XVIII International AIDS Conference (AIDS 2010)
18–23 July 2010
"The Encontros project: A successful multi-level STI/HIV intervention to improve condom use, reduce sexually transmitted infections, and change the social environment among sex workers in Brazil"
Sheri A. Lippman, Magda Chinaglia, Angela Donini, Deanna Kerrigan, Arthur Reingold, and Juan Diaz
HIV prevention programs that do not modify social and structural contexts that put people at risk may fail to produce sustained improvements in health, particularly among groups who experience discrimination and exclusion from public life. We conducted a multi-component, multi-level intervention with sex workers to reduce incident sexually transmitted infections, including improved clinical care coupled with strategies to modify social and structural factors.
An STI/HIV intervention program called Encontros was implemented in Corumbá, Brazil, between 2003 and 2005. In addition to improved access and quality to reproductive and sexual health services at a public clinic, the program aimed to create social cohesion, expand social networks, and stimulate community mobilization. Longitudinal behavioral and STI data were collected from 420 female and male sex workers over the course of the project in three-month intervals. We estimated the effect of participating in the project on incident chlamydia and gonorrhea infections and condom use using generalized estimating equations and inverse probability weighting. We also determined the relationship between participation in the intervention and perceived social cohesion and participation in networks.
Participation in the intervention was associated with a higher odds of consistent condom use with new clients (OR; 1.6, 95% CI: 0.9–2.8), regular clients (1.9, 1.1–3.3), and nonpaying partners (1.5, 0.9–1.5). The odds of an incident STI were reduced for participants compared to nonparticipants (0.46, 0.2–1.3). Project participation was associated with significant increases in perceived cohesion and participation in networks.
This is one of the first projects to provide evidence that a multi-level clinical and social intervention can increase social cohesion and participation in networks, improve condom use, and reduce STIs among sex workers. Replication of these findings in a randomized community trial is warranted, as is research to explore mediating pathways of the social environment on HIV/STI outcomes.
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