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Sexual risk among Filipina Female Bar workers
– Reported, January 13, 2012
The effects of three interventions designed to reduce sexual risk among Filipina female bar workers (FBWs) were compared with each other and with usual care (nonintervention). The interventions were developed iteratively by a community-based participatory research (CBPR) partnership comprising lay community members, organizational representatives (including nongovernmental organizations), and academic researchers from the United States and the Philippines. Peer educators and bar managers from 110 different establishments in three southern regions were recruited and trained to increase knowledge of HIV and of condom use rules and regulations within establishments, as well as to change attitudes about risk reduction, provide HIV and sexually transmitted infection (STI) testing referrals, and build condom use skills among FBWs. Compared with the control community, all three interventions increased HIV and STI testing; however, only FBWs in the combination peer-educator and manager-training intervention significantly increased condom use from baseline to 2-year follow-up. Condom use was significantly associated with higher HIV knowledge, attendance of a prevention class, and being taught how to use condoms properly. Given these findings, research is warranted to further explore and understand various forms of commercial sex work and to test adapted peer-educator and manger-training interventions within HIV epicenters.
The 911 Female bar workers (FBW) study participants averaged 23.5 years old (range 1554), 8.96 years of education, and 12.47 months of commercial sex work employment at their current establishment. Among the FBWs, 8% reported being married, with 55.3% reporting at least one child. Average weekly income from their work in the establishment was 1,372.5 pesos (approximately U.S.250).
Among the four conditions, over 90% of FBWs in the combined peer-educator and manager-training condition had, and received results from, HIV and STI testing in the past 6 months and were informed of their results, compared with about 85% of FBWs in the peer-education condition, 85% in the manager-training condition, and 51% in the control condition. FBWs in the combined condition were significantly more likely to consistently use condoms than the other conditions.
Among the four groups, FBWs in the intervention conditions had significantly higher levels of HIV knowledge than those in the control condition. FBWs in the manager training and the combined peer-educator and manager-training intervention conditions also had higher levels of self-esteem than those in the control condition.
A greater proportion of FBWs in the combined peer-educator and manager-training condition attended regular meetings and were more likely to report discussing condom use rules and regulations in these meetings compared with the control condition. FBWs in the combined peer-educator and manager-training condition were found to be most likely to attend an HIV prevention class (46%) and reported that the class increased their consistent condom use (42%). Over 70% of FBWs in the manager training condition and the combined peer-educator and manager-training condition reported being taught to use condoms properly, and over 60% reported being taught by medical professionals.
Managers of FBWs in all three intervention conditions were significantly more likely to participate in HIV prevention-related activities than those in the control conditions. More than 80% of the managers in the combined peer-educator manager-training condition reported attending a community HIV meeting or an HIV prevention class while only about 60% of the managers in the control condition reported attending a community HIV meeting and less than 45% attended an HIV prevention class.
Adjusting for individual demographic characteristics (age, education, work duration, weekly wage, and partner status), knowledge and self-esteem did not significantly increase the likelihood of HIV and STI testing. Several intervention process-related variables were found to be significantly associated with HIV and STI testing. FBWs in the control condition were significantly more likely to report HIV and STI testing if they also reported attending a prevention class, felt that the attended prevention class increased their own condom use, or had been taught to use condoms properly, particularly by medical professionals. Managers seemed to positively influence HIV and STI testing among FBWs in the control condition but not significantly.
Consistent condom use was positively associated with various cognitive characteristics, intervention process-related variables, and manager-related variables . For FBWs in the combined peer-educator manager-training condition, the significant factors were higher levels of HIV knowledge, attending an HIV prevention class, and knowledge of proper condom use. Managers of FBWs in the control group who offered an HIV prevention class for FBWs significantly increased consistent condom use among FBWs.
Although further rigorous research would be helpful, multiple studies document the value of going beyond individual-level interventions to incorporate community stakeholders and other influences at the institutional, organizational, and governmental levels to support health changes and to reduce rates of HIV and STIs (Chiao & Morisky, 2007; Chiao, Morisky, Ksobiech, & Malow, 2009; Kerrigan et al., 2006; Morisky, Ang, Coly, & Tiglao, 2004; Morisky et al., 2006; Morisky et al., 2002). As Fang et al. (2007) suggested, including other community network members (e.g., friends, family, employers, community and other organizations, and institutions) in future intervention designs may well improve the likelihood of achieving desired outcomes.
Moreover, it has been suggested that the most successful interventions to prevent HIV may need to be based on responding to immediate community priorities and needs while building capacity for communities to act on their own behalf (Gupta, Parkhurst, Ogden, Aggleton, & Mahal, 2008). Our CBPR approach did just that; its focus and approach came from the community and it provided key skills (e.g., communication, problem solving, leadership, social support) that may be lifelong and transferable to other community concerns.
Credits: Donald E. Morisky, Robert M. Malow, Teodora V. Tiglao, Shu-Yu Lyu, Aaron T. Vissman, and Scott D. Rhodes
More Information at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096438/?tool=pubmed
