Evaluation of a program on condom use among female sex workers (FSW) in Dominican Republic, 2006-2008
B. Nieto-Andrade1, J. Hasbun2, K. Colon3, C. Szymanski3, G. Agudelo3
1Population Services International, Guatemala, Guatemala, 2External Consultant, Santo Domingo, Dominican Republic, 3Population Services International, Santo Domingo, Dominican Republic
Background: In the Dominican Republic, PSI is part of a collaborative HIV-prevention program targeting FSW, one of the most at risk populations, with an HIV-prevalence of 3.0%(SESPAS, 2007). The program consists of inter-personal communication developed by government and partner NGOs, as well as general mass-media developed by PSI.
Methods: To evaluate the impact of this program on FSWs' sexual behavior, two cross-sectional surveys were conducted among FSWs, using time-location sampling, in 2006(n=715) and 2008(n=789). Surveys collected information on sexual practices, determinants of condom use, and exposure to the program. Controlling for socio-demographic factors, Unianova analysis was conducted to check for changes over time and impact. Values are reported using mean scores (likert scales ranging from 1=totally disagree to 4=totally agree) or percentages.
Results: Condom use at last sex with a client kept stable above 95% in 2006-2008. With non-commercial partners it increased from 57.2% to 84.2% (p< 0.001), but the increase cannot be attributed alone to the program: in 2008 levels of condom use were significantly higher than in 2006 among FSW both exposed and unexposed.Nevertheless, the program demonstrated impact on FSW´s intention to use condoms with all their partners (mean value changed from 3.62 to 3.79, p< 0.001); perceived negotiation skills to wear condoms with regular clients (3.07 to 3.45, p< 0.001); belief that having sex without condoms is not good (2.38 to 2.66, p< 0.001); having condoms at home (71.4% to 79.6%, p< 0.01); and knowledge that HIV is not transmitted through mosquito bite (53.5% to 60.8%, p < 0.05).
Conclusions: Collaborative work between NGOs and government proves to have positive results. The HIV-prevention program contributed to less risky behavior among FSW by improving indicators related to condom use at last sex. Next steps include more aggressive strategies that promote condom use beyond commercial relations, such as those with trusted partners.
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