Use of Spermicide and Impact of Prophylactic Condom Use Among Sex Workers in Santa Fe de Bogota, Colombia

Abstract

Condom use is one of the most important preventive measures sex workers can take to reduce the risk of becoming infected with a sexually transmitted disease. However, a client may refuse to use a condom when requested. Some sexually transmitted disease prevention programs are recommending that sex workers use spermicide as an alternative prophylaxis when a condom is refused, yet little is known about the effect of this recommendation on prophylactic condom use.To determine if using spermicide, either in conjunction with condoms or as a backup, influenced overall condom use among a group of sex workers at high risk of sexually transmitted diseases in Santa Fe de Bogota, Colombia.Participants were assigned randomly to one of three condom use groups: use of condoms only (Condoms Only), use of condoms and spermicides concurrently (Condom and Spermicide), or use of spermicide when condoms were refused (Spermicide as a Backup). A total of 199 sex workers entered the study and were asked to return for follow-up every 2 weeks for a period of 12 weeks.Women assigned to the Spermicide as a Backup group used a condom for an average of 78.1% of their reported acts of intercourse, compared with an average of 94.5% in the Condom Only and 92.3% in the Condom and Spermicide groups. However, women in the Spermicide as a Backup group used a condom or spermicide for an average of 96.9% of their acts of intercourse. Condoms were used for every intercourse act by less than 5% of the women in the Spermicide as a Backup groups, compared with 50.7% in the Condom Only group and 41.2% in the Condom and Spermicide group (P 0.001). When condoms were not used, client refusal was the primary reason reported. The incidence of sexually transmitted diseases and other urogenital inflammations in all groups was lower than expected.Among Colombian sex workers, condom use declined substantially when women were instructed to use spermicides if they were unable to persuade their partner to use a condom. However, these same women usually used the study spermicide as an alternate prophylaxis.Some sexually transmitted disease (STD) prevention programs recommend that prostitutes use spermicide as an alternative prophylaxis when a condom is refused. 199 female sex workers in Santa Fe de Bogota, Colombia, participated in a study to assess the effect of this recommendation upon condom use. Women were randomly assigned to use condoms only, use condoms and spermicides concurrently, or use spermicide when condom use was refused. They were instructed to return for follow-up every 2 weeks for 12 weeks. Women in the spermicide-as-a-backup group used a condom for an average of 78.1% of reported acts of intercourse, compared to an average of 94.5% among the condom-only users and 92.3% among the women instructed to use both condoms and spermicide. Women in the spermicide-as-a-backup group used either a condom or spermicide for an average of 96.9% of their acts of intercourse, but less than 5% used a condom for every act of intercourse. 50.7% of women in the condom-only group and 41.2% in the condom/spermicide group used a condom for every act of intercourse. There was a lower than expected incidence of STDs and other urogenital inflammations in all groups.