title: Environmental-structural factors significantly associated with consistent condom use among female sex workers in the Dominican Republic.
abstract: OBJECTIVE
  To examine the influence of environmental-structural factors in promoting consistent condom use (CCU) among female sex workers (FSW) and their regular paying partners in the Dominican Republic.
  
  
  METHODS
  A cross-sectional survey was conducted with 288 FSW recruited from 41 sex establishments in Santo Domingo from March to June 1998. Sex workers were asked about their sexual behavior, self-efficacy at negotiating safe sex, perceived intimacy with their most recent regular paying partner, and the physical, social and policy environment of the establishment where they worked. Factor and reliability analysis were utilized to develop aggregate measures for self-efficacy (Cronbach's Alpha 0.60), intimacy (Cronbach's Alpha 0.80), and environmental-structural support (Cronbach's Alpha 0.72).
  
  
  RESULTS
  Controlling for sociodemographic characteristics of participants in multivariate analyses, environmental-structural support for condom use and HIV/sexually transmitted infection (STI) prevention was a significant predictor of CCU (OR 2.16; CI 1.18-3.97) among FSW and their regular paying partners. Safe sex self-efficacy (OR 2.80; CI 1.31-5.97) and low perceived intimacy with the most recent regular paying partner (OR 7.20; CI 3.49-14.83) were also significantly associated with CCU in multivariate analysis.
  
  
  CONCLUSIONS
  Environmental-structural support for condom use and HIV/STI prevention is a significant predictor of CCU among FSW in the context of regular paying partnerships. Environmental-structural factors, in addition to relational and individual cognitive factors, should be assessed and addressed by behaviorally guided theory, research and interventions related to HIV/STI prevention and female sex work.
authors.affiliation: Johns Hopkins School of Public Health, 615 North Wolfe Street, Room E7141, Baltimore, MD 21245, USA. dkerriga@jhsph.edu
authors.forename: Deanna
authors.initials: D
authors.lastname: Kerrigan
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Ellen
authors.forename: Luis
authors.initials: L
authors.lastname: Moreno
authors.forename: Santo
authors.initials: S
authors.lastname: Rosario
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: Michael
authors.initials: M
authors.lastname: Sweat
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004293:Dominican Republic / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015999:Multivariate Analysis; D021841:Safe Sex; D020377:Self Efficacy; D011477:Sex Work / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D012747:Sexual Partners