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8.4 Condom use at last commercial sex, reported by client
Program Area: Sexual behavior 
Definition: The percent of men respondents reporting condom use the last time they had sex with a sex worker, of those who report having had sex with a sex worker in the last 12 months. 
Numerator: The number of male respondents reporting condom use the last time they had sex with a sex worker. 
Denominator: Total number of male respondents who report having had sex with a sex worker in the last 12 months. 
Measurement Tools: UNAIDS general population survey; DHS AIDS Module; FHI BSS. 
What It Measures: This indicator gives an indication of the success or failure of campaigns to increase condom use among clients of sex workers. It measures condom use by men with partners they consider to be commercial partners. 
How to Measure It: This indicator is only relevant to settings where commercial sex or prostitution is well defined. In general population surveys or in specialised surveys among groups of men who fit the profile of clients of sex workers (the military, truck drivers, etc.), men are asked if they had sex with a sex worker in the previous 12 months. If they reply yes, they are further asked whether they used a condom the last time they had sex with a sex worker.

The indicator is the number of men who report that they used a condom at last sex with a sex worker, divided by all those say they have had sex with a sex worker in the last 12 months. 

Strengths and Limitations: This indicator is invaluable in tracking the success of major programmes to promote condom use in commercial sex.

Most AIDS programmes aim to increase consistent use of condoms with sex workers. Surveys of clients of sex workers will almost certainly want to ask whether they use a condom always, sometimes or never in sex with sex workers over the last 12 months. However the pressure to say "always" is strong. Asking about a particular, and recent, act of sex may give a more robust measure of levels of condom use in commercial sex. This measure should therefore be used as the core indicator. However it is strongly recommended that programmes focusing prevention resources on increasing condom use in commercial sex also construct an indicator of consistent use of condoms in commercial sex. If both questions are asked, the "last time you had sex with a sex worker" question should precede the "always, sometimes, never" question.

Where there are several distinct populations of sex workers with different levels of perceived risk-for example, brothel-based prostitutes may be thought of as having riskier behaviour than girls in night-clubs-data may be collected separately for separate categories of sex worker. This can provide important information for programming. For example, men may report very high levels of consistent condom use in brothels, but much lower levels with women working out of night-clubs. This may be a warning signal for a shift of the high prevalence from one group to another. In constructing the indicator, however, only the last commercial sex partner of any sort should be considered.

It is possible to construct a similar indicator for clients of male sex workers in special surveys of men who have sex with men. 

Use of Indicator: Core indicator for concentrated epidemics - Additional indicator for generalised epidemics with defined populations of sex workers 
Tools: Surveys (UNAIDS, DHS, FHI) 
SSO Code: IR 4.1.13 
UNGASS: No 
The President's
Emergency Plan:
Yes 
OVC: No 
MDG: No 

USAID | UNAIDS | UNICEF | WHO | CDC | US Census Bureau
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