Background: Condom use is a key component of STD prevention and control, but little is known about how men and women engaging in transactional sex negotiate condom use in the United States.
Objectives: To examine sources of condom knowledge, attitudes, acquisition, and use among women engaging in transactional sex and their male sexual partners.
Methods: As part of a larger study, twenty-five women and twenty men who engaged in transactional sex were recruited utilizing incentivized snowball sampling. Respondents completed STI testing and a face-to-face interview that included open-ended questions about condoms, including, “What do you know about condoms?”and “In what situations would you (would you not) use condoms?” Interviews were audio recorded, transcribed, and coded using qualitative methods.
Results: The diverse sample included 45 participants 19-65 years old (mean=37). Nearly all of the participants (40/45) had recently exchanged sex for money or drugs. Seventeen participants (15 women and 2 men) tested positive for at least one STI. Condom use by women was impacted by drug use, type of sex act, male partner desire to use condoms, increased compensation for non-use, and perceived likelihood of acquiring an STI from a particular partner. Condom use by men was motivated by physical pleasure and the belief that their sexual partner was disease free.
Conclusions: The respondents in this sample were disproportionately infected with STI secondary to a variety of behavioral risks. Motivation and ability to negotiate condoms varied by gender but overall, reported condom use was low.
Implications for Programs, Policy, and/or Research: Interventions to increase condom use among sex workers and clients may be improved by recognizing that different motivations for use exist for men and women. Increased understanding of the factors motivating condom use and other potentially modifiable sexual health behaviors will improve STI control efforts for this vulnerable and marginalized population.