Biomedical contraceptives and their association with condom use consistency among female sex workers in China: Results from a national cross-sectional study

Purpose: To characterize contraceptive needs and patterns of use among Chinese FSW and investigate the effect of contraceptive choice on condom use practices with clients. Methods: Data come from a cross-sectional study conducted in eight cities (Beijing, Tianjin, Shenzhen, Kunming, Jiaozhou, Yunfu, Xiangyang and Longnan) throughout seven provinces in China between August 17 and October 17, 2019. We used logistic regression to compare odds of consistent condom use with clients between FSW who do and do not use biomedical contraceptives (defined as oral pills, injectables/implants/patches/rings, intrauterine devices, and sterilization) and assessed subgroup effects of interest. Results: Of the 1229 participants, 62.4% reported ever having an unintended pregnancy. Biomedical contraceptive use was non-significantly associated with consistent condom use with clients generally (aOR=0.95, 95% CI:0.75–1.21). This association between biomedical contraceptive use and consistent condom use was lower among FSW with at least a high school education (aOR=0.33, 95% CI: 0.18–0.62) and those who had never married (aOR=0.60, 95% CI: 0.38–0.93); it was higher among FSW employed at middle tier commercial sex venues (aOR=1.67, 95% CI: 1.13–2.45). Conclusions: Taken together these findings highlight the pressing unmet need for contraceptives in Chinese FSW and the complex interplay between reproductive and sexual health needs in this key population.