HORIZONS PROJECT
Evaluation of a 100-Percent Condom Use Policy in Sex Establishments

This study assessed the impact and cost-effectiveness of two environmental–structural approaches to achieving 100-percent condom use in sex establishments: (1) a voluntary, solidarity-based approach that encourages compliance through mobilization and education, and (2) a solidarity approach combined with government policy  and regulation. These models were implemented in two cities in the Dominican Republic, Santo Domingo and Puerto Plata, respectively.

Key findings include:

• Improvements in both cities from pre- to post-intervention in the study’s key outcome variables: increased consistent condom use, increased rejection of unsafe sex, and decreased prevalence of sexually transmitted infections.

• Type and level of changes in variables varied by intervention approach.

• The Puerto Plata model—which included the government policy and regulation component—appears to have been more successful in bringing about significant increases in consistent condom use with regular partners.

• The ability of sex workers to reject unsafe sex rose significantly only in Puerto Plata.

• Triangulation of data shows that while both models had a positive impact on reducing vulnerability to HIV, the impact appears to have been broader in Puerto Plata.

• The Puerto Plata model is much more cost-effective than the Santo Domingo model.

Triangulation of data from different sources highlights that the combined solidarity- and government policy-based model tested in Puerto Plata is a feasible, acceptable, and effective intervention package for the Dominican Republic. With funding from The Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Bank; and USAID, the implementing NGOs in coordination with the Dominican government are scaling up the combined model in areas of the country where commercial sex is prevalent.

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Location

Santo Domingo and Puerto Plata, Dominican Republic

Duration

February 1999–July 2002

Horizons and Population Council researchers

Ellen Weiss, Johannes van Dam

Non-Council collaborators

Deanna Kerrigan and Michael Sweat (Johns Hopkins University)

Santo Rosario (Centro de Orientación e Investigación Integral)

Bayardo Gómez (Centro de Promoción y Solidaridad Humana

Institute of Dermatology and Skin Surgery (Instituto Dermatológico de Cirugia de la Piel or IDCP)

Donor

US Agency for International Development

Publications/Resources on this project

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Related Project

• Inspiring Male Involvement: Formative Research Toward the Development of HIV/STI Prevention Interventions Among Male Clients of Female Sex Workers in the Dominican Republic

See Also

• Dominican Republic

• Horizons Program

• HIV and AIDS

• HIV and AIDS/Policy Development

• HIV and AIDS/Prevention

• Reproductive Health

• Reproductive Health/Contraception

• Reproductive Health/RTIs and STIs

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