Structural Determinants of Dual Contraceptive Use Among Female Sex Workers in Gulu, Northern Uganda

ObjectiveTo describe the characteristics of female sex workers (FSWs) who do and do not use dual contraceptives (i.e. male condoms plus a non-barrier method) in Gulu, northern Uganda.MethodsThe present analysis was based on data gathered as part of a questionnaire-based, cross-sectional study conducted between May 2011 and January 2012. FSWs aged 14 years or older were recruited through peer-led or sex worker-led outreach and community-based services. Logistic regression was used to identify correlates of dual contraceptive use.ResultsAmong the 400 FSWs who participated, 180 (45.0%) had ever used dual contraceptives. In the multivariate model, dual contraceptive use was positively associated with older age (adjusted odds ratio [AOR] 1.09, 95% confidence interval [CI] 1.04–1.15; P = 0.001), prior unintended pregnancy (AOR 1.53, 95% CI 1.01–2.34; P = 0.046), and HIV testing (AOR 5.22, 95% CI 1.75–15.57; P = 0.003). Having to rush sexual negotiations owing to police presence was negatively associated with dual contraceptive use (AOR 0.65, 95% CI 0.42–1.00; P = 0.050).ConclusionAlthough a history of unintended pregnancy and accessing HIV testing might promote contraceptive use, criminalized work environments continue to pose barriers to uptake of sexual and reproductive health services among FSWs in post-conflict northern Uganda. Integrated links between HIV and sexual health programs could support contraceptive uptake among FSWs.