Factors influencing condom use among male clients of FSWs in Haiti
S.E. Jean1, E. Charles1, M. Kays2, N. Lehnertz3, R. Smith2
1Population Services International/Haiti, Port-au-Prince, Haiti, 2Population Services International, Research & Metrics, Washington, United States, 3University of Minnesota, Minneapolis, United States
Background: Haitian clients of female sex workers (FSWs) have a higher prevalence of HIV than the general population (7.2% vs. 2.2%), and serve as a bridging population. Male clients requested PSI to expand its program with FSWs, branded Condomania, to include prevention communications targeted towards them.
Methods: To design client-specific communication, PSI/Haiti implemented a study called Framework on Qualitative Research for Social Marketing (FoQus), an audience-centered approach that qualitatively segments the target audience to identify determinants of a behavior. Clients were trained as interviewers and conducted in-depth interviews with 24 of their peers, who also completed photo-narratives on sex-seeking and spoken narratives about their last visit to a FSW.
Results: Clients demonstrated a low internal locus of control: many feel that in a country with diminished economic hopes, alcohol consumption and sex with FSWs are necessary distractions. Few implemented strategies to avoid HIV and most feel that abstinence is not a physically viable choice.
Clients reported that condoms are widely available and their use is largely initiated by FSWs. Clients' condom use is situation dependent - they do not use condoms with trusted or regular FSW partners as “a true man shows respect to a woman by not using condoms.” Condom use is also viewed as beyond one's control when intoxicated or with an extremely beautiful woman.
Though HIV knowledge is high, many clients doubt its existence or have low perceived susceptibility: “If I have not gotten it yet, I am not going to get it.”
Conclusions: Condomania has been successful in improving FSW initiation of condom use. Health promotion interventions targeting clients will focus on improving perceptions of HIV susceptibility and clients' locus of control regarding HIV prevention. Interventions will also seek to improve condom use in established FSW-client relationships.
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