Published in PLOS One on 2026-04-10, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Mulat Belay Simegn, Habtamu Geremew, Fraol Daba Chinkey, Zekarias Tadele Alemneh, Eyasu Bamlaku Golla, Alegntaw Abate, Mohammed Ahmed Ali, Smegnew Gichew Wondie, Hawi Kumbi, Werkneh Melkie Tilahun
Source: PLOS One • DOI 10.1371/journal.pone.0346903
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Inconsistent condom use represents the most proximal behavioral risk factor for acquisition and transmission of sexually transmitted infections, including human immunodeficiency virus. However, certain situations hinder female sex workers from practicing consistent condom use. This study aimed to assess the pooled estimate of inconsistent condom use among female sex workers and identify factors associated with it.
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2020 reporting checklist. Electronic databases (PubMed, Cochrane Library, Epistemonikos, Hinari, and Science Direct), Google Scholar, and other university repositories were searched until March 20, 2024, based on the eligibility criteria. Three independent reviewers screened the titles, abstracts, and full texts. Two independent reviewers extracted the data. The Joanna Briggs Institute quality appraisal checklist was used. The Higgin’s I² test was used to quantify heterogeneity. Pooled analysis was conducted using a random-effects model. Sensitivity and subgroup analyses were done. Publication bias was assessed using Egger’s regression test and funnel plot. The pooled prevalence and statistical association were declared at a p-value < 0.05 with the 95% CI.
A total of 24 studies involving 23,496 female sex workers with a median age of 27.3 years were included. The overall pooled prevalence of inconsistent condom use among FSW in Africa was estimated at 46.73% (95% CI: 37.60, 55.86), I² = 99.59%, and p = 0.00. Condom availability (AOR = 0.68; 95% CI: 0.50, 0.92), depression (AOR = 1.51; 95% CI: 1.00, 2.30), no education (AOR = 1.87; 95% CI: 1.19, 2.93), two or more nonpaying clients (AOR = 2.90; 95% CI: 1.51, 5.54), having >9 current client number (AOR = 0.46; 95% CI: 0.29, 0.74), violence (AOR = 1.74; 95% CI: 1.33, 2.27), and police harassment (AOR = 2.28; 95% CI: 1.03, 5.05) were significant factors.
Inconsistent condom use was high in Africa. Factors including availability of condoms, depression, and education, having two or more nonpaying clients, client numbers, violence, and police harassment were significant factors. Strategies like improving peer education, providing mental health support, empowering women, and improving female sex workers educational status, ensuring condom availability, and strengthening supply for easily accessible condoms can decrease inconsistent condom use and protect FSWs from STI including HIV.
Introduction
Human immunodeficiency virus (HIV) infection remains a global challenge that affects about 38 million individuals, and nearly 70% of them are living in sub-Saharan African countries [1]. Female sex workers (FSW) in African countries are disproportionately affected by HIV. For instance, a study reported that 19% of new HIV infections in Western and Central Africa occur among sex workers, the highest proportion across all regions [2]. In Ethiopia, the HIV prevalence among FSWs is estimated to be around 18.5% [3]. One important risk group for HIV is FSWs, whose risk is 14 times higher than that of women in general population [4].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Mulat Belay Simegn, Habtamu Geremew, Fraol Daba Chinkey, Zekarias Tadele Alemneh, Eyasu Bamlaku Golla, Alegntaw Abate, Mohammed Ahmed Ali, Smegnew Gichew Wondie, Hawi Kumbi, Werkneh Melkie Tilahun. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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