title: Promoting female condoms in the sex industry in 4 towns of Southern China: context matters.
abstract: BACKGROUND
  The female condom (FC) is an effective tool for dual protection, but it remains underused. Individual and contextual reasons need to be explored.
  
  
  OBJECTIVE
  The aim of this study was to compare individual and contextual characteristics of FC multitime users, 1-time users, and nonusers among women in the sex industry of 4 study sites in China.
  
  
  METHODS
  A standardized 1-year FC intervention along with male condoms was implemented through outreach to sex establishments. Three serial cross-sectional surveys were conducted at baseline and after each of two 6-month intervention phases.
  
  
  RESULTS
  A total of 445, 437, and 290 eligible women were interviewed at 3 cross-sectional surveys, respectively. At the first and second postintervention surveys, 83.3% and 81.7% of women reported knowing about FC, and 28.8% and 36.6% had used FC at least once. Women who used FC multiple times reported less unprotected sex than nonusers in the last 30 days (3.0% vs. 17.2% at first and 3.2% vs. 16.8% at second postintervention survey, P < 0.01). Polytomous logistic regression showed that both 1-time and multitime users were more likely to come from one particular site (approximately 3 times more than the reference site). Higher intervention scores (adjusted odds ratio, 1.8-4.0) and working in boarding houses (adjusted odds ratio, 3.4) were associated with FC use.
  
  
  CONCLUSIONS
  Adding FC into male-condom-only intervention may reduce unprotected sex among women in sex establishments in rural and small urban areas of China. Adoption of FC may be related not only to intervention exposure but also to contextual factors associated with study site and type of sex establishments.
authors: Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
authors: Li
authors: L
authors: Nie
authors: Susu
authors: S
authors: Liao
authors: Margaret R
authors: MR
authors: Weeks
authors: Yanhong
authors: Y
authors: Wang
authors: Jingmei
authors: J
authors: Jiang
authors: Qingning
authors: Q
authors: Zhang
authors: Yuejiao
authors: Y
authors: Zhou
authors: Bin
authors: B
authors: He
authors: Jianghong
authors: J
authors: Li
authors: Jennifer
authors: J
authors: Dunn
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D019111:Single-Use Internal Condom; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology / Q000635:transmission*; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*
references: Am J Public Health. 2008 Oct;98(10):1841-8
references: 18703460
references: Sex Health. 2012 Mar;9(1):18-26
references: 22348629
references: Sex Transm Dis. 2004 Nov;31(11):695-700
references: 15502679
references: Int J STD AIDS. 2006 Oct;17(10):652-9
references: 17059633
references: AIDS Care. 2011 Jun;23 Suppl 1:66-74
references: 21660752
references: AIDS Educ Prev. 2009 Dec;21(6):538-51
references: 20030498
references: Sex Transm Dis. 2000 Sep;27(8):431-7
references: 10987447
references: AIDS Educ Prev. 2010 Jun;22(3):252-71
references: 20528132
references: Am J Public Health. 2011 Aug;101(8):1410-9
references: 21680923
references: Am J Prev Med. 2008 Aug;35(2 Suppl):S211-24
references: 18619402
references: AIDS Educ Prev. 2003 Apr;15(2):109-21
references: 12739788
references: AIDS Educ Prev. 2002 Apr;14(2):158-71
references: 12000233
references: Public Health. 2011 May;125(5):283-92
references: 21513961
references: AIDS Behav. 2006 Jul;10(4 Suppl):S35-45
references: 16823627
references: Contraception. 2002 Sep;66(3):179-85
references: 12384207
references: AIDS Care. 2011 Jun;23 Suppl 1:1-4
references: 21660746
references: Rev Panam Salud Publica. 2004 Jun;15(6):373-9
references: 15272983
references: AIDS Educ Prev. 2008 Apr;20(2):121-34
references: 18433318
references: Zhonghua Yu Fang Yi Xue Za Zhi. 2009 Nov;43(11):1009-15
references: 20137527
references: Sex Transm Dis. 2008 Jan;35(1):102-10
references: 17767093
references: Lancet Infect Dis. 2008 Jun;8(6):343
references: 18501845
references: Am J Epidemiol. 2007 Jul 1;166(1):88-96
references: 17420182
references: Contraception. 2007 Jan;75(1):66-70
references: 17161127