A Prospective Study Assessing the Effects of Introducing the Female Condom in a Sex Worker Population in Mombasa, Kenya

The researchers conducted a 12-month, prospective study of 210 female sex workers in Mombasa, Kenya, to assess the impact and costs of adding female condoms to a peer education program promoting and distributing male condoms.

Participants were interviewed about their sexual behavior every two months for a total of seven interviews. After the third interview, they were introduced to female condoms. The researchers collected cost data and calculated the cost and cost-effectiveness of adding the female condom to the existing program.

The addition of the female condom to the HIV prevention program "led to small, but significant, increases in consistent condom use with all sexual partners," the researchers found. However, substitution for male condoms was high. At the program level, the cost per additional consistent female condom user was estimated at $2,160 (95 percent confidence interval: 1338 to 11,179).

The results suggest the female condom "has some potential for reducing unprotected sex among sex workers," the authors concluded. "However, given its high cost, and the marginal improvements seen here, governments should limit promotion of the female condom in populations that are already successfully using the male condom." The investigators called for more research to find effective ways of "encouraging sex workers to practise safer sex with their boyfriends."

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