Use of Dual Protection Among Female Sex Workers In Swaziland

This 10-page journal article shares insights gained from a survey of 325 female sex workers, related to condom use and non-barrier contraceptive methods in Swaziland. As stated in the article, programmes and policies related to female sex workers have tended to emphasise HIV protection, and not family planning needs. The optimal approach for preventing HIV and STIs, and unintended pregnancy may be the use of dual protection, condom and non-barrier methods such as oral contraceptives, injectables, and sterilisation. However, little research or analysis is available to assess the feasibility or efficacy of this dual approach for female sex workers. This research therefore aims to offer a better understanding of sex workers' use of condoms and nonbarrier methods and highlights the need to "incorporate HIV prevention into family planning interventions, particularly among female sex workers who have children and non-commercial partners".

The study methodology comprised of an hour long questionnaire, which measured condom and non-barrier method use across a 30 day time period, as well as in different kinds of partnerships - new clients, regular clients, and non-commercial partners. Participants were considered to be consistent condom users if they reported that they had always used condoms in the past month with each type of partner that they were involved with. Socio-demographic information was also collected and considered.

The article notes that "after adjustments were made for background and behavioural factors, 16% of female sex workers were found to be consistent users of condoms alone; 39% used non-barrier modern methods (without consistent condom use); 8% were dual method users; and 38% were inconsistent condom users or used other methods or none. Women who reported recent condom failure were less likely than others to be consistent condom users (6% vs. 22%). Consistent use of condoms alone was more common among women who had had no non-commercial partners in the past month than among those who reported two or more such partners (39% vs. 3%). In addition, respondents who had children were more likely than their nulliparous counterparts to report use of non-barrier methods alone (65% vs. 14%)."

The findings of the study suggest that there is a need to further explore the contraceptive needs of female sex workers. As well, "as has been demonstrated in previous studies, HIV-positive status was not associated with higher levels of consistent condom use or other contraceptive use. HIV-positive women are at risk not only of transmitting HIV to their partners, but also of experiencing unintended pregnancy and transmitting HIV to their infants. Furthermore, the use of non-barrier contraceptives without supplemental condom use has been documented among HIV-positive women." It is possible that some women may wrongly believe that non-barrier contraceptive methods also protect against transmission of HIV and other STIs, which is an area that still needs to be explored.

The findings also suggest that the "negative association between recent condom failure and consistent condom use is noteworthy. More than half of the participants had reported condom failure in the last month, which raises questions about the cause of such frequent breakage and slippage. Further investigation should consider both the quality of available condoms and condom-compatible lubricants, as well as female sex workers’ knowledge about how to use condoms and lubricants correctly."

The article concludes that "inconsistent or no condom use among non-barrier contraceptive users underscores the need to incorporate HIV prevention into family planning interventions, particularly among female sex workers who have children and non-commercial partners." This may include incorporating contraceptive counselling and provision into HIV services, such as voluntary counselling and testing services or condom distribution programmes. HIV service providers and peer educators can also be trained to assess the need for family planning, and offer counselling and methods. In addition, because little is known about female sex workers' beliefs about the safety and effectiveness of non-barrier modern methods, surveillance research should be initiated to improve understanding of their contraceptive knowledge and attitudes.