IJE Advance Access published online on January 15, 2009
International Journal of Epidemiology, 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
1Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
2Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
3Department of Clinical Laboratories, Kilimanjaro Christian Medical College, Moshi, Tanzania.
4Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA.
5Department 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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