Improving the measurement and understanding of correct and consistent condom use among commercial sex workers in the Russian Federation

Background: Correct and consistent condom use are primary HIV preventive behaviors promoted among commercial sex workers (CSW). Yet condom use is often over-reported among CSW, impeding accurate tracking of behavior change. This study demonstrates two simple ways of enhancing the accuracy of reported condom use among CSW in two Russian regions, and examines determinants of condom use. Methods: A behavioural tracking study was conducted in 2006 with a probability sample of CSW (N=771). Differences between means were assessed by paired t-tests, after adjusting for socio-demographics. Multivariate analyses identified predictors of condom use. Main Findings: Probing about whether a condom was used from the beginning to the end of intercourse reduced initial rates of reported condom use at last sex with a client (from 96.5% to 86.2%; p<0.00). Primary determinants of condom non-use were low self-efficacy in convincing clients to use condoms, and believing that getting HIV depends on luck. Respondents who reported “always” using a condom with clients during the past month were asked to consider the previous month again and confirm that a condom was used every time; “consistent” condom use declined (from 79.7% to 68.4%; p<0.00). Primary determinants of inconsistent condom use were low accessibility to condoms, low self-efficacy for refusing unprotected sex, and fear of losing clients if insisting on condom use. Recommendations: Programs targeting CSW should emphasize the risks associated with incorrect and inconsistent condom use. Priority are approaches which improve accessibility to condoms, raise CSW's self-efficacy to insist on their use, and promote internal locus of control regarding HIV prevention. Behavioral tracking surveys of CSW and evaluations of programs targeting CSW should adopt the improved measures of condom use.