Prevalence and determinants of condom failure among female sex workers in Ethiopia

Background: Condom failure is one of the main factors that exposes female sex workers (FSWs) to sexually transmitted infections (STIs), including HIV. To date, evidence on the factors contributing to condom failure is scarce in Ethiopia. Therefore, this study was conducted to identify the determinants of condom failure among FSWs and generate evidence to support the nation’s STI/HIV prevention program. Methods: A national cross-sectional study was conducted in Ethiopia using a respondent-driven sampling technique among 6085 FSWs in 16 major towns in the country. A structured interview was used to collect the data. Descriptive statistics as well as multiple logistic regression analyses were used. A p-value < 0.05 was used to determine the statistical significance. Results: The mean (SD) age of the study participants was 26.3 (± 0.08) years. Those who were never married and completed their primary education were 48.4% and 58.5%, respectively. The prevalence of condom failure among FSWs within the 30 days preceding the survey was 29.7%. Divorced, separated, or widowed women were more likely to report condom failure than married women (AOR = 1.45, 95% CI: 1.04–2.03, P = 0.027). FSWs with no formal or primary education had higher odds of condom failure compared with those who had secondary education and above (AOR = 1.56, 95% CI: 1.33–1.83, P < 0.001). FSWs who had harmful alcohol drinking (AOR = 1.2, 95% CI: 1.01–1.41, P = 0.035), alcohol dependency (AOR = 1.62, 95% CI: 1.40–1.87, P < 0.001), and used other drugs (AOR = 1.35, 95% CI: 1.13–1.62, P < 0.001) had a higher risk of condom failure. Furthermore, those who started selling sex before the age of 20 were more likely to report condom failure than those age above 25 (AOR = 1.35, 95% CI: 1.13–1.62, P < 0.001). Factors that were also significantly associated with condom failure were ever being raped in the last 12 months (AOR = 1.65, 95% CI: 1.39-1.96, P < 0.001), and being HIV positive (AOR = 1.35, 95% CI: 1.16-1.57, P < 0.001). Conclusion: Condom failure was a major challenge among FSWs and was significantly associated with various determinants. This finding will help the country to strengthen prevention and control strategies to halt the acquisition and transmission of HIV and other STIs among FSWs.