Condom use among sterilized and nonsterilized women in county jail and residential treatment centers

Purpose: Although sterilized women do not need condoms for pregnancy prevention, they may still be at risk for sexually transmitted infections (STIs). Previous studies have shown that sterilized women have lower rates of condom use but have not controlled for the nested multilevel structure of data in which individual women have multiple partners with different STI risk factors. We address this limitation by testing the association of condom use and tubal ligation using multilevel analysis. Methods: Data were obtained from a cross-sectional survey of sterilized and nonsterilized women aged 18 to 44 in substance abuse treatment centers or county jail. Multilevel, random intercept logistic models examined the association of tubal ligation and any condom use in the 30 days before entry and controlled for individual- and partner-level correlates. Findings: Of 484 premenopausal respondents without hysterectomy, 194 (40.1%) reported tubal ligation. Overall, 48.4% of all women reported any condom use. In unadjusted and adjusted analyses, sterilized women were less likely to report any condom use. Women were least likely to use condoms with their main partners and more likely to use condoms with other partners and partners with whom they trade sex for drugs or money. Women were also more likely to use condoms if they are HIV positive or if they have partners they believe are HIV positive. Conclusion: In these high-risk settings, we found a high prevalence of women reporting tubal ligation and lower odds of condom use among these women. Condom use interventions targeting sterilized women in these settings are needed.