Objective:
At 71%, HIV prevalence is disproportionately high among Malawi’s female commercial sex workers (FCSWs)
(NSO and Macro, 2011) (NAC, 2006). Yet little is known about FCSWs risk behaviors. This study sought to
determine the risk factors for inconsistent condom use among FCSWs in three Malawi districts in 2011.
Methods:
This was a secondary analysis of a cross-sectional primary study that collected data in October 2011 of
FCSWs in Malawi’s three southern districts of Blantyre, Mwanza and Zomba to inform a behavior change
intervention. The primary study used respondent driven sampling to recruit 198 FCSWs. Data from all the
participants of the primary study were included in the secondary analysis. A structured questionnaire was
used to collect information on socio-demographics; sex and sexual history; and condom use with different
partner types. The dichotomous outcome variable “inconsistent condom use” was generated from a
composite of variables: condom use with last sex and condom use in the last 30 days – which were
measured across partner types. Descriptive analysis was performed and categorical data were reported as
proportions and frequencies while continuous data as means or median. Chi square analysis was used to
detect associations in cross tabulations and two multivariate logistic regression models were built for
inconsistent condom use - across all partners and clients.
Results:
Overall, slightly less than half of FCSWs (45.92%) used condoms consistently (n=196). FCSWs with secondary
school education were 2.18 times more likely than FCSWs with primary school education to be inconsistent
condom users (across all partners). FCSWs who first had sex between the ages of 15 to 19 years were .39
times less likely to be inconsistent condom users (across all partners) than FCSWs who first had sex under 15
years of age. FCSWs who had residence in the area for more than four years were 7.2 times more likely to be
inconsistent condom users than the reference group (FCSWs who had stayed in the area for one year or
less). An increase in number of paying partners by one partner is associated with decreased likelihood of
inconsistent condom use by 31% (0.69 times) (AOR .69, .52 – .92).
Conclusions:
FCSWs remain a key population in the HIV epidemic. All efforts should promote 100% condom use across all
partner types of FCSWs with particular focus on the regular, intimate partner.