Predictors of Unprotected Sex Among Female Sex Workers in Madagascar: Comparing Semen Biomarkers and Self-Reported Data

Research on the determinants of condom use and condom non-use generally has relied on self-reported data with questionable validity. We identified predictors of recent, unprotected sex among 331 female sex workers in Madagascar using two outcome measures: self-reports of unprotected sex within the p...

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Bibliographic Details
Published in:AIDS and behavior 2010-12, Vol.14 (6), p.1279-1286
Main Authors: Gallo, Maria F., Steiner, Markus J., Hobbs, Marcia M., Weaver, Mark A., Hoke, Theresa Hatzell, Van Damme, Kathleen, Jamieson, Denise J., Macaluso, Maurizio
Format: Article
Language:English
Subjects:
Acquired Immune Deficiency Syndrome
Adolescent
Adult
Age Factors
Biomarkers
Biomarkers - analysis
Condoms
Condoms - utilization
Data Collection
Enzyme-Linked Immunosorbent Assay
Female
Females
Health Psychology
HIV Infections - prevention & control
Humans
Infectious Diseases
Logistic Models
Madagascar
Male
Medicine
Medicine & Public Health
Original Paper
Prevention
Prostate-Specific Antigen - analysis
Prostitution
Public Health
Risk-Taking
Self Report
Semen - metabolism
Sex industry
Sex Work
Sexual behavior
Sexual Partners
Sexually transmitted diseases
Sexually Transmitted Diseases - prevention & control
STD
Unsafe Sex
Women
Young Adult
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Summary:Research on the determinants of condom use and condom non-use generally has relied on self-reported data with questionable validity. We identified predictors of recent, unprotected sex among 331 female sex workers in Madagascar using two outcome measures: self-reports of unprotected sex within the past 48 h and detection of prostate-specific antigen (PSA), a biological marker of recent semen exposure. Multivariable logistic regression revealed that self-reported unprotected sex was associated with three factors: younger age, having a sipa (emotional partner) in the prior seven days, and no current use of hormonal contraception. The sole factor related to having PSA detected was prevalent chlamydial infection (adjusted odds ratio, 4.5; 95% confidence interval, 2.0–10.1). Differences in predictors identified suggest that determinants of unprotected sex, based on self-reported behaviors, might not correlate well with risk of semen exposure. Caution must be taken when interpreting self-reported sexual behavior measures or when adjusting for them in analyses evaluating interventions for the prevention of HIV/STIs.
ISSN:1090-7165
1573-3254
DOI:10.1007/s10461-010-9742-8