November 2003

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

Program Activities

The health communicator (HC) program has several positive characteristics, including minimal costs for implementation and a large supply of motivated and knowledgeable educators who are college social work students. However, there were concerns about the substantial turnover of HCs and whether social work students, about half of whom are female, are the most effective HIV prevention educators for a largely male construction worker population. The new program uses construction worker peer educators to promote HIV risk reduction and fosters management involvement and support for the workplace program. While PE programs have been found to be effective in many settings, local authorities were concerned about whether construction workers could be capable educators and could be motivated to stick with the program.

During the study period, initial and refresher training on HIV/STI prevention, participatory teaching methods, and group facilitation skills were offered to both PEs and HCs. Labor union staff acted as liaison with company management and as coordinators of the workplace programs.

Methods

The research consists of an experimental design with two intervention arms and three rounds of data collection. Twenty-three construction sites were selected after a mapping exercise of large construction sites in 19 of 22 districts across Ho Chi Minh City. They were randomly assigned to the PE or HC intervention. Half of the companies in the PE arm agreed to participate (n = 6). The first six HC sites contacted also agreed; therefore, a total of 12 sites initially took part in the study. The number of sites expanded as PEs completed their work and moved on to new work sites; new sites were also added in the HC arm for purposes of comparability. Permission from management was sought for each new work site.

The research included a formative phase to help develop the intervention activities. During the evaluation phase, a combination of qualitative and quantitative research methodologies was used to assess the process, cost, and impact of the different interventions. Monitoring forms were collected weekly from PEs and after each visit to the construction sites from HCs. Detailed information on indirect and direct costs was kept throughout the project. All active peer educators and health communicators were surveyed at baseline (n = 68 PEs and 69 HCs, respectively), six months (n = 56 and 46, respectively), and 12 months (n = 45 and 45, respectively). Focus group discussions and in-depth interviews were also held with company managers, PEs, HCs, workers, and labor union staff.

Surveys were conducted with construction workers before the intervention, and six and twelve months later. A baseline survey was administered to all workers (i.e., a census sample) in each of the PE (n = 742) and HC (n = 502) sites. During the follow-up period the number of exposed workers increased, as PE sites increased to 15 due to the movement of PEs to new sites when their work was complete, and an additional 6 HC sites were selected. As a result, a sample instead of a census of workers was selected for the second (PE sites: n = 751 workers; HC sites: n = 505 workers) and third rounds (PE sites: n = 363; HC sites: n = 211).

Characteristics of the Study Populations

Survey findings show that the great majority of workers were male (~ 85 percent) and in their late 20s. Most had completed "lower secondary" school or less. About half were married, and half were single. Most had lived in Ho Chi Minh City for less than two years.

There are some noticeable differences between the characteristics of peer educators and health communicators, and how they carried out their work. At baseline, most PEs indicated that they joined the program because their workplace or labor union had requested it, while HCs said their main reasons were for perceived personal benefit or to help workers. In addition, HCs were more likely than PEs to be younger and single, to have higher levels of education, and to have lived in HCMC for a shorter period of time.

More than 80 percent of the PEs, who came from a mostly male work force, were male, whereas about half of the HCs were male. While a small proportion of construction workers were female (~15 percent), and female PEs and HCs tended to work with female workers, there were also many female HCs who interacted regularly with male workers. But HCs were more limited in their interactions with workers than PEs, since HCs generally visited construction sites during break periods and held one-on-one or small group discussions outside the construction area because safety rules prevented them from entering most sites.

Many of these differences were expected, since PEs were drawn from the ranks of workers and HCs were students completing their social work degrees. However, some of these differences, particularly the sex of the educators and how they were able to interact with workers, may help to explain differences in effectiveness between the two programs.

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This page updated
19 Oct 2007