Original Paper

AIDS and Behavior

, Volume 14, Issue 6, pp 1279-1286

First online:

Predictors of Unprotected Sex Among Female Sex Workers in Madagascar: Comparing Semen Biomarkers and Self-Reported Data

  • Maria F. GalloAffiliated withDivision of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Email author 
  • , Markus J. SteinerAffiliated withFamily Health International
  • , Marcia M. HobbsAffiliated withDepartment of Medicine, University of North Carolina, Chapel HillDepartment of Microbiology and Immunology, University of North Carolina, Chapel Hill
  • , Mark A. WeaverAffiliated withFamily Health International
  • , Theresa Hatzell HokeAffiliated withFamily Health International
  • , Kathleen Van DammeAffiliated withDepartment of Medicine, University of North Carolina, Chapel Hill
  • , Denise J. JamiesonAffiliated withDivision of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
  • , Maurizio MacalusoAffiliated withDivision of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention

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Abstract

Research on the determinants of condom use and condom non-use generally has relied on self-reported data with questionable validity. We identified predictors of recent, unprotected sex among 331 female sex workers in Madagascar using two outcome measures: self-reports of unprotected sex within the past 48 h and detection of prostate-specific antigen (PSA), a biological marker of recent semen exposure. Multivariable logistic regression revealed that self-reported unprotected sex was associated with three factors: younger age, having a sipa (emotional partner) in the prior seven days, and no current use of hormonal contraception. The sole factor related to having PSA detected was prevalent chlamydial infection (adjusted odds ratio, 4.5; 95% confidence interval, 2.0–10.1). Differences in predictors identified suggest that determinants of unprotected sex, based on self-reported behaviors, might not correlate well with risk of semen exposure. Caution must be taken when interpreting self-reported sexual behavior measures or when adjusting for them in analyses evaluating interventions for the prevention of HIV/STIs.

Keywords

Female sex workers Condoms Biological markers Prostate-specific antigen Africa