Why do condoms break? A study of female sex workers in Bangalore, south India
- Janet Bradley1,2,
- S P Rajaram3,
- Stephen Moses4,
- Marie Claude Boily5,
- B M Ramesh3,4,
- Shajy Isac3,
- Anil Lobo3,
- G Chandrashekhar Gowda6,
- R Pushpalatha7,
- Kaveri Gurav3,
- Sunil Kumar3,
- Reynold Washington3,4,
- Michael Pickles5,
- Michel Alary2
- 1CHARME-India Project, Bangalore, India
- 2URESP, Centre de recherche FRSQ du CHA affilié Universitaire de Québec, Québec, Canada
- 3Karnataka Health Promotion Trust, Bangalore, India
- 4Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
- 5Imperial College, London, UK
- 6Swasti-Health Resource Centre, part of Catalyst Group, Bangalore, India
- 7Swathi Mahila Sangha, Bangalore, India
- Correspondence to Janet Bradley, CHARME-India Project, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore 560 044, India;
Contributors JB, BMR, SI, MA and MCB designed the study. JB supervised the fieldwork with GCG/RP and SK and wrote the manuscript. SR managed all the data analysis. All authors contributed to discussions of the methodology and commented on the manuscript.
- Accepted 31 December 2011
- Published Online First 27 January 2012
Objectives The purpose of the study was to obtain a better understanding of the relative importance of personal factors, male partner factors and situational factors, in determining condom breakage in a population of female sex workers (FSWs) in Bangalore.
Methods The authors conducted a cross-sectional study that included a face-to-face interview and condom application test, with 291 randomly selected FSWs in Bangalore, India, in early 2011.
Results Ninety-seven per cent of respondents noted condom use at last sex; 34% reported a condom breakage in the last month. Combining individual, situational and partner aspects of condom breakage into one logistic regression model and also controlling for client load, the authors found that partner and situational factors were dominant since the only significant predictors of condom breakage included being a paying client (adjusted odds ratio 4.61, 95% CI 1.20 to 17.58, p=0.025), the condom being too small for the penis (adjusted odds ratio 2.29, 95% CI 0.97 to 5.40, p=0.056) or too big for the penis (adjusted odds ratio 4.29, 95% CI 1.43 to 12.80, p=0.009) and rough sex (adjusted odds ratio 6.39 CI 3.55 to 11.52, p<0.001).
Conclusions Condom use among Bangalore FSWs is now very high. However, condom breakage is still a not uncommon event and puts women and their clients at unnecessary risk of infection. It may be difficult to eliminate the problem completely, but every effort should be made to discuss with sex workers the findings of this survey that point to possible personal markers of risk seen in the univariate analysis and to highlight the importance of avoiding rough sex and of ensuring the condom fits the client.
- female sex workers
- condom breakage
- sexual health
- epidemiology (general)
- sexual behaviour
- STD control
Funding This research was funded by the Bill & Melinda Gates Foundation. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation, grant number 33978.
Competing interests None.
Patient consent Verbal witnessed consent was used. This is a normal procedure for sex work research in India as many subjects are illiterate.
Ethics approval Institutional Ethical Review Board of the St John's Medical College and Hospital, Bangalore, India.
Provenance and peer review Not commissioned; externally peer reviewed.