Condom Utilization and Associated Factors Among Female Sex Workers in Addis Ababa, Ethiopia: Community Based Cross-sectional Study

Condom utilization is a critical measure of the effectiveness of condom programming and is a key health outcome in assessing behavioral changes and progress in preventing human immunodeficiency virus and sexually transmitted infections among high-risk groups, particularly female sex workers. This study aimed to assess individual and institutional factors influencing condom utilization among female sex workers in Addis Ababa, Ethiopia. The objectives to assess condom utilization and identify associated factors among female sex workers in Addis Ababa, Ethiopia, 2024, to inform for preventing new HIV/STI infections. A methods used cross-sectional study design, supplemented with qualitative methods, was conducted in communities from September 15 to October 15, 2024. Out of 403 FSWs in Addis Ababa, was sampled using a snowball sampling technique, and data were collected through structured questionnaires. Data entry and completeness checks were performed using Epi Data version 3.1, and analysis was conducted using SPSS version 27. Binary and multivariable logistic regression models were used to identify factors significantly associated with condom utilization (p <0.05). Qualitative data were analyzed thematically and described indirect words. The results response rate was 97.5%, with 393 FSWs participating. The overall condom utilization rate was 77.2% (95% CI: 73.1%-81.2%), which is below the national expectation of 90%. Factors significantly associated with condom utilization included workplace (AOR=6.77, 95% CI=1.43-32.17), communication (AOR=0.06, 95% CI=0.01-0.24), condom use skills (AOR=0.16, 95% CI=0.04-0.73), consistent condom use (AOR=0.12, 95% CI=0.04-0.35), availability (AOR=0.21, 95% CI=0.06-0.73), and health service visits (AOR=0.09, 95% CI=0.02-0.41). Conclusions of the study revealed that condom utilization among FSWs in Addis Ababa is suboptimal level (77.2%) compared to the national target (90%). Key barriers included limited workplace access, poor condom communication, lack of condom use skills, sexual behavior, poor quantification, and stock interruptions contributed to low utilization. Strengthening peer-to-peer education, improving supply accessibility and availability, and enhancing monitoring are essential to promote consistent condom use and sustainability among target groups.