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. NIH Public Access 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...

HIV-related stigma and discrimination (S&D) have been shown to impede prevention, care and treatment. Yet, few quantitative studies have tested the associations between stigma, service utilization and status disclosure, especially in countries with concentrated HIV epidemics. Surveys, administered to a random sample of 1,775 truck drivers crossing Southern borders in Brazil, included items on multiple conceptual domains of S&D, such as fear of casual contact and blame towards people living with HIV/AIDS. Pearson's chi-square tests and logistic regression were used to examine correlations. Less stigma (both individual items and grouped as a scale) was significantly correlated with VCT use (p

Background Sexually transmitted infection (STI)/HIV prevention programs which do not modify social-structural contexts that contribute to risk of STI/HIV may fail to bring about improvements in health, particularly among groups who experience discrimination and exclusion from public life. We conducted a multi-level intervention with sex workers, including improved clinical care and community mobilizing strategies to modify social-structural factors that shape sexual behavior, in order to improve condom use and reduce incident STI. Methods We followed 420 sex workers participating in the Encontros intervention in Corumbá, Brazil from 2003-2005. We estimated the effect of the intervention on incident chlamydia and gonorrhea infections and condom use using generalized estimating equations and inverse probability weighting by comparing those who actively engaged in the intervention activities (exposed) to those who were less engaged (unexposed). We also determined the association of participation on reported social cohesion and participation in networks. Results Exposed participants had significantly higher odds of reporting consistent condom use with regular clients (OR:1.9, 95%CI:1.1-3.3) and non-significantly increased odds with both new clients (OR:1.6, 0.9-2.8) and nonpaying partners (OR:1.5, 0.9-1.5). The odds of an incident STI were non-significantly reduced for exposed participants compared to unexposed (OR:0.46, 0.2-1.3). Participation was significantly associated with increased perceived cohesion and participation in networks. Conclusion This prospective study provides evidence that multi-level interventions with mobilizing strategies to modify aspects of the social environment can improve condom use, reduce STIs, and increase social cohesion and participation in networks among sex workers.

MSM sex workers have higher sexual risk behaviours as well as social vulnerabilities than the general population of MSM. HIV/sexually transmitted infection prevention efforts should be targeted to this riskier subgroup. Programmes should be transgender sensitive, should recognise that MSM sex workers have sex with men and women and address other factors that influence risk, such as homophobic abuse.

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We are indebted to Keith Sabin (CDC/GAP) who was always prompt in providing technical support for implementing respondent-driven sampling. Other technical assistance was also kindly provided by Julie Pulerwitz,

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