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Condom Negotiations among Female Sex Workers in the Philippines: Environmental Influences

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  • Lianne A Urada
  • Donald E Morisky
  • Nymia Pimentel-Simbulan
  • Jay G Silverman
  • Steffanie A Strathdee

Abstract

Background: Social and structural influences of condom negotiation among female sex workers (FSWs) remain understudied. This study assesses environmental and individual factors associated with condom negotiation among FSWs at high risk for acquiring HIV in a large urban setting of Metro Manila, Philippines. Methods: Female bar/spa workers (N = 498), aged 18 and over, underwent interview-led surveys examining their sexual health practices in the context of their risk environments. Data were collected from April 2009-January 2010 from 54 venues. Multiple logistic regressions were conducted to assess socio-behavioral factors (e.g., age, education, length of time employed as an entertainer, and alcohol/drug use) and socio-structural factors (e.g., venue-level peer/manager support, condom rule/availability, and sex trafficking) associated with condom negotiation, adjusting for individuals nested within venues. Results: Of 142 FSWs who traded sex in the previous 6 months (included in the analysis), 24% did not typically negotiate condom use with venue patrons. Factors in the physical environment - trafficked/coerced into work (AOR = 12.92, 95% CI = 3.34–49.90), economic environment - sex without a condom to make more money (AOR = 1.52, 95% CI 1.01–2.30), policy environment - sex without a condom because none was available (AOR = 2.58, 95% CI = 1.49–4.48), and individual risk - substance use (AOR = 2.36, 95% CI = 1.28–4.35) were independently associated with FSWs' lack of condom negotiation with venue patrons. Conclusions: Factors in the physical, economic, and policy environments, over individual (excepting substance use) and social level factors, were significantly associated with these FSWs' condom negotiations in the Philippines. Drawing upon Rhodes' risk environment framework, these results highlight the need for policies that support safer sex negotiations among sex workers in the context of their risk environments. Interventions should reduce barriers to condom negotiation for FSWs trafficked/coerced into their work, substance using, and impacted by economic conditions and policies that do not support condom availability.

Suggested Citation

  • Lianne A Urada & Donald E Morisky & Nymia Pimentel-Simbulan & Jay G Silverman & Steffanie A Strathdee, 2012. "Condom Negotiations among Female Sex Workers in the Philippines: Environmental Influences," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-9, March.
    • Handle: RePEc:plo:pone00:0033282
    DOI: 10.1371/journal.pone.0033282
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    References listed on IDEAS

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    1. Pande Putu Januraga & Julie Mooney-Somers & Hailay Abrha Gesesew & Paul R Ward, 2020. "The Logic of Condom Use in Female Sex Workers in Bali, Indonesia," IJERPH, MDPI, vol. 17(5), pages 1-12, March.
    2. Schmidt-Sane, Megan, 2022. "Male partners of female sex workers: The intersectional risk environment of HIV/AIDS in a Kampala informal settlement," Social Science & Medicine, Elsevier, vol. 298(C).
    3. Shalini Bharat & Bidhubhusan Mahapatra & Suchismita Roy & Niranjan Saggurti, 2013. "Are Female Sex Workers Able to Negotiate Condom Use with Male Clients? The Case of Mobile FSWs in Four High HIV Prevalence States of India," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-8, June.
    4. Lianne A. Urada & Janie Simmons & Betty Wong & Kiyomi Tsuyuki & Gerlita Condino-Enrera & Laufred I. Hernandez & Nymia Pimentel Simbulan & Anita Raj, 2016. "A human rights-focused HIV intervention for sex workers in Metro Manila, Philippines: evaluation of effects in a quantitative pilot study," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 61(8), pages 945-957, November.

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