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
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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.