The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Sydney, Australia.
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
PLoS One. 2020 Aug 10;15(8):e0236552. doi: 10.1371/journal.pone.0236552. eCollection 2020.
Paying for sex has often been associated with risky sexual behavior among heterosexual men, and men who pay for sex are considered as a bridging population for sexually transmitted infections. Consistent condom use during paid sex is essential for reducing sexually transmitted infections, including HIV/AIDS. In this study, we assessed the prevalence and predictors of consistent condom use among men who pay for sex in sub-Saharan Africa.
We pooled data from 29 sub-Saharan African countries' Demographic and Health Surveys. A total of 3,353 men in sub-Saharan Africa who had paid for sex in the last 12 months preceding the surveys and had complete information on all the variables of interest were used in this study. The outcome variable for the study was consistent condom use for every paid sex in the last 12 months. Both bivariate and multivariable logistic regression analyses were carried out. Results were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Statistical significance was declared at p< 0.05.
Overall, the prevalence of consistent condom use during paid sex in sub-Saharan Africa was 83.96% (CI = 80.35-87.56), ranging from 48.70% in Benin to 98% in Burkina Faso. Men aged 35-44 [AOR, 1.39 CI = 1.04-1.49], men in the richest wealth quintile [AOR, 1.96 CI = 1.30-3.00], men with secondary level of education [AOR, 1.69 CI = 1.17-2.44], and men in Burkina Faso [AOR = 67.59, CI = 8.72-523.9] had higher odds of consistent condom use during paid sex, compared to men aged 15-19, those in the poorest wealth quintile, those with no formal education, and men in Benin respectively. Conversely, Muslim men had lower odds [AOR = 0.71, CI = 0.53-0.95] of using condom consistently during paid sex, compared to Christian men.
Empirical evidence from this study suggests that consistent condom use during paid sex encompasses complex social and demographic characteristics. The study also revealed that demographic characteristics such as age, wealth quintile, education, and religion were independently related to consistent condom use for paid sex among men. With sub-Saharan Africa having the highest sexual and reproductive health burden in the world, continuous application of evidence-based interventions (e.g., educational and entrepreneurial training) that account for behavioural and social vulnerabilities are required.
付钱发生性行为往往与异性恋男性的危险性行为有关，而付钱发生性行为的男性被认为是性传播感染的桥梁人群。在付费性交易中始终如一地使用安全套对于减少性传播感染（包括艾滋病毒/艾滋病）至关重要。在这项研究中，我们评估了撒哈拉以南非洲地区付钱发生性行为的男性中始终如一地使用安全套的流行率和预测因素。
我们汇总了来自撒哈拉以南非洲 29 个国家的人口与健康调查的数据。共有 3353 名在调查前的过去 12 个月内有过付费性经历且所有相关变量均完整的撒哈拉以南非洲男性被纳入本研究。本研究的结果变量是过去 12 个月内每次付费性交易中始终如一地使用安全套。进行了单变量和多变量逻辑回归分析。结果以调整后的优势比及其相应的 95%置信区间表示。统计显著性定义为 p<0.05。
总体而言，撒哈拉以南非洲地区付费性交易中始终如一地使用安全套的流行率为 83.96%（CI=80.35-87.56），范围从贝宁的 48.70%到布基纳法索的 98%。35-44 岁的男性（AOR，1.39 CI=1.04-1.49）、最富有五分之一的男性（AOR，1.96 CI=1.30-3.00）、接受过中等教育的男性（AOR，1.69 CI=1.17-2.44）和布基纳法索的男性（AOR=67.59，CI=8.72-523.9）在付费性交易中始终如一地使用安全套的可能性更高，而 15-19 岁的男性、最贫穷五分之一的男性、未接受过正规教育的男性和贝宁的男性则相反。相比之下，穆斯林男性在付费性交易中始终如一地使用安全套的可能性较低（AOR=0.71，CI=0.53-0.95），而基督教男性则更高。
本研究的实证证据表明，付费性交易中始终如一地使用安全套涉及复杂的社会和人口特征。研究还表明，年龄、财富五分位数、教育程度和宗教等人口特征与男性在付费性交易中始终如一地使用安全套独立相关。撒哈拉以南非洲地区是世界上性健康和生殖健康负担最重的地区，需要持续应用基于证据的干预措施（例如教育和创业培训），以应对行为和社会脆弱性。
