Risk factors for HIV infection among sex workers in Johannesburg, South Africa.

Our objective was to determine the prevalence and risk factors for HIV infection among female sex workers in Johannesburg, South Africa. A cross-sectional survey of female sex workers was conducted using interviewer-administered questionnaires. Prevalent sexually transmitted infections including HIV were evaluated through standard laboratory testing. HIV infection was identified in 137 (46.4%) of 295 subjects tested. Increasing frequency of condom use was significantly negatively associated with HIV infection (odds ratio [OR] for moderate use = 0.21; 95% confidence interval [CI]: [0.09, 0.50]; OR for high use = 0.14; 95% CI: [0.06, 0.34]). Sex workers aged > or = 29 years reported significantly different patterns of behaviour than younger workers. Among women aged > or = 29, a negative association with HIV infection (OR = 0.16; 95% CI: [0.07, 0.38]) was found, but only among those not infected with Neisseria gonorrhoeae. Older women in the Johannesburg sex industry may have adaptive behavioural strategies besides condom usage which reduce their risk of acquiring HIV. However, older sex workers with gonorrhoea constitute a high-risk subgroup.

Acceptability of the female condom in different groups of women in South Africa--a multicentred study to inform the national female condom introductory strategy.

OBJECTIVES: To assess the acceptability of the female condom to different groups of women and their partners in South Africa. DESIGN: Descriptive, cross-sectional study. SETTING: Multicentre study conducted in five sites. SUBJECTS: The study recruited 678 women from five centres to an acceptability trial of the female condom. Acceptability and successful use varied between the centres. OUTCOME MEASURES: Factors affecting successful use and willingness and intention to use the method again. RESULTS: In total, 209 women used the condom at least once. Discontinuation rates were high, with partner reluctance to try the method as the main reason given for discontinuation at all sites. Women who had previous experience with the male condom or who received a more intensive training session generally found the device easier to use. The main issues concerning women were over-lubrication (27%) and concern that the device was too large (28%). The majority of women said that they would be interested in using the method again (86%) and would recommend it to friends (95%). CONCLUSIONS: Overcoming partner opposition is an important issue to address when introducing the method. The study was used to address the national introductory strategy of the female condom, which began in 1998.

Compliance and use behaviour, an issue in injectable as well as oral contraceptive use? A study of injectable and oral contraceptive use in Johannesburg.

This study examines the compliance, use behaviour and knowledge of method of women using injectable and oral contraceptives in two clinic sites in the Johannesburg area, South Africa. An interviewer administered questionnaire was used to collect information in the clients' home language. A total of 400 women were interviewed in the clinics. The mean age of clients was 26.2 years (range 13 to 43 years). Of the clients not wanting to get pregnant, 30.4 per cent of injectable users and 18.4 per cent of oral contraceptive (OC) users had stopped using their method temporarily before returning to the same method (called the nonuse segment) and had not used any other form of contraception during this time. Almost one third of injectable users (31.2 per cent) had been late for their next injection at least once. Although nearly all women using injectables had experienced some menstrual disturbances, over one third (38.5 per cent) had not been informed by the providers about the possibility of these changes. Many women gave the disruption of their menstrual cycle as the reason for the nonuse segment. The majority of OC users lacked information on how to use their method correctly. Nearly all women expressed an interest in obtaining more information on their current method and other available methods. This study shows that compliance is an issue in injectable as well as OC users.

PIP: Interviews conducted at two South African family planning clinics (urban Johannesburg and the Orange Farm settlement) assessed method compliance in 400 current users of oral contraceptives (OCs) or injectables. The mean age of study respondents was 26 years in the inner city clinic and 25 years in the informal settlement. The median duration of use was 24 months for injectables and 21 months among OC users. 31.2% of injectable users had either forgotten or been unable to return to the clinic for their next injection on at least one occasion. Among women not wanting to become pregnant, 30.4% of injectable users and 18.4% of OC users had stopped using their method temporarily and had not used any other contraceptive method during this time. Disruption of the menstrual cycle was a major contributing factor to segments of nonuse. Although almost all injectable users experienced some menstrual disturbances, 38.5% had not been informed by a provider about the likelihood of such changes. 26.6% of OC users reported a change in their normal menstrual cycle, but 86% were not told the pill might affect their period. Moreover, 79.5% of OC users had not been counseled about what to do if they missed a pill. Overall, these findings suggest that South African women are not being given adequate information on what to expect from and how to use their method correctly--a lack that may have serious implications for contraceptive compliance.