USE OF SPERMICIDE AND IMPACT OF PROPHYLACTIC CONDOM USE AMONG SEX WORKERS IN SANTA-FE DE BOGOTA, COLOMBIA

Background and Objectives: Condom use is one of the most important pre ventive measures sex workers can take to reduce the risk of becoming i nfected with a sexually transmitted disease, However, a client may ref use to use a condom when requested, Some sexually transmitted disease prevention programs are recommending that sex workers use spermicide a s an alternative prophylaxis when a condom is refused, yet little is k nown about the effect of this recommendation on prophylactic condom us e. Goal: 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. Study Design: Participants were assigned randoml y 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 Back up), A total of 199 sex workers entered the study and were asked to re turn for follow-up every 2 weeks for a period of 12 weeks. Results: Wo men 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 Spe rmicide groups. However, women in the Spermicide as a Backup group use d a condom or spermicide for an average of 96.9% of their acts of inte rcourse, Condoms were used for every intercourse act by less than 5% o f the women in the Spermicide as a Backup group, compared with 50.7% i n 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 r eason reported, The incidence of sexually transmitted diseases and oth er urogenital inflammations in all groups was lower than expected. Con clusions: Among Colombian sex workers, condom use declined substantial ly when women were instructed to use spermicides if they were unable t o persuade their partner to use a condom, However, these same women us ually used the study spermicide as an alternate prophylaxis.