IJE Advance Access originally published online on January 15, 2009
International Journal of Epidemiology 2009 38(2):552-560; doi:10.1093/ije/dyn358
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A case-crossover analysis of predictors of condom use by female bar and hotel workers in Moshi, Tanzania
1 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
2 Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
3 Department of Clinical Laboratories, Kilimanjaro Christian Medical College, Moshi, Tanzania.
4 Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA.
5 Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
* Corresponding author. Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave., Kresge Suite 816B, Boston, MA 02115, USA. E-mail: ktassiop{at}hsph.harvard.edu
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Abstract |
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Background Factors related to specific sexual encounters can influence condom use during these encounters. These situation-specific factors have not been adequately studied in resource-poor countries where HIV infection has in some areas reached epidemic levels. This study was undertaken to identify situation-specific factors associated with condom use among 465 female bar and hotel workers in Moshi, Tanzania.
Methods We conducted a case-crossover study in which women provided information about their most recent unprotected and protected sexual encounters. Conditional logistic regression was used to estimate paired odds ratios and 95% confidence intervals for the association between situation-specific factors and condom use.
Results A subject-based or mutual decision about condom use (compared with partner based), casual partner type, a first-time sexual encounter and receiving gifts in exchange for sex were independently associated with increased odds of condom use, while sex at home and sex with a partner more than 10 years older was associated with reduced odds of use. There was also effect modification between partner type and decision-making: subject-based or mutual decisions were more protective with casual than regular partners; also, when the partner made the decisions about condom use, the type of partner had no effect.
Conclusions Decision-making about condom use is a potentially modifiable predictor of unprotected sex, but its effect varies by partner type. Behavioural interventions are needed that encourage discussion about condom use and increase women's self-efficacy, but other types of interventions as well as female-controlled HIV prevention methods are needed for women in regular partnerships.
Keywords Case-crossover, decision-making, partner type, condoms, HIV, Tanzania
Accepted 4 December 2008
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