Abstract
Background: Ten percent of sexually active men in sub-Saharan Africa report having had sex with a sex worker - a subpopulation facing a disproportionate burden of HIV and other sexually transmitted infections (STIs). In South Africa, an estimated 5% of new heterosexual HIV infections are attributable to female sex workers and 42% to their male clients. Despite this high vulnerability, empirical research on male clients of sex workers remains limited.
Purpose: This study examined behavioral and cognitive determinants of self-reported condom use among male construction worker clients of sex workers in the Western Cape, South Africa.
Methods: A cross-sectional survey was conducted among 227 male construction workers who reported sex with a female sex worker in the preceding three months. Participants were recruited across 18 construction sites operated by seven companies in the Western Cape. Three measures of self-reported condom use were analyzed: (1) condom use at last sex with a sex worker (retrospective), (2) frequency of condom use with sex workers in the past three months (retrospective), and (3) intention to use a condom at next sex with a sex worker (prospective). Logistic and multiple regression analyses were used to identify predictors of condom use across these measures.
Results: Respondents’ engagement in risky sexual behaviors, HIV/AIDS transmission knowledge, attitudes toward condom use, and perceived control over condom use were statistically significant predictors across models.
Conclusion: The construction industry’s high labor mobility, informality, and limited access to health services - combined with the criminalization of sex work, entrenched masculinities, and unequal power dynamics in condom negotiation - create a unique risk environment for male clients of sex workers. The study underscores the importance of using both retrospective and prospective measures to accurately capture condom-use behavior, with the prospective measure (intention to use condoms) demonstrating the greatest explanatory power. These findings have implications for the design of future survey instruments and interventions aimed at reducing HIV risk among this population.
Author ORCID Identifier
https://orcid.org/0009-0009-9736-185X; https://orcid.org/0000-0003-1471-623X;https://orcid.org/0000-0003-2720-7653
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
Recommended Citation
Yakubu, Kamal K.; Bowen, Paul; and Govender, Rajen
(2025)
"Explaining Condom use among Male Construction Worker Clients of Sex Workers in the Western Cape, South Africa,"
Health Behavior Research:
Vol. 8:
No.
4.
https://doi.org/10.4148/2572-1836.1338
Included in
Gender and Sexuality Commons, Health Psychology Commons, Quantitative, Qualitative, Comparative, and Historical Methodologies Commons, Social Psychology and Interaction Commons
