Barriers to Condom Negotiation and Use Among Female Sex Workers in the United States and United States-Mexico Border Cities: A Systematic Review

AIDS Behav. 2023 Sep;27(9):2855-2864. doi: 10.1007/s10461-023-04009-z. Epub 2023 Feb 14.


Despite the effectiveness of male condoms, many Female Sex Workers (FSWs) report using condoms infrequently with multiple clients during sexual activity. As such, inconsistent condom use by FSWs is a public health concern as it can increase STI and HIV transmission. This systematic review synthesized extant evidence regarding barriers to condom use experienced by FSWs in the U.S and U.S. - Mexico border towns. The search was conducted through PubMed, CINAL, Cochrane, Medline, and PsychInfo. Studies were included if: they were conducted in the U.S. or U.S. - Mexico borders, their target population was FSWs, they examined condom use barriers experienced by FSWs, and they were published in English between 2011 and February 2021. Condom use barriers among FSWs were reported in all the articles including alcohol consumption and drug use before sex, venue stability, socio-economic status vulnerability, violence and gendered power dynamics, trust of regular clients, and age. The review findings indicate the need to develop interventions promoting condom use for both FSWs and their clients, as well as alternative interventions for HIV prevention such as pre-exposure prophylaxis (PrEP).

Keywords: Condom use barriers; Female sex workers; Human Immunodeficiency Virus; Inconsistent condom use; Sexual transmitted infections.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Cities
  • Condoms
  • Cross-Sectional Studies
  • Female
  • HIV Infections* / epidemiology
  • HIV Infections* / prevention & control
  • Humans
  • Male
  • Mexico / epidemiology
  • Negotiating
  • Sex Workers*
  • United States / epidemiology