Factors associated with inconsistent condom use with clients among female sex workers in Podgorica, Montenegro.

Introduction: Female sex workers (FSWs) are a group at increased risk for human immunodeficiency virus (HIV) infection, and inconsistent condom use with clients is a known risk factor for infection in this group. Objective: The aim of the study was to determine factors associated with inconsistent condom use with clients among female sex workers in Podgorica, Montenegro. Methods: We conducted an HIV bio-behavioral cross-sectional study in a sample of female sex workers recruited by snowball sampling. Results: A total of 142 FSWs were recruited. Eighty-one (57.0%) of them used condoms consistently with clients. HIV prevalence was 0.0%. In the multivariate analysis inconsistent condom use with clients in the previous month was associated with clients' negative personal attitude [age-adjusted odds ratio (AOR) = 22.7, 95% confidence interval (CI) = 2.3­228.0] or client's indifference (AOR = 13.0, 95% CI = 1.4­118.9) towards using condom during sex with sexual workers, decision making by clients or by mutual agreement with client about using a condom (AOR = 10.2, 95% CI = 3.7­28.0), and early age of first sex (AOR = 5.4, 95% CI = 1.6­18.5). Conclusion: Our results suggest not only the need for further promotion of condom use, information and education for FSW but also the need to strengthen negotiation skills of FSWs with clients on regular use of condoms, as well as the need to extend prevention programs to clients of FSWs.