{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T08:12:25Z","timestamp":1788250345262,"version":"build-2803163510"},"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Inconsistent condom use represents the most proximal behavioral risk factor for acquisition and transmission of sexually transmitted infections, including human immunodeficiency virus. However, certain situations hinder female sex workers from practicing consistent condom use. This study aimed to assess the pooled estimate of inconsistent condom use among female sex workers and identify factors associated with it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2020 reporting checklist. Electronic databases (PubMed, Cochrane Library, Epistemonikos, Hinari, and Science Direct), Google Scholar, and other university repositories were searched until March 20, 2024, based on the eligibility criteria. Three independent reviewers screened the titles, abstracts, and full texts. Two independent reviewers extracted the data. The Joanna Briggs Institute quality appraisal checklist was used. The Higgin\u2019s I\u00b2 test was used to quantify heterogeneity. Pooled analysis was conducted using a random-effects model. Sensitivity and subgroup analyses were done. Publication bias was assessed using Egger\u2019s regression test and funnel plot. The pooled prevalence and statistical association were declared at a p-value\u2009&lt;\u20090.05 with the 95% CI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 24 studies involving 23,496 female sex workers with a median age of 27.3 years were included. The overall pooled prevalence of inconsistent condom use among FSW in Africa was estimated at 46.73% (95% CI: 37.60, 55.86), I\u00b2\u2009=\u200999.59%, and p\u2009=\u20090.00. Condom availability (AOR\u2009=\u20090.68; 95% CI: 0.50, 0.92), depression (AOR\u2009=\u20091.51; 95% CI: 1.00, 2.30), no education (AOR\u2009=\u20091.87; 95% CI: 1.19, 2.93), two or more nonpaying clients (AOR\u2009=\u20092.90; 95% CI: 1.51, 5.54), having &gt;9 current client number (AOR\u2009=\u20090.46; 95% CI: 0.29, 0.74), violence (AOR\u2009=\u20091.74; 95% CI: 1.33, 2.27), and police harassment (AOR\u2009=\u20092.28; 95% CI: 1.03, 5.05) were significant factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion and recommendation<\/jats:title>\n                    <jats:p>Inconsistent condom use was high in Africa. Factors including availability of condoms, depression, and education, having two or more nonpaying clients, client numbers, violence, and police harassment were significant factors. Strategies like improving peer education, providing mental health support, empowering women, and improving female sex workers educational status, ensuring condom availability, and strengthening supply for easily accessible condoms can decrease inconsistent condom use and protect FSWs from STI including HIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0346903","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:33:03Z","timestamp":1775842383000},"page":"e0346903","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Inconsistent condom use and its associated factors among female sex workers in African countries: Systematic review and meta-analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4101-6377","authenticated-orcid":true,"given":"Mulat Belay","family":"Simegn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9027-9847","authenticated-orcid":true,"given":"Habtamu","family":"Geremew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fraol Daba","family":"Chinkey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zekarias Tadele","family":"Alemneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyasu Bamlaku","family":"Golla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7896-9087","authenticated-orcid":true,"given":"Alegntaw","family":"Abate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Ahmed","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smegnew Gichew","family":"Wondie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hawi","family":"Kumbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werkneh Melkie","family":"Tilahun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"pone.0346903.ref001","doi-asserted-by":"crossref","DOI":"10.1093\/infdis\/jix402","article-title":"The world health organization\u2019s response to emerging human immunodeficiency virus drug resistance and a call for global action","volume":"216","author":"S Bertagnolio","year":"2017","journal-title":"J Infect Dis"},{"issue":"1","key":"pone.0346903.ref002","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13690-022-00851-0","article-title":"HIV prevalence and risk behaviors among female sex workers in Togo in 2017: a cross-sectional national study","volume":"80","author":"AM Bitty-Anderson","year":"2022","journal-title":"Arch Public Health"},{"issue":"1","key":"pone.0346903.ref003","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1186\/s12889-023-17253-8","article-title":"Prevalence and factors associated with inconsistent condom use among female sex workers in Ethiopia: findings from the national biobehavioral survey, 2020","volume":"23","author":"MA Rameto","year":"2023","journal-title":"BMC Public Health"},{"issue":"7","key":"pone.0346903.ref004","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S1473-3099(12)70066-X","article-title":"Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis","volume":"12","author":"S Baral","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"pone.0346903.ref005","article-title":"Factors associated to inconsistent condom use among sex workers","volume":"27","author":"LB Magalh\u00e3es R de","year":"2019","journal-title":"Rev Lat Am Enfermagem"},{"key":"pone.0346903.ref006","unstructured":"Magalh\u00e3es LRMS, Elucir G. 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