Condom use among female sex workers in China: Roles of gatekeepers and venues

Background: Condom use is one of the most effective approaches for HIV and STD prevention. Existing studies have examined the association between FSW’s perceptions of gatekeepers’ attitudes and condom use among female sex workers (FSW). However, limited study has explored the role of gatekeepers and venues in FSW’s condom use based on dual data sources. The objective of this study is to examine how gatekeepers’ attitudes and guidance, and venues’ support of using condoms associate with condom use among FSW.  

Method: A total of 122 gatekeepers and 700 FSW from 76 entertainment venues in Southwest China participated in the survey.  FSW reported demographics, and frequency and intention of using condoms when had sex with their clients.  Gatekeepers reported attitude and guidance of condom use, and venues’ support of using condoms for FSW. FSW data were aggregated into 120 clusters based on their subordination to gatekeepers. After matching gatekeepers and FSW clusters (G-F), we finally had a sample of 104 matched G-F data for analysis.  

Results: After controlling for demographics including age, education level and monthly income, gatekeepers’ attitudes and guidance of condom use, and venues’ support of condom use were significantly associated with frequency of using condoms (β=0.27 and β=0.19, ps<0.05) and intension of using condoms among FSW (β=0.32 and β=0.24, ps<0.05).

Discussion: To improve consistent condom use among FSW, healthcare professionals should work with managers and gatekeepers in entertainment venues to provide supports and guidance for FSW's condom use.