Population Council Research that makes a difference

A Council-led team of epidemiologists, physicians, social scientists, sex worker advocates, and government representatives developed a clinical and social intervention called Encontros ("Coming Together") to improve health behaviors and reduce sex workers' vulnerability to STI/HIV/AIDS transmission in Corumbá, Brazil. The project was designed to engage sex workers on an individual level via participation in counseling on and testing for HIV and other STIs, on an interpersonal level via peer education, and on a community level via outreach and social activities.

The behavioral and clinical components of the project involved periodic psychosocial and behavioral assessments, STI screening and management, and counseling with an emphasis on promoting STI/HIV protective behaviors; clinic staff members were trained to offer care that emphasized confidentiality and respect.  Social mobilization strategies included a bi-monthly community party with presentations of dance, fashion, music, and theatre mixed with messages on STI/HIV prevention stigma reduction, and artisanal, theatre, and fashion design workshops and other activities providing safe spaces for promoting community and discussion.

An evaluation of the project measured reported behavior change and STI incidence of new infections by following a cohort of 420 commercial sex workers, who responded to questionnaires and received STI testing every three months for one year. All enrolled participants were encouraged to participate in project sponsored events, and the analysis compared participants who were more or less exposed to the intervention. 

Project impact

The project had a significant impact on the level of new STI infections during the study period. The prevalence of gonorrhea dropped from 4.4% in the first visit (baseline) to 3.1% in the second and to 2.6% in the fourth. Chlamydia prevalence fell from 14.7% in the first visit to 5.9% in the second and to 5.2% in the fourth. The odds that high participators would test positive for gonorrhea or chlamydia were half the odds of low participators.