Understanding negotiation and use of female-controlled barrier methods

Female-controlled methods to prevent STI transmission could be a useful tool to prevent STI transmission. Preliminary results of a prior five-month longitudinal study show a high acceptability of female condoms and diaphragms among sex workers in Dominican Republic. We conducted 19 in-depth interviews with a subgroup of participants who completed this longitudinal study, in order to better understand how they negotiated use of these methods with clients and in which conditions they chose to use these methods.

During the study, participants attended monthly visits where they received 30 female condoms, 30 male condoms and a diaphragm along with proper counseling about their use. We designed an interview guide to explore in detail negotiation and experiences in using both methods. Interviews were conducted in a period of three months after the completion of the longitudinal study.

Preliminary results show half of women had good experiences with the diaphragm, using it as a secret back-up protection against STIs in case the male condom breaks or when the sexual partner is unwilling to use any method. Others used it during menstruation. The women preferring female condoms felt having control to protect themselves against any STI. Moreover, it does not break and is comfortable. Some women disliked the female condom because of its size and the visible outside ring. The introduction of female-controlled methods improved women's options to have protected sex since they were able to negotiate their use with clients who refuse to use male condoms. Economic benefits were also mentioned.