Using condoms
Sex workers need thorough knowledge about condom use. This includes how to store condoms, check expiry dates, open packets without damaging condoms, roll the condom onto the penis at the best possible time, and remove and dispose of condoms.
Many projects encourage sex workers to exchange practical information and offer opportunities to demonstrate and practise condom use.
Problems with condoms
The most common problems are condoms slipping off or breaking.
Sex workers suggest several reasons why condoms may slip off. They include:
* the condom is not the correct size or shape for the penis
* the penis is not erect
* too much lubricant has been used
* the client has deliberately caused it to slip or break.
Often sex workers hold the base of the condom onto their client's penis (or their own) to minimise slippage. If sex goes on for a while, the sex worker should stop to check that the condom is still in place. Sex workers should note which positions they feel least able to control and check the condom throughout sex.
One of the most frequent questions asked by sex workers is what they should do if a condom breaks. Immediately after a condom breaks during sex, sex workers can douche or wash the vagina or anus to reduce the amount of semen present, or rinse their mouths with anti-bacterial mouthwash. Female sex workers who do not already use additional contraception to condoms may wish to take emergency contraception (a pill taken up to three days after unprotected sex) if available.
Often sex workers request advice about HIV or STD testing after a condom has broken. Sometimes health advisors find it necessary to counsel sex workers or clients to alleviate exaggerated fears of acquiring HIV in this circumstance.
Some sex workers prefer to use two condoms at the same time to reduce the possibility of condom failure. Recent research examined condom breakage in commercial sexual transactions with female sex workers in Thailand. In about half of 5,040 vaginal sex services, double condoms were used. Hardly any condoms broke, but where they did, the breakage rate was lower where two condoms were used (0.02 per cent compared with 1.78 per cent where only one condom was used). Using two condoms may decrease sensitivity. Some sex workers who use two condoms suggest placing some lubricant on the penis before putting the condoms on. Where two condoms are used they should not be prelubricated, nor should lubricant be applied between the condoms as this can cause them to slip.