title: Structural determinants of dual contraceptive use among female sex workers in Gulu, northern Uganda.
abstract: OBJECTIVE
  To describe the characteristics of female sex workers (FSWs) who do and do not use dual contraceptives (i.e. male condoms plus a non-barrier method) in Gulu, northern Uganda.
  
  
  METHODS
  The present analysis was based on data gathered as part of a questionnaire-based, cross-sectional study conducted between May 2011 and January 2012. FSWs aged 14 years or older were recruited through peer-led or sex worker-led outreach and community-based services. Logistic regression was used to identify correlates of dual contraceptive use.
  
  
  RESULTS
  Among the 400 FSWs who participated, 180 (45.0%) had ever used dual contraceptives. In the multivariate model, dual contraceptive use was positively associated with older age (adjusted odds ratio [AOR] 1.09, 95% confidence interval [CI] 1.04-1.15; P=0.001), prior unintended pregnancy (AOR 1.53, 95% CI 1.01-2.34; P=0.046), and HIV testing (AOR 5.22, 95% CI 1.75-15.57; P=0.003). Having to rush sexual negotiations owing to police presence was negatively associated with dual contraceptive use (AOR 0.65, 95% CI 0.42-1.00; P=0.050).
  
  
  CONCLUSIONS
  Although a history of unintended pregnancy and accessing HIV testing might promote contraceptive use, criminalized work environments continue to pose barriers to uptake of sexual and reproductive health services among FSWs in post-conflict northern Uganda. Integrated links between HIV and sexual health programs could support contraceptive uptake among FSWs.
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Erickson
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Shira M
authors.initials: SM
authors.lastname: Goldenberg
authors.affiliation: The AIDS Support Organization, Gulu, Uganda.
authors.forename: Mirriam
authors.initials: M
authors.lastname: Ajok
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Muldoon
authors.affiliation: The AIDS Support Organization, Gulu, Uganda.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Muzaaya
authors.affiliation: Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. Electronic address: gshi@cfenet.ubc.ca.
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017280:Condoms / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D060728:Reproductive Health; D034121:Reproductive Health Services / Q000458:organization & administration; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014454:Uganda; D055815:Young Adult
keywords: Condoms; Contraceptive use; Family planning; HIV; Sex workers; Uganda