Findings From Encontros

Abstract

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.

Project Shikamana: Baseline Findings From a Community Empowerment–Based Combination HIV Prevention Trial Among Female Sex Workers in Iringa, Tanzania

“…Limited work, however, has been conducted on how social cohesion and community empowerment approaches can target HIV care and treatment outcomes that are critical to both the health and human rights of FSWs and curbing ongoing transmission. 33 Because we continue to promote, facilitate, and support opportunities for solidarity and mobilization among FSWs in Iringa, we will be looking closely at how these factors influence the impact of intervention over time.…”

Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study

“…Structural interventions, like community mobilization, have been largely effective in reducing sexually transmitted diseases through the collective power for condom use with clients among FSW (Beattie et al, 2014; Kerrigan et al, 2006; Lippman et al, 2012). The 100% condom campaign among FSW in Thailand was successful at altering condom use norms by empowering FSW to use condoms with clients, leaving clients without a choice on condom use (Rojanapithayakorn, 2006; Rojanapithayakorn & Hanenberg, 1996).…”

Conceptualizing Community Mobilization for HIV Prevention: Implications for HIV Prevention Programming in the African Context

“…In the area of HIV prevention, community mobilizing interventions have demonstrated successes in increasing condom use [2-7], improving service access and quality [7,8], increasing social capital or social cohesion [7,9] and most recently in promoting uptake of HIV counseling and testing [10]. Beyond these demonstrated successes, community mobilization (CM) will play a key role in effective implementation of key bio-medical interventions in the future.…”