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Intentional and Unintentional Condom Breakage and Slippage in the Sexual Interactions of Female and Male Sex Workers and Clients in Mombasa, Kenya

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Abstract

We examined why male condoms broke or slipped off during commercial sex and the actions taken in response among 75 female and male sex workers and male clients recruited from 18 bars/nightclubs in Mombasa, Kenya. Most participants (61/75, 81%) had experienced at least one breakage or slippage during commercial sex. Many breakages were attributed to the direct actions of clients. Breakages and slippages fell into two main groups: those that were intentionally caused by clients and unintentional ones caused by inebriation, forceful thrusting during sex and incorrect or non-lubricant use. Participant responses included: stopping sex and replacing the damaged condoms, doing nothing, getting tested for HIV, using post-exposure prophylaxis and washing. Some sex workers also employed strategies to prevent the occurrence of condom breakages. Innovative client-oriented HIV prevention and risk-reduction interventions are therefore urgently needed. Additionally, sex workers should be equipped with skills to recognize and manage breakages.

Resumen

Examinamos por qué hubo rotura o deslizamiento de condones durante encuentros sexuales comerciales y las acciones de respuesta tomadas por 75 trabajadores sexuales—tanto hombres como mujeres—y sus clientes masculinos, reclutados de 18 bares/clubes nocturnos en Mombasa, Kenya. Las mayoría de los participantes (61/75, 81%) habían experimentado por lo menos una ocasión de rotura o deslizamiento durante sexo comercial. Muchas roturas fueron atribuídas a las acciones directas de clientes. Hubo dos temas en las ocasiones de roturas y deslizamientos: aquellos causados por clientes y aquellos no intencionales causados por intoxicación, empujes enérgicos durante sexo y uso incorrecto (o no uso) de lubricantes. Entre las respuestas se incluían: interrupir el sexo y reemplazar los condones dañados; no hacer nada; obtener una prueba para el VIH; usar la profilaxis de post-exposición; y “lavado”. Algunos trabajadores sexuales utilizaron una variedad de estrategias para evitar que los condones se rompieran. Se necesita urgentemente intervenciones innovadoras y centrados en el cliente para la prevención del VIH y la reducción del riesgo. Asismismo, los trabajadores de sexo deberían adquirir las habilidades para reconocer y manejar las roturas.

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Acknowledgements

This research was supported by a NIMH Grant (R01-MH103034; PI, Joanne E. Mantell, MS, MSPH, Ph.D.) and a NIMH center Grant (P30-MH43520; PI: Robert H. Remien, Ph.D.). Dr. Tocco was supported by a NIMH training Grant (T32-MH19139 Behavioral Sciences Research in HIV Infection; PI: Theodorus G.M. Sandfort, Ph.D.). We would also like to acknowledge all the sex workers and clients who participated in this study, including the sex worker peer educators from the ICRH-Kenya.

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Authors and Affiliations

  1. Department of Sociology and Anthropology, College of the Holy Cross, Worcester, MA, USA

    Tsitsi B. Masvawure

  2. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA

    Joanne E. Mantell, Jack Ume Tocco & Theo G. M. Sandfort

  3. International Centre for Reproductive Health, Mombasa, Kenya

    Peter Gichangi & Sophie Vusha Chabeda

  4. Brown School of Public Health, Brown University, Providence, RI, USA

    Arjee Restar

  5. International Centre for Reproductive Health-Ghent University, Ghent, Belgium

    Peter Gichangi & Yves Lafort

  6. Department of Anatomy, University of Nairobi, Nairobi, Kenya

    Peter Gichangi

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  1. Tsitsi B. Masvawure
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  8. Theo G. M. Sandfort
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Correspondence to Tsitsi B. Masvawure.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Masvawure, T.B., Mantell, J.E., Tocco, J.U. et al. Intentional and Unintentional Condom Breakage and Slippage in the Sexual Interactions of Female and Male Sex Workers and Clients in Mombasa, Kenya. AIDS Behav 22, 637–648 (2018). https://doi.org/10.1007/s10461-017-1922-3

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