Examining the association between self-reported condom use and sexually transmitted infections Public Deposited

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  • March 21, 2019
  • Wesson, Jennifer
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Two analyses were performed using data from an 18-month study of a condom promotion intervention among 1000 female sex workers (FSW) in two cities in Madagascar. The first analysis explored whether participating in such a study and being exposed to such an intervention over time would change the strength of the association between self-reported condom use and incident sexually transmitted infections (STI). The analysis found no evidence of a change in the association over time. In addition, there was no indication of a dose-response relationship between the number of reported unprotected sex acts and incidence of STI. The second analysis tested the risk of STI associated with self-reported condom use by partner type. Over the 18 months of the study, participants reported greatly increased rates of condom use with clients, but continued low condom use with personal partners. Participants who reported less than 100% condom use with personal partners, but 100% condom use with clients had no increased odds of STI as compared to those who reported 100% condom use with both partner types (odds ratio (OR) 0.9, 95% confidence interval (CI) 0.5, 1.6). Conversely, participants who reported inconsistent condom use with clients, but consistent condom use with their personal partners had an 8.3 times higher odds of STI (95% CI 0.5, 138.0) as compared to consistent condom users with both partner types. We conclude that asking study participants to report the actual number of sex acts and the number of those sex acts that were protected by condoms may result in falsely precise estimates of their exposure to risky sex acts. The results indicating that unprotected sex with personal partners does not contribute to risk of STI are contrary to indications from other recent studies in West Africa about the infection status of personal partners of FSW. The relationship should be further explored before programs change the message that FSW should use condoms with all partners.
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  • Behets, Frieda
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