Understanding the Dynamics of Condom Use Among Female Sex Workers in China

Objectives and Background: Condom use within the context of commercial sex work is a complex issue. Drawing on a hypothesized theoretical model that combines concepts from the health belief model and social cognitive theory, this study examines the complex relationships between multiple levels of determinant factors of condom use with clients among female sex workers in China. Methods: Data were collected through the baseline Survey of an HIV prevention project among 454 establishment-based female sex workers in a rural county of Guangxi, China in 2004. Path analysis was performed to test the hypothesized model that specifies relationships between all observed variables. Results: Within the context of this study's model, STD/HIV knowledge and condom use skills were related to self-efficacy which in turn related to condom use. Susceptibility/severity was related to perceived benefits of unprotected sex. Perceived benefits were in turn inversely related to condom use. STD/HIV knowledge, condom use skills, and susceptibility/severity had no direct effect on condom use. Their effects on condom use were mediated by self-efficacy and perceived benefits. Self-efficacy was not associated with perceived benefits of unprotected sex. Perceived establishment-level support was positively related to condom use. Conclusions: Self-efficacy, perceived benefits of unprotected sex, and perceived establishment-level support are proximate determinants of condom use among female sex workers. Future HIV prevention interventions should integrate these factors into conceptual frameworks.