HIV prevention through peer education and condom promotion among truck drivers and their sexual partners is described. Trends during an initial 18-month intensive phase, followed by a 24-month maintenance phase, were monitored with surveys. Trends for self-reported condom use were: increase among men (56 to 74%) during the first phase with a decrease (72%) during the maintenance phase. Respective figures for women were 51%, 91% and 70%. Multivariate analyses revealed that men most likely to report using condoms were unmarried, had children, were more educated, had previously reported a genital ulcer, and perceived themselves at risk for HIV infection (OR = 1.95-3.47). Women tending to use condoms were unmarried, aware of the limitations of condoms, not in denial as to the existence of HIV, harboured inaccurate information about HIV transmission and were afraid (OR = 1.35-2.52). Both sets of results suggest that the most sexually experienced men and women who did not have a permanent stable relationship and who perceived themselves at risk, were most likely to use a condom. Peer education was an effective tool for increasing knowledge and encouraging appropriate behaviour change. It was most effective as an intensive high-input intervention and sustainable with the relatively stable population of truck drivers.
Objective: In Mwanza region, an HIV/STD intervention program has been in progress in the rural population since 1991. The information in this study was gathered to increase understanding about lay concepts of sexually transmitted diseases and to provide information to inform HIV/AIDS/STD interventions. Methods: During a rapid ethnographic survey, 4 investigators conducted more than 100 interviews in 3 rural villages and one roadside settlement with a wide range of key informants including fishers, truck drivers, professional sex workers, STD patients, traditional healers, health care workers, bar attendants, and traders. Results: High-risk transmission sites included bars, guesthouses, periodic markets, and beaches. People at high risk included men with money and/or away from home such as truck drivers, fishers, government officials, and businessmen, and single women who are barmaids, traders, and secondary school students. Despite linguistic differences in typologies, signs and symptoms were similar in many reported STD conditions when compared to the biomedical model. Some common conditions and diseases e.g. schistosomiasis were believed incorrectly to be sexually transmitted. Multiple sources of treatment were sought. Conclusion: The existence of transient social groups with high-risk behaviour is a challenge to the organization and delivery of STD services. Effective interventions will entail cooperation between multiple sectors based on detailed knowledge of local populations and conditions. Interventions should be accompanied by simple research techniques to assist timely assessment.
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