FHI/Laos Raises HIV Awareness with Games and Fairs

MAY 2007 — With entertaining games and activities, FHI/Laos is encouraging behavior change by educating thousands of low-income sex workers throughout the country about HIV and other sexually transmitted infections (STIs). The women are also invited to fairs and mass screenings at wellness centers where any asymptomatic STI infections they have can be diagnosed and treated.

Fun, but far from frivolous
FHI/Laos Program Manager Phayvieng Philkone explains, "The games and activities address themes directly related to the reported interests and needs of the women." For example, risk cards drive home important facts about HIV and STI transmission; body mapping and reproductive health aprons help explain condom use and the dangers of asymptomatic STIs; and a puzzle matching male and female responses suggests tactics that the women can use when their clients do not want to use condoms. Now, all the activities have been compiled in an easy-to-use manual called "Learning about Healthy Living."

Playing the boyfriend game
"The Boyfriend Story Game" addresses the fact that sex workers use condoms much less frequently with lovers and boyfriends (in only about 50 percent of episodes) than with paying customers (85 percent).

The Boyfriend Story Game is played with 10 small photos of beautiful women and 10 of handsome men. The backs of three of the photos are marked with an X to signify HIV infection. Participants do not see which photos are marked. Cards the same size as the photos—10 blue and 10 green—are also used.

Each participant chooses a photo to represent herself and another to represent her boyfriend. She places them next to each other, then adds other photos and cards to represent her boyfriend's other sexual partners, past and present, and all the known partners of their partners. Blue (male) and green (female) cards are used when the participant has never seen the partner in question. After building this network, the participant turns over the picture cards. The potential route of HIV infection may then be traced through the series of partners to the boyfriend and the sex worker.

The content is grim, but participants enjoy playing this game and joke about the pictures and their boyfriends. They gain awareness of the dangers of not using condoms with their lovers and are encouraged to convince their boyfriends to go for HIV testing.

Outreach workers and their training
FHI/Lao interviewed 197 women before selecting 34 to be outreach volunteers. Each new activity or teaching tool was presented to these volunteers in a one-day training, followed by two days of practice in drink shops, with mentoring and feedback by FHI staff.

FHI/Lao found that personality and enthusiasm were more important to an outreach volunteer's success than level of education and age, and learned that pride and ownership of the project could be fostered by providing volunteers with pens, paper, and other materials and allowing them to make their own tools.

The volunteers presented the activities at wellness centers, where sex workers come for health education and STI services, as well as in the drink shops where they often find clients. To facilitate the sessions in drink shops, collaborative relationships were established with drink shop owners, who were invited to quarterly meetings.

Screenings and fairs at wellness centers
At the seven wellness centers in the country—four in Vientiane municipality and one each in the provinces of Luang Prabang, Champasak, and Savannakhet—FHI/Lao arranged week-long mass screening and presumptive treatment fairs every three months, when sex workers are tested for gonorrhea, chlamydia, and syphilis. Many of these women have sub-clinical STIs that could increase their risk for HIV, and they are currently reluctant to seek screening after an episode of unsafe sex. Approximately 80 percent of the population has been reached at two treatment fairs, and a third fair is scheduled in June 2007.

Each center is staffed by a nurse-manager from the provincial health department, four outreach volunteers, and an STI physician. They offer free STI screenings once a week, provide risk-reduction and pre- and post-test counseling, and make referrals to HIV testing sites.

Supported initially through USAID's IMPACT Project, these efforts are receiving continuing support from a cooperative agreement with USAID's Regional Development Mission/Asia.

PHOTOS: (top) In Vientiane in February 2007, women play "The Boyfriend Story Game," which makes them aware of risks they may be taking when their regular partners do not use condoms. (bottom) The women are pointing to a reproductive health apron, used to explain how condoms work and their role in preventing sexually transmitted infections. (FHI/Laos)