care-seeking practices were found to be high among the FSWs. Inconsistent condom use and a high number of sex partners could be the reasons for high levels of STI symptoms. Innovative objectively verifiable approaches should be tested to collect condom use data.

The use of the Multidimensional Condom Attitude Scale in Chinese young adults

Background

Attitude towards condom use is an important predictor of consistent condom use. However, this topic is an understudied area in Chinese populations, and no validated Chinese instrument is available to capture condom attitude. To fill this research gap, the present study aimed to evaluate the psychometric properties of the University of California, Los Angeles (UCLA) Multidimensional Condom Attitudes Scale (MCAS) and assessed the attitudes towards condom use amongst Chinese adults aged 18–29 years old.

Methods

In this cross-sectional study, a total of 500 people aged 18–29 years old were randomly recruited in Hong Kong. The primary outcome was the attitude towards condom use as measured by the UCLA MCAS. Factor structure, internal construct validity, known-group validity and internal consistency were assessed.

Results

Instead of the five-factor structure designed by the original developers of the MCAS questionnaire, this study proposed a novel six-factor scale: (1) Reliability and Effectiveness, (2) Excitement, (3) Displeasure, (4) Identity Stigma, (5) Embarrassment about Negotiation and (6) Embarrassment about Purchase. The internal construct validity and reliability of the new scale were high. The revised MCAS could differentiate between subgroups, including gender, sexual orientation and sexual experience. In terms of attitudes, over 40% of the participants believed that condoms are not reliable, though the vast majority of the sample did not perceive any stigma related to condom use. In addition, more than half (55.4%) of the respondents felt embarrassed to be seen when buying condoms while a quarter (25.8%) felt uncomfortable buying condoms at all.

Conclusions

Overall, the psychometric analysis found that attitude to condom use is culturally specific. The study also highlighted the need for more public health campaigns and interventions to help people cope with the embarrassment of purchasing condoms.

Left behind?: male clients of female sex workers in Zambia

Male clients of female sex workers (CFSWs) are a key-affected group within the HIV epidemic. However, few studies have quantified HIV/STI burdens among CFSWs. This study used nationally representative data from the 2013-14 Zambia Demographic and Health Survey to estimate proxies for HIV and STI prevalence among sexually active men aged 15-59 paying for sex recently (past 12 months) [5%, n = 679] or in their lifetime [15%, n = 1,887]. Chi-square tests were calculated to assess differences in prevalence estimates between CFSWs and non-clients. Multivariable logistic regression models were generated to identify sociodemographic factors associated with prevention characteristics. CFSWs had higher odds of reporting HIV infection (recent: aOR 1.413, p < 0.05; lifetime: aOR 1.604, p < 0.001) and past-year STI symptomology (recent: aOR 3.342, p < 0.001; lifetime: aOR 2.266, p < 0.001) than non-clients, irrespective of transactional sex recency. Compared to non-clients, CFSWs were more likely to be <25yo (42% vs. 29%, p < 0.001), have a cohabitating partner (43% vs. 35%, p < 0.001), use condoms at last sex (31% vs. 27%, p < 0.001), and never test for HIV (36% vs. 29%, p < 0.001). When comparing CFSWs to non-clients, marital status was an effect modifier of HIV testing, medical circumcision, and condom use at last sex. Findings suggest high HIV/STI burdens and highlight the urgent need for differentiated HIV prevention programming for CFSWs in Zambia including the provision of PrEP.

Low uptake of HIV testing among male clients of female sex workers in China

Male client of female sex workers (MCFSW) is a sizable population transmitting HIV from high-risk population to female general population in China. This study was to investigate the prevalence of taking up any forms of HIV testing in lifetime and in the past year among MCFSW in Hong Kong. Factors associated with uptake of any forms HIV testing in the past year were also investigated. A cross-sectional survey was conducted. Participants were Hong Kong Chinese males aged ≥18 years, and self-reported had patronized at least one female sex workers (FSW) in the last six months. A total of 303 MCFSW recruited online (n = 160) or from venues (n = 143) completed the self-administered questionnaire. Logistic regression was used for data analysis. The prevalence of taking up any forms of HIV testing in lifetime and last year was 49.2% and 23.8%, respectively. Adjusting for these background variables, scale scores representing perceived severity of HIV infection (AOR: 1.17), perceived benefits of HIV testing (AOR: 1.18) and perceived self-efficacy in taking up HIV testing (AOR: 1.36) were significantly and positively associated with uptake of any forms of HIV testing in the last year, while negative associations were found for the Perceived Psychological Barrier Scale (AOR= 0.88) and the Perceived Logistical Barrier Scale (AOR: 0.78). MCFSW in Hong Kong reported low uptake of HIV testing. Health promotion is urgently needed. Modifying perceptions related to the Health Belief Model are potential useful strategies. The potential of using HIV self-testing to increase HIV testing coverage among MCFSW should also be considered.