SUMMARYThis quasi-experimental study evaluated the influence of structural intervention components (e.g., changing organizational and social influence factors) in reducing biological sexually transmitted infections (STIs) and reports of unprotected sex among female bar workers (FBWs) in the Philippines (N = 369 at baseline). Recruited from four large southern Philippines cities, FBWs were exposed to a standard care, a manager influence, a peer influence, or a combined manager/ peer influence condition. After the two-year intervention period, FBWs in the combined peer and manager intervention condition showed greater reductions in STIs and unprotected sex relative to those in the standard care condition. FBWs in the combined and the manager only conditions also showed a decrease in STIs compared to those in the standard care condition. Managers in the standard care condition reported lower positive condom attitudes and lower attendance at HIV/ AIDS related training sessions compared to those in the combined condition. The combined effect of managers and peers had a positive, synergistic effect on condom use behavior and STI reduction compared to the standard care. This research provides empirical evidence that structural changes such as rules, regulations, and increased accessibility of condoms must be in combination with normative changes (individuals' attitudes, beliefs and normative expectancies) in order to achieve the greatest benefit in condom use behavior and STI reduction/prevention.
KeywordsFemale bar workers; HIV/AIDS risk; structural intervention; STIs; condom useIn the Asian sex industry, commercial sex related activity has been transitioning outside of the brothel as legal pressures escalate and as customers perceive this pressure. Thus, increasing proportions of female sex workers are now operating in such venues as beer gardens, bars, nightclubs, karaoke TV centers, massage parlors, or disco dance (Hanenberg & Rojanapithayakorn, 1998; WHO, 2001), where they have become known as indirect sex workers or as female bar workers (FBWs).The FBWs' lifestyle tends to be particularly distinctive from that of brothel based sex workers who are commonly referred to as commercial sex workers (CSWs). This is especially true in the realm of heterosexual relationships (Bloom et al., 2002). Unlike brothel-based CSWs, FBWs predominantly host or entertain male customers within the confines of the establishment by serving drinks, conversing or other similar activities. FBWs receive only small salaries and/or commissions based on quantity of drinks and food items which they serve. FBWs generally negotiate sexual activities inside the work establishment, which typically take place off-premise. If the negotiated off-premise activities do occur during "working hours," the patron is generally expected to pay a "bar fine" to the establishment's manager for any of the FBWs "leave-time."The FBWs' compensation for this negotiated off-premise sex work tends to be much greater than the meager establishment wages and is perceived...