November 2003

Expanding Workplace HIV Prevention Programs for a Highly Mobile Population in
Ho Chi Minh City

Conclusions and Recommendations

Findings about the impact of the program on workers indicate that the peer education program reached a higher proportion of the workers than the health communicator program. There were also greater improvements in such impact variables as knowledge on where to get a condom and support for risk reduction norms, and greater declines in stigmatizing attitudes toward people living with HIV and AIDS. Evidence also suggests a diffusion effect in the PE intervention sites, given that workers at the PE sites who were not directly exposed to PE activities also reported positive change in HIV-related knowledge.

Reported risky sexual behavior in the surveys was quite low in this population, so conclusions about the impact of the programs on sexual risk behavior are limited. There is some evidence—such as an increase in condom use with a non-marital sexual partner—that suggests an impact in that area. Furthermore, the qualitative data suggest that there was both more HIV risk behavior on the part of workers than what was found in the close-ended surveys, and that reductions in risk behavior and increases in safer sex practices occurred, particularly among workers exposed to the peer education intervention. These findings highlight the importance of triangulating information gathered on sensitive issues from multiple sources and with varied methodologies.

Although at baseline PEs had poorer knowledge of HIV/AIDS than HCs and were less comfort-able discussing sensitive topics, after training and six months of experience in the field, PEs were more comfortable discussing sensitive topics than were HCs and had equivalent levels of know-ledge. A somewhat lower proportion of PEs than HCs dropped out of the program. Therefore, many of the potential disadvantages of using PEs expressed at the beginning of the intervention, such as concern that the construction workers might not be capable PEs or might drop out in greater numbers, were not supported by the data. Moreover, study findings indicate that the peer educators continued to implement activities after moving from their original site to other work sites, which supports the original supposition that a peer education strategy might be advantageous for a mobile workforce.

The cost per worker reached by the PE program was lower than that of the HC program, and it would be substantially less expensive to replicate the PE intervention in additional sites. This finding is of great relevance both for local authorities who are determining which program to take forward and scale up, and for construction companies that are considering implementing a peer education program with their own funds.

Given these findings, local authorities have determined that they will focus their efforts on the peer education program, while maintaining a cadre of health communicators for companies that are unable or unwilling to implement a peer education program. To strengthen the PE program, peer educators should be trained regularly when new sites are added to maintain an appropriate ratio between peer educators and workers. Also, the role of the peer coordinator was an important one and should be continued in order to support the peer educators and foster good relations with the management. Finally, the role that gender dynamics may have played in the ability of the HCs to do their jobs successfully and remain in the program should be further investigated.

Gaining the support of management is key. Since an important difference between the two interventions may have been the outreach made to engage management for the PE program, a management motivation component should be included in the HC program as well. Management endorsement of their work could potentially increase the effectiveness of HCs. Local authorities indicated that the management motivation component was deemed sufficiently successful to recommend its use in all types of local workplace programs.

While both the PE and HC programs had a positive impact on workers, the PE program appears to have a number of advantages over the HC program for this type of work environment. These findings should help inform future efforts to scale up and improve the sustainability of these programs in Vietnam, as well as provide global lessons regarding workplace HIV/AIDS interventions.

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This page updated
19 Oct 2007