title: Social and behavioural factors associated with condom use among direct sex workers in Siem Reap, Cambodia.
abstract: OBJECTIVE
  To determine the social and behavioural factors associated with condom use among direct sex workers in Siem Reap, Cambodia.
  
  
  METHODS
  Using a structured behavioural questionnaire, interviews were conducted with 140 direct sex workers attending a health centre in Siem Reap for HIV screening.
  
  
  RESULTS
  Consistent condom use with their clients was reported by 78% of sex workers compared to only 20% with their non-paying partners. Consistent condom use with clients was significantly higher among higher income than lower income sex workers (adjusted prevalence ratio: 1.91, 95% CI: 1.15 to 3.18) and those with good rather than poor negotiation skills (adjusted prevalence ratio: 1.51, 95% CI: 1.01 to 2.26), after adjustment for age, educational level, marital status, number of sexual encounters per week, and knowledge of AIDS/HIV and sexually transmitted infections. The most frequently reported reason for not using condoms with clients was not being able to persuade them (66.7%), while for non-paying partners, the reason was that they loved them (60.0%).
  
  
  CONCLUSIONS
  To complement the government's current programme of client education, 100% condom policy and brothel administrative measures, additional strategies to increase condom use among clients and non-paying partners should be directed at (i) the social policy and community levels to address sex workers' economic and cultural barriers to condom use, and (ii) personal level empowerment through developing sex workers' condom negotiation skills.
authors.affiliation: Department of Community, Occupational and Family Medicine (MD 3), Faculty of Medicine, National University of Singapore, Singapore. cofwml@leonis.nus.edu.org
authors.forename: M L
authors.initials: ML
authors.lastname: Wong
authors.forename: I
authors.initials: I
authors.lastname: Lubek
authors.forename: B C
authors.initials: BC
authors.lastname: Dy
authors.forename: S
authors.initials: S
authors.lastname: Pen
authors.forename: S
authors.initials: S
authors.lastname: Kros
authors.forename: M
authors.initials: M
authors.lastname: Chhit
mesh_terms: D000328:Adult; D002160:Cambodia / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000175:diagnosis; D006801:Humans; D007182:Income; D015999:Multivariate Analysis; D012044:Regression Analysis; D011477:Sex Work / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D012747:Sexual Partners