Sexual safety practices of massage parlor-based sex workers and their clients

The Outreach and Research in Community Health Initiatives and Development (ORCHID) project examines social and structural factors that contribute to HIV/AIDS risk among women working in Vancouver's indoor sex industry and their clients. From 2006 to 2009, two mixed method studies were undertaken in ORCHID: one exploring experiences of women working in the indoor sex industry, mainly in massage parlors, and the other exploring experiences of men as sex “buyers.” Both studies emphasize sexual health and safety, risk and protective behaviors, and related contextual factors. No analyses examining the sexual health and safety practices of massage parlor-based sex workers and clients exist in the Canadian context. To address this gap, we analyze two survey datasets – with 118 sex workers and 116 clients. Upon comparing demographics of sex workers and clients, we discuss their condom use and sexually transmitted infections (STI) and HIV testing practices. Sex workers and clients reported high rates of condom use for vaginal/anal intercourse. While both groups reported lower rates of condom use for oral sex during sex transactions, clients did so to a greater extent (p < 0.001). Condom use with noncommercial sex partners was reported to be less consistent by both groups. STI testing was higher among sex workers than clients (p < 0.001). Initiatives targeting clients of massage parlor-based sex workers for STI education and testing are needed. Future research should investigate how different types of relationships between sex workers and clients impact their sexual safety practices.     

Perceived partner beliefs about condoms and self-efficacy communication within the context of the theory of gender and power

The theory of gender and power provides a unique framework for understanding condom use by accounting for distinct challenges faced by minority women in particular. This study examined whether self-efficacy about condom use communication (SECC) and perceived partner's beliefs about condom (PPBC) use had an influence on condom use frequency; and whether these associations varied by gender. A sample of 252 African–American college students (101 males and 151 females) completed a confidential online survey assessing SECC, PPBC, and condom use behavior. SECC and PPBC showed significant associations with condom use behavior. Furthermore, there was a gender interaction effect with PPBC on condom use behavior. As PPBC increases toward positive associations about condom use, condom use behavior increased significantly more for females (B = 0.42; p = .02) as compared to males (B = 0.26; p = .19). This study supports the need to teach young women effective communication skills in order for them to accurately assess what their partner thinks about condom-related behaviors; and ultimately not allow partner discouragement to influence their decisions to use condoms. Interventions aimed at reducing risky sexual behavior on predominantly Black college campuses, in particular, may benefit from directly addressing relationship power and focusing on building self-efficacy in communicating condom use.     

娱乐场所预防艾滋病行为干预的试点研究

目的 探讨在娱乐场所服务小姐中开展预防艾滋病的健康教育和行为干预的方法、效果及可行性。方法 调查员深人现场，采用面对面的深人访谈与咨询，免费分发宣传材料和避孕套，演示避孕套正确使用方法等，运用封闭式调查问卷和定性访谈方法，评价干预效果。结果 干预前后分别调查385人和399人。通过干预，服务小姐艾滋病预防知识水平有显提高，对避孕套预防艾滋病经性传播的态度和信念有明显转变。在与固定和非固定性伴性行为中，最近一次避孕套的使用率分别为63．9％和89．0％；最近三次性行为中，每次都使用避孕套的分别达到39．1％和64．2％，较干预前均有显提高。结论 在娱乐场所服务小姐中开展预防艾滋病的健康教育和行为干预是可行的而且是有效的。     

Identification of Strategies for Promoting Condom Use: A Prospective Analysis of High-Risk African American Female Teens

Condom promotion strategies for adolescents typically include provision of STD/HIV-associated knowledge, fostering favorable attitudes toward condom use, promoting positive peer norms regarding condom use, improving condom-related communication skills and self-efficacy, and overcoming barriers to condom use. The purpose of this study was to identify which of these constructs were prospectively associated with condom use among a high-risk sample of African American adolescent females reporting sexual activity with a steady male partner. Adolescents, 14–18 years old, were recruited from schools and health clinics. Adolescents completed an in-depth survey and interview at baseline and again 6 months later. Analyses were limited to adolescents with steady partners who reported sexual activity between the baseline and 6-month follow-up assessment periods (N = 179). At baseline, five-scale measures and a single-item measure were used to assess predictive constructs. At follow-up, adolescents were asked about their frequency of condom use over various periods of recall. Multivariate models were created to control for the confounding influence of pregnancy status. The findings were remarkably distinct. The evidence strongly supported the predictive role of perceived barriers toward condom use and peer norms. The measure of sexual communication achieved significance for two of the six assessed outcomes. Alternatively, measures of attitudes toward condom use, condom negotiation self-efficacy, and knowledge about STD/HIV-prevention were consistently nonsignificant. The findings suggest that to improve effectiveness of individual-level STD/HIV prevention programs, designed for this population, program emphasis should be on reducing barriers to condom use, teaching partner communication skills, and fostering positive peer norms relevant to condom use.     

The 100% condom use programme in Asia

One of the main reasons for the rapid spread of HIV in Asian countries is the massive transmission among sex workers and clients. Therefore, effective interventions to prevent HIV transmission through sex work are necessary. Many efforts have been made to promote condom use in sex work. The most significant approach is the 100% Condom Use Programme. Since its conception in 1989, this programme has been implemented in Thailand, Cambodia, Philippines, Viet Nam, China, Myanmar, Mongolia and Laos PDR, with variations in programme components between countries. The main principle is to promote the practice of "No condom - No sex" in all types of sex work, through collaboration between local authorities, sex business owners and sex workers. Variations include formation of sex workers' self-help groups, peer education and issuance of membership cards by local authorities. Sex workers are empowered when they are able to refuse sex without a condom. In Thailand, the programme has increased the use of condoms in sex work from 14% in early 1989 to over 90% since 1992. The 100% Condom Use Programmes in Thailand and Cambodia, which are being implemented on a nationwide basis, are the main reason for the decline in the HIV epidemic. Scaling-up of activities is taking place in all other six countries.     

"No party hat, no party": successful condom use in sex work in Mexico and the Dominican Republic

Sex workers and their clients are particularly vulnerable to HIV/STI transmission. Most research on condom use has focused on barriers preventing use; less is known about attitudes, motivations and strategies employed by those who feel positively about condoms and who use them successfully. For this qualitative study, we conducted focus group discussions with sex workers (14), both female and transvestite, in Ciudad Juarez, Mexico, and female sex workers (17) and male clients (11) in Santo Domingo, Dominican Republic, who identified themselves as successful condom users in a condom use questionnaire. Discussions explored definitions of successful condom use, motivations and strategies for condom use and messages for future condom promotion. Sex workers defined successful condom use as being in agreement with their clients and partners about using condoms, protecting themselves from disease and unwanted pregnancy, and feeling good about using condoms. Condoms were seen to be hygienic, offer protection and provide a sense of security and peace of mind. Specific strategies included always having condoms on hand, stressing the positive aspects of condoms and eroticising condom use. Future educational messages should emphasise condom use to protect loved ones, increase security and pleasure during sex, and demonstrate respect for both sex workers, clients and partners.     

Young men's project: Great Yarmouth, UK

The Young Men's Project has been working with young men and young fathers as part of Great Yarmouth Primary Care Trust in the UK since June 2001. The Project works in schools and other educational environments to promote positive personal development, particularly around sex and relationships, and to increase accessibility of sexual health and contraceptive services, and support for young fathers. Young men generally want to look after themselves and to act responsibly in sexual relationships. Knowledge through education and appreciation of how to understand and express themselves as men are crucial. If they are likely to engage in penetrative sex, then being able to access condoms and use them correctly for every sexual encounter is next. Culturally, we set low expectations of young men when it comes to sexual health and taking responsibility. The same is true of our expectations of young fathers. This is not due to their lack of desire to be involved. Our work challenges the much repeated notion that young men are a hard-to-reach group, which throws the responsibility onto them. I believe we should recognise that we, and the services we provide, have been failing to meet their needs.     

Predictors of difficulty inserting the female condom

This article describes the frequency of initial difficulty inserting the female condom and identifies predictors of insertion difficulty among women at risk of sexually transmitted diseases (STDs). Female STD clinic patients (n = 1144) were taught how to insert the female condom by using an anatomic model, then given an opportunity for self-insertion practice. Correct placement of the condom was verified by a nurse clinician, and the number of attempts required for correct insertion was recorded. Sociodemographic and psychosocial predictors of refusing the insertion practice and of difficulty inserting the female condom were evaluated using logistic regression. Only 5% of study participants refused the self-insertion practice. Women who never had a Papanicolaou smear test, did not use tampons, never used an inserted method of STD prevention/birth control, and disliked the insertion features of intravaginal barrier methods were more likely to refuse the self-insertion practice. Of those who attempted self-insertion, 25% were unable to insert the female condom correctly on the first attempt. Women who never expressed their sexual likes and were indifferent to the positive features of intravaginal contraceptive methods were more likely to experience difficulty their first insertion attempt. Other variables associated with insertion difficulty included longer fingernails. Insertion refusal and difficulty affect use of the female condom for a sizable proportion of women. Women in this study who refused the self-insertion practice had greater aversion to inserting intravaginal barrier methods. Women who had initial difficulty inserting the female condom had a different profile from those who refused and can benefit from intensive skills training that includes supervised self-insertion practice.     

Knowledge of,attitudes toward,and stage of change for female and male condoms among denver inner-city women

Despite availability for a decade and documented acceptability among some groups of women for the method, female condom use is still rare. We surveyed 198 young women (15–25 years old) living in the inner city of Denver about their knowledge of, attitudes toward, and practices regarding female and male condoms. Most (75%) women had ever considered using male condoms; 32% had ever considered using female condoms; and use of either was sporadic. We examined predictors for being in either precontemplation or a later stage along the change continuum at both the bivariate and multivariate levels. Our findings suggest that African Americans and younger women are more likely to contemplate using female condoms. Both lack of knowledge and positive attitudes toward female condoms in this sample suggest that programs designed to raise awareness and knowledge of female condoms while improving their image are needed. This project was carried out in part under a cooperative agreement with the Association of Teachers of Preventive Medicine (TS310-1615) and the Division of Reproductive Health at the Centers for Disease Control and Prevention. The content of this publication does not necessarily reflect the views or policies of the Association or the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.     

Establishment of safety paradigms and trust in emerging adult relationships

There is a critical need to understand the interplay between relationship trust and public health outcomes. The purpose of this study was to develop an understanding of emerging adult women’s processes of establishing trust in sexual relationships. Twenty-five women aged 18–24 years participated in semi-structured interviews. Throughout the interviews, women compared and contrasted experiences in which they felt comfortable engaging in sexual intercourse with a partner versus times in which they did not feel comfortable. Analysis was based on a critical qualitative research orientation. When asked to speak to instances when they felt comfortable having sex, most women spoke about relationship trust. Many participants conceptualised trust based on past experiences with bad relationships or sexual violence. Based on their previous experiences of feeling unsafe or undervalued, emotional and physical security became prioritised in relationship development. Trust was developed through friendship, communication over time, and through shared life experiences. This research is among the first to qualitatively investigate trust formation and other impersonal dynamics related to sexual health decision-making. Insights from this study should be translated into future action by public health practitioners to promote healthy sexual relationships and communication about sexual health topics as a form of trust building.