Socio-demographic characteristics
We recruited a total of 40 study participants. Half of them were between the age of 18 and 24 years. About half of the study participants had steady partners. The majority of FSWs interviewed had attended only primary school as their highest level of academic achievement. The majority of FSWs interviewed were Christian. Many study participants reported selling sex in night clubs, streets and few reported to sell sex in hotels.
Awareness of consequences of condom failure
Most of FSWs were aware of the consequences of condom failure
“I know that if my client doesn’t use a condom properly, I can get pregnant or be infected with STI including HIV. I always try my best to avoid condom failure ”[Age range 25-30 years old FSW]
“Many organizations come to teach us how to protect ourselves against STI including HIV. They discuss with us many issues on contraceptives. We are also taught how to help clients to use condoms properly . We know that if condoms are not used properly our clients may infect us.” [FGD 1]
Experience with condom failure
Many FSWs experienced condom slippages and breakages, before the interviews. Some study participants tried to avoid condom failure.
“One day this man took me for sex in his house. He promised me good money and we had sex. After ejaculation he did not remove his penis, after few minutes he slept. I tried to pull myself out but the condom remained. I did not go to the hospital because it was too late. The condom was removed the following day at the nearest hospital. The man convinced me that he doesn’t have HIV, ndiye basi zinatera pompho (then the issue ended like that)” [Age range 20-25 years FSW].
“He took me to his home we agreed on the amount to pay me. Everything was set. We started well, but later he decided to change the style. He recommended the doggy style and he was very rough than before, then the condom ruptured. He ejaculated in me. It was a deliberate action. I told him to stop but he refused. I felt very bad!!!!Why? (Asked the facilitator). Because I didn’t even know him, why did he ejaculate in me? Did you tell anybody else? (Asked the facilitator). No! Only the doctor, even my mother doesn’t know! The following day I went to the hospital, I explained everything then I was treated with injections and pills. They tested my blood then they told me that I am HIV positive, I am not sure if I got the virus from the previous men I had sex with or this last client”. [Age range 20-25 years old FSW].
“You don’t know men…they puncture condoms with finger nails deliberately”[Age range 20-25 years old FSW]
Other women’s focus was only on the amount of money paid by their clients after sexual intercourse. Condom failure was not an issue.
“While having sexual intercourse we realized that the condom has ruptured .I told the man to come out and ejaculate outside but he refused and he said that he will give me MK 20,000 Kwacha, I accepted then he continued until he finished. That day I made enough money to feed my children.” [Age range30-35 years old FSW]
“I am a sex worker and I know already the risks, I can catch HIV and other sexual transmitted infections. As long as he pays me well, he can continue enjoying the sex even after condom rupture”. [Age range 25- 30 years old FSW]
Action taken by FSWs after condom failure
Study participants reported having taken different actions after condom failure. The majority of FSWs reported to have stopped immediately and changed the condom and then resumed sexual intercourse. Other than condom replacement these FSWs didn’t know what to do and where to go for help. They thought condom replacement was enough. Others stopped sexual intercourse but sought medical care which included post-exposure prophylaxis (PEP) for HIV, STI treatment, and contraceptives. Some reported that they did not stop the sexual intercourse but only squatted and/or douched after sexual intercourse. Other FSWs interviewed reported not to have stop sexual intercourse and no any other actions were taken after condom failure. Many FSWs reported to have douched, urinated, and/or squatted to prevent pregnancy, STI and HIV acquisition after condom failure, and then asked for extra pay. Due to stigma and discrimination FSWs often were not willing to share their experience on condom failure with anybody else.
“Ine zinandichitikira, kondomu inaphulika (I experienced condom failure) I shared my experience with one closest friend who is also a FSW. One week later I heard the same story from many FSWs here at Kachele. It is not good to share the experience with anybody else. Even if you discuss about it with your client it is just a waste of time. He can shout at you!!!!. To go to the hospital, manyazi!!!(I failed to go to the hospital because I was feeling shy to explain the incident to the health care provider) Only God knows”. [Age range 15-20 years old FSW]
“After urinating, squatting, or douching, sperm and all viruses come out. But HIV….. I am not sure, but pregnancy no!! Believe me! But the man must pay extra money after condom rupture ” [Age range 30-35 years old FSW]
“We do douching or squatting or urinate always after unprotected sex. We use water or beer (when water is not available). After douching you become smart and the vagina outlet becomes narrow while you are waiting for the next client. It really makes you smart but beer’s smell is not good but in the absence of water you can use it. When douching you remove all diseases and sperm”. [FGD 2]
“It depends on where you are. I met one client who took me to………. Hotel. We had sex the whole night and during the process the condom ruptured. I went to the toilet and had a bath and the man changed the condom and then we resumed the sexual intercourse. There was no need to go to the hospital. It was too late and the hospital was very far.” [Age range 15-20 years old FSW]
“I went to the hospital after the condom ruptured while having sex with one of my clients. The doctor tested my blood for HIV. Fortunately I was negative. I was given ARVs for HIV prophylaxis. I was also given some contraceptives, one injection and some tablets. I felt very uncomfortable with the injection and the ARVs. It is good to avoid unplanned pregnancies and HIV but we feel very uncomfortable to explain the circumstances of condom rupture.”[Age range 20-25 years old FSWs]
Access to contraceptives, pre- and post-exposure prophylaxis (PrEP &PEP) of HIV
“We heard that there are some ARVs which protect people against HIV. Most of us are not aware of them.” [FGD 3]
“Accessing those drugs it’s not easy, they are very scarce in Government hospitals. Sometimes you can spend the whole day there at the health center then you go back in the evening without drugs. We can’t afford to settle the bills in private hospitals. [FGD 4]
We can’t get those drugs ( for HIV, PEP&PrEP) from our peer FSWs because they don’t keep secrets, they even tell our clients and other FSWs about our status. Once our clients are aware that we are sick, they stop coming to us, so we lose business.” [FGD 5]
“Many NGO bring condoms, drugs, vaginal lubricants and some contraceptives. They are very helpful because most of the times they find us either in our homes, night clubs or by the road. No need to go to the hospital.” [FGD 6]