Objectives-We sought to determine the association of social-environmental factors with condom use and sexually transmitted infections (STIs) among 420 sex workers participating in an STI/HIV prevention study in Corumbá, Brazil, to inform future intervention efforts.Methods-Participants provided urine samples for polymerase chain reaction testing of chlamydia and gonorrhea and responded to multi-item scales addressing perceived social cohesion, participation in networks, and access to and management of resources. We conducted multivariate log-linear and negative binomial regression analyses of these data.Results-Increased social cohesion was inversely associated with number of unprotected sex acts in the preceding week among women (adjusted incidence rate ratio [IRR]=0.80; P<.01), and there was a marginal association among men (adjusted IRR=0.41; P=.08). Women's increased participation in social networks was associated with a decrease in frequency of unprotected sex acts (adjusted IRR=0.83; P=.04), as was men's access to and management of social and material resources (IRR=0.15; P=.01). Social-environmental factors were not associated with STIs.Conclusions-The social context within which populations negotiate sexual behaviors is associated with condom use. Future efforts to prevent STI/HIV should incorporate strategies to modify the social environment.With growing agreement about the importance of economic, political, and social contexts in shaping sexual behaviors and the course of the HIV epidemic, HIV prevention researchers have escalated calls for implementation of multilevel structural and social interventions that modify social environments and empower communities. [1][2][3][4][5][6][7][8][9] Interventions that seek to create social cohesion, improve access to resources, create networks, ensure community participation, Correspondence should be sent to Sheri A. Lippman, PhD, MPH, Center for Aids Prevention Studies, University of California San Francisco, 50 Beale St., suite 1200, CA, 94105 (LippmanS@globalhealth.ucsf.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.
Human Participant ProtectionThis study was approved by the Population Council's internal review board, the Committee for the Protection of Human Subjects at the Federal University of Mato Grosso do Sul in Brazil, and the Brazilian National Ethics Committee. All participants provided informed consent in their language of choice (Portuguese or Spanish) before enrollment.
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Author ManuscriptAm J Public Health. Author manuscript; available in PMC 2011 April 1.
NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript mobilize communities, and otherwise establish human rights are especially important for marginalized groups that experience discrimination and exclusion from public life.Improving social-environmental factors has become an integral element in HIV prevention 2, 5,10,11 and health promotion generally. [12][13][14][15] The United Nations Joint Programme on...