DETERMINANTS OF CONDOM USE IN 24000 PROSTITUTE CLIENT CONTACTS IN THEGAMBIA

Objective: To determine the factors that influence condom use among pr ostitutes and their clients in The Gambia. Design: A cohort of 181 pro stitutes working in seven bars and several rural markets in The Gambia were monitored daily for 14 months. A sample of 747 clients of these prostitutes was also questioned. Main outcome measure: Proportion of s exual contacts for which a condom was used. Results: Data on 24181 sex ual contacts reported by the prostitutes indicated condom use varied a ccording to type of partner (from 84% with clients to only 4% with reg ular partners). Condom use with clients varied according to location ( from 91% in high-class bars to 59% in rural markets), decreased from 9 1% with the first client of the evening to 37% with the tenth client, and from 75% with clients paying higher charges (> D19) to 52% with th ose paying lower charges (< D20). Condom use was not related to the so cio-demographic characteristics of the prostitutes. Clients reported l ower condom use than prostitutes. Clients aged 20-24 years were least likely to use condoms, while white collar workers, traders, and those paying higher charges, were more likely to use condoms. Conclusions: T he level of condom use in this cohort of prostitutes was high but not consistent. Condom use was determined more by the type of establishmen t and the characteristics of clients, than by any fixed tendency among the prostitutes. Thus, education campaigns should be directed as much to clients as to prostitutes. In The Gambia, 'lower-class' bars and t hose in rural areas where prostitutes work should be a priority target .