Promoting HIV Testing and Condom Use Among Filipina Commercial Sex Workers: Findings from a Quasi-Experimental Intervention

Study

A report by Raphael Abacan and Aimee Capinpuyan

Introduction
y Establishment-based female sex workers have increasingly

contributed to the spread of HIV in Southeast Asia. y As a result, sexual risk reduction (consistent condom use) and HIV testing have been targeted towards this population. y Studies on promoting HIV testing and consistent condom use in the commercial sex context have mostly focused on the relationships between psychosocial determinant variables and sexual health related behaviors. y This gave limited success but scholars have increasingly turned to the contextual approach in an effort to get better results

Introduction
y Previous research rarely took into consideration the

importance of multi-level contextual factors incorporated into intervention program designs affect the protective health practices of FCSWs. y Social action-based theory (SABT) offers a solution to this.

Social Action Theory

y Founded by Max Weber y People vary their actions according to social

contexts and how it will affect other people; when a potential is not desirable, the action is modified accordingly y Creating an environment that will promote a desired resultant action y SABT predicts health protection behavior is an interaction among three major domains: (1) the self-regulation capabilities of the individual; (2) the larger environmental context; and (3) responses to internal affective states.

Research Problematique
y Is Social Action a good basis for interventions that aim to

increase HIV testing and condom usage among FCSWs?

y Which type of intervention is the most effective? y Peer counseling? y Manager training? y Both???

Hypothesis and Tentative Explanations

y The self-regulatory process and contextual factors will be

positively associated with two health behavioral change outcomes, HIV testing and consistent condom use in FCSWs. y Peer counseling and education y Manager Training y In essence it is all about forming an environment that positively reinforces them into using condoms and getting tested for HIV.

Hypothesis and Tentative Explanations

Work environment ---> condom use & HIV testing

IV

DV

Hypothesis and Tentative Explanations

CONCEPTS: 1.) Changes in work environment INDICATORS: Peer counseling Manager training test scores interviews clinic samples

2.)condom use & HIV testing

Measurable Indicators
I. HIV testing Information was collected by self-report from FCSWs whether they had been tested for HIV for the past 6 months (yes/no).

Measurable Indicators
II. Consistent Condom use ON A 6-ITEM SCALE, RESPONDENTS WERE ASKED, HOW OFTEN DO YOU 1 Never 5 - Always

1. 2. 3. 4. 5. 6.

use a condom when engaging in vaginal sex? suggest using a condom to their partner? carry a condom on your person? do not use a condom for making more money? do not use a condom because one is not available? ask a customer to bring a condom when engaging in sex?

Measurable Indicators
The average score was computed by a summated score divided by six after a reversed-coded adjustment for two scale items. The higher the score was, the more consistently FCSWs used condoms.

Methodology
y Randomized quasi-experimental approach
y 4 test sites were randomly chosen from a box (Legaspi, Cebu,

Cagayan de Oro and Ilo-Ilo) y First site selected was the peer site, the second the manager training site, the third was the combination site and the fourth served as the control site which used the usual care system.
y Numbers were drawn with replacement, providing equal

probability for all selected sites

Methodology
y Staff from the University of the Philippines and UCLA

carried out the interventions y Data was collected by trained interviewers with language competencies ( also, had to attend a 1-week intensive training program) y Face-to-face interviews, via baseline and posttest surveys were conducted y The participation rates at baseline and posttest assessments were over 95%, reducing the likelihood for biased participant pool.

Methodology
y Quality assurance and quality control y Monthly meetings of coordinators with FCSW peer

educators re:
y delivery of STI prevention messages to other workers in the

establishments y problems encountered y Suggestions for alternative interpersonal approach

y 10% random samples of all clinic visits and outcomes during

the previous month by research manager

Methodology
Research Manager
Legaspi Site Coordinator Peer Counselors CDO Site Coordinator Establishment Managers Cebu Site Coordinator Peer Counselors Establishment Managers Iloilo Site Coordinators FCSWs

Methodology
y Results indicated less than a 3% discrepancy between

findings of site coordinator and research manager

y The 5-day intervention training program was followed up

with monthly reinforcement sessions bet. peer educators and managers.

Flowchart~

Descriptive Statistics

More Descriptive Statistics

Analysis: There was an INCREASE in EVERYTHING except

More Descriptive Statistics

Analysis: There was an INCREASE in EVERYTHING except

More Descriptive Statistics

Analysis: There was an INCREASE in EVERYTHING except

More Descriptive Statistics

Analysis: There was an INCREASE in EVERYTHING except

More Descriptive Statistics

Analysis: There was an INCREASE in EVERYTHING except

More Descriptive Statistics

Analysis: There was an INCREASE in HIV-related knowledge and AIDS perceived control, except in

Even More Descriptive Statistics

PEER EDUCATION + HIV testing

- employers supportive attitude - willingness to talk to employer re: condom -use - condom availability in the workplace - condom use

MANAGER TRAINING

+ HIV testing (BIGGEST INCREASE) + condom availability in the workplace + condom use

- employers supportive attitude - willingness to talk to employer re: condom -use

PEER EDUCATION + MANAGER TRAINING + condom availability in the workplace + condom use + employers supportive attitude + willingness to talk to employer re: condom -use

- HIV testing

CONTROL

- HIV testing - condom availability in the workplace - condom use - employers supportive attitude - willingness to talk to employer re: condom -use

Conclusion
y Results of the present study provide empirical data that

support SABT, emphasizing and demonstrating the importance of workplace context on behavior change. y The manager group had the most significant increase in HIV testing and condom usage y The attitudes, beliefs and relative status of the establishment managers, with the development of an infrastructure related to promoting healthy practices (such as the loan plan to FCSWs for STI medications previously described), led FCSWs to the desirable, protective behavioral actions of condom use and HIV testing.

Conclusion
y The managers attitudes and their emphasis on health proved

to be the most important factor in increasing the positive responses of the FCSWs y This result argues persuasively for the importance of developing management organizations and/or associations that address and reinforce protective practices in the workplace.