Condom Use during Commercial Sex among Male Clients of Female Sex Workers in Sichuan China: A social cognitive theory analysis

摘要

There has been very little theory-based research focusing on condom use among male clients of female sex workers (CFSW) in China. The current study applied social cognitive theory (SCT) to understanding condom use behavior during commercial sex among CFSW in China. Face-to-face structured interviews were conducted among 584 CFSW recruited through snowball sampling. Bivariate and multivariate logistic regression models were applied to examine factors associated with consistent condom use. A minority (30.65%) of respondents reported using condoms consistently with FSW, 7 of 12 social cognitive dimensions/sub-dimensions were significantly influential. The most significant protective and risk factors were self-efficacy (APR: 2.11, 95%CI: 1.74-2.43) and high personal pleasure reduction (APR: 0.3, 95%CI: 0.15-0.6). HIV-related knowledge, perceived HIV susceptibility, condom cost, condom efficacy, and embarrassment for carrying condom were not associated with condom uses with FSW. Findings from the current study suggest future prevention programs should target sex venues, and condom access should ensure both quantity and quality. Peer education could focus on both knowledge education and peer norms, and knowledge education should include information on HIV infection severity, and address how to increase pleasure with condom use.