title: A case-crossover analysis of predictors of condom use by female bar and hotel workers in Moshi, Tanzania.
abstract: BACKGROUND
  Factors related to specific sexual encounters can influence condom use during these encounters. These situation-specific factors have not been adequately studied in resource-poor countries where HIV infection has in some areas reached epidemic levels. This study was undertaken to identify situation-specific factors associated with condom use among 465 female bar and hotel workers in Moshi, Tanzania.
  
  
  METHODS
  We conducted a case-crossover study in which women provided information about their most recent unprotected and protected sexual encounters. Conditional logistic regression was used to estimate paired odds ratios and 95% confidence intervals for the association between situation-specific factors and condom use.
  
  
  RESULTS
  A subject-based or mutual decision about condom use (compared with partner based), casual partner type, a first-time sexual encounter and receiving gifts in exchange for sex were independently associated with increased odds of condom use, while sex at home and sex with a partner more than 10 years older was associated with reduced odds of use. There was also effect modification between partner type and decision-making: subject-based or mutual decisions were more protective with casual than regular partners; also, when the partner made the decisions about condom use, the type of partner had no effect.
  
  
  CONCLUSIONS
  Decision-making about condom use is a potentially modifiable predictor of unprotected sex, but its effect varies by partner type. Behavioural interventions are needed that encourage discussion about condom use and increase women's self-efficacy, but other types of interventions as well as female-controlled HIV prevention methods are needed for women in regular partnerships.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. ktassiop@hsph.harvard.edu
authors.forename: Katherine
authors.initials: K
authors.lastname: Tassiopoulos
authors.forename: Saidi
authors.initials: S
authors.lastname: Kapiga
authors.forename: Noel
authors.initials: N
authors.lastname: Sam
authors.forename: Trong T H
authors.initials: TT
authors.lastname: Ao
authors.forename: Michael
authors.initials: M
authors.lastname: Hughes
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D018592:Cross-Over Studies; D003657:Decision Making; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D021841:Safe Sex / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners; D013636:Tanzania; D055815:Young Adult