Determinants of condom use: perceived by female sex workers.

Thesis Report.

SUMMARY: This study was conducted with the purpose to explore the determinants of condom use. The specific objectives was to assess the knowledge of Female Sex Workers (FSWs) on correct method of condom use, to explore the perceived factors of FSWs behind the use and non use of condom and to find out the dual contraceptive prevalence among Female Sex Workers. A cross sectional, exploratory study was conducted in Makwanpur district along the highway route and inner Village Development Committee (VDCs). Both qualitative and quantitative study approach was taken to conduct the study. The sample size of 85 Female Sex Workers (FSWs) was interviewed using snow balling techniques. Two Focus Group Discussions with homogenous group of FSWs were conducted to gather qualitative information and for the triangulation purpose. The collected quantitative information was entered in Statistical Program on Social Science (SPSS)program and qualitative information was handled manually. More than half of the sex workers were home based sex workers having few regular clients who visited them in when there husbands were away. The client contact place for FSWs were market, jungle, bus stop, hotel, liquor shop and through phone contacts. Majority (81%) of married clients of various occupations were the clients of FSWs of age 20 to 85 years. Drivers, servicemen and laborer were among the most frequent visiting clients. Of 85 FSWs interviewed 5 reported not using condoms at last sexual contact and same number using condom inconsistently. The perceived factors for increase in clients using condom was increase awareness among the clients about condom and the diseases such as STI and HIV/AIDS. The perceived factors for non use of condom were mostly due to client's sexual displeasure, client's risk taking behavior and less awareness and education among some of the occupations like farmers, garage workers. About 80% of female sex workers had knowledge of correct method of condom use and 81% negotiate about condom use with their clients. 69% of sex workers used condom from starting to the end of the intercourse while about 31% used just before insertion or ejaculation. Hundred percent of SWs were involved in vaginal sex, the second most frequently served sexual act was oral sex (32%). Dual contraceptive prevalence of condom and FP devices was 12 % while the dual contraceptive prevalence of condom use alone was 74%. Lastly consistent condom use among FSWs at Makwanpur district was very high. They have enough knowledge about correct method of condom use and negotiate with clients about condom. Dual contraceptive prevalence of FP devices with condom was less but dual contraceptive prevalence of condom alone was high. FSWs perceived that the increase awareness among clients about sexually transmitted diseases and condom use was the main reason for increase in condom use while clients' negligence was the main reason for non use of condom. Alternative sexual measures were offered and practiced by FSWs when condom was not used.