Abstract
Abstract
Background
Contraceptive and condom use remain low among women in marginalized communities, including those who sell sex, use or inject drugs, or are sexual partners of people who use or inject drugs (key populations). This study examines how selling sex and drug use relate to contraceptive and condom use with different partner types in Myanmar, alongside structural risk contexts.
Methods
We analyzed a cross-sectional survey among women from key populations (women who sell sex, use drugs, or are sexual partners of men who use drugs) recruited through community-based organizations across four sites in Northern and Eastern Myanmar. The analysis focused on women of reproductive age (15–49 years). Participants completed standardized questionnaires assessing contraceptive use in the past 12 months and condom use with partner types in the past 3 months. Descriptive and bivariate analyses were conducted, and multivariable Poisson regression models estimated adjusted prevalence ratios (aPRs) for contraceptive and condom use in relation to selling sex, drug use, and selected covariates.
Results
In multivariable analyses among 336 women, those reporting drug use only (aPR 0.68, 95% CI 0.48–0.95) had lower contraceptive uptake compared with women with no personal experience of selling sex or drug use. Women who had never used drugs were more likely to use contraception than opioid users (aPR 0.64, 95% CI 0.43–0.95) or stimulant users (aPR 0.72, 95% CI 0.57–0.92). Work-provided housing was associated with higher contraceptive use (aPR 1.43, 95% CI 1.01–2.05). This association was strongest among individuals selling sex, for whom such housing may represent brothel environments that facilitate access to contraceptives. Experience of selling sex was associated with higher condom use with casual partners, whereas drug use only or neither experience was associated with lower condom use with casual partners, highlighting prevention gaps outside sex-work-focused outreach.
Conclusion
Among women from key populations in Myanmar, contraceptive and condom use were determined by structural factors and risk contexts. Drug use was associated with lower contraceptive uptake, while experience of selling sex and work-provided housing were linked to higher use, likely reflecting differential access to outreach-based services. Scaling up reproductive health and HIV-prevention services within harm reduction and outreach, while addressing housing insecurity, is essential to improve outcomes in these populations.