Female sex workers are a vulnerable population at risk of HIV, other STIs, harassment, and unplanned pregnancies. Female condoms are available to mitigate these risks. However, the acceptability and usage of female condoms among sex workers in small South African towns are not well understood. This study aimed to explore the knowledge, attitudes, and practices of female sex workers towards female condoms and contraceptives.
Participants were mostly female-only with at least a matric level of education. Poverty and unemployment were cited as reasons for engaging in sex work. The HIV prevalence among participants was 30.4%, lower than previous reports but still higher than the general population.
Implanon and injectable contraceptives were the most commonly used methods among participants. This preference for medium- to long-term contraceptives aligns with other studies. However, some sex workers avoid certain methods due to side effects that may impact their work.
While condoms were used in the most recent sexual encounter by most participants, barriers to consistent condom use were reported. Factors such as client refusal, income loss, and substance use influenced condom use decisions.
Only 43.5% of participants had adequate knowledge about condom use. Those with adequate knowledge were more likely to report barriers to condom use. Strengthening health promotion strategies could improve knowledge and attitudes towards condom use.
The study highlights the low acceptability of female condoms among sex workers in South Africa. Effective marketing strategies, improved access, and addressing barriers to use are essential to promote female condom acceptability. Strengthening community education and empowerment programs can help improve safer sexual practices among sex workers.
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