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Final Report for the AIDSCAP
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Table of Contents I. Country Program Description
III. Non-Subproject Highlights II. Subproject Highlights Research Formative Research for a 100% Condom Program
Objectives The "100% Condom Program," which began in Thailand, consists of a policy intended to enforce consistent condom use in brothels through the use of sanctions for brothel owners whose commercial sex workers (CSWs) become infected with an STI. Significant reductions in STI were recorded in Thailand as a result of this program. In the Dominican Republic, the infrastructure already exists to successfully adopt a 100% condom policy. To date, however, the government inspectors responsible for monitoring the brothels have failed to apply sanctions and close sites when violations occur. The purpose of this project was to carry out a qualitative study on the potential implementation of a 100% condom policy. Results would be used to design a pilot intervention to establish the program in areas of commercial sex trade within the Dominican Republic. Businesses would sign an agreement with COIN to implement a 100% condom policy. The main objective of this intervention was to sign an agreement with the Ministry of Health to provide the monitoring and sanction/incentives component for a 100% Condom Program. Also the project had to design and pre-test educational materials. COIN's Health Messengers network served as the proper vehicle to carry on this implementation. Upon completion of the 100% condom study, the findings were presented by COIN to AIDSCAP with a proposal for a pilot project to AIDSCAP. Accomplishments The study selected 2 brothels and 3 bars and one pre-test site based on the following criteria: business located in a commercial sex trade zone covered by COIN with at least 5 years in practice, employing more than 10 female CSWs. Through COIN's existing HM network, adult CSWs, their steady partners and clients, and owners and managers of sex establishments were invited to participate in the study on a volunteer basis. CSWs had to have been employed for at least three months in a particular business, and clients must have made at least 3 visits in the past year. All brothel and bar owners were directly asked to participate in the study. A total of 207 interviews (193 in-depth, 14 key informant) were conducted. The interviewers took personal histories, basic demographic information, and inquired about beliefs and knowledge on topics related to STI/HIV/AIDS, and asked participants how they felt condom use could be improved in their particular business locale. Constraints Three businesses sites had to be changed during the course of the study because there were too few clients visiting around the time of the presidential election. Of the 193 in-depth interviews conducted with sex establishment informants, only 168 were codified because in some interviews that were taped, the tapes couldn't be heard clearly or the tapes were lost. Findings and Recommendations As expected, CSWs are extremely vulnerable to HIV infection. Of those who participated, the majority (57%) were between the ages of 21 and 25 years of age and had received between 6 to 8 years of formal education (43%). While 100% of the CSWs reported condom use with a new client, only 89 percent used a condom with repeat clients (three to five encounters constituted a repeat client). Of the CSWs who had a long-term partners, 29 percent used a condom with that partner. Seventy-nine percent of the CSWs had access to condoms where they worked. Alcohol and drug use were prevalent among the CSWs interviewed, with 33 percent reporting consuming more than six beers/day and 40 percent regularly received drug offers. The clients interviewed for the study continued to demonstrate high risk behaviors. Their use of condoms varied depending on the type of sexual encounter. Some 58 percent of clients used a condom with CSWs, but only 1 percent reportedly used a condom with their long-term partners. CSWs long-term partners were also found to be at a high risk of infection as only 11.1 percent of them reported always using a condom with their partner (the CSW involved in the study) while 55.6 percent never used a condom with their partner. Only half of these men used condoms with other long-term partners, thus enlarging the network of persons exposed to HIV infection. With regard to condom accessibility, six of the eight brothel and bar owners who were interviewed said that condoms were available in their business. Roughly 66 percent of the condoms were sold to CSWs while the remaining 33 percent were given to CSWs. Participants suggested and ranked various ideas for the promotion of condoms at the workplace. These included obligatory medical check-ups, regular meetings with CSWs about condom use, enforcement of condom use by public health officials or by owners, placing free condoms in all of the rooms, and refusing services to clients who would not use a condom. The information gained in this study allowed for the development of a 100% condom policy pilot program to be conducted by COIN/AIDSCAP from March to June 1997. 100% Condom Use Pilot Project (FCO 54048)
The purpose of this project was to implement two types of interventions. The first, an environmental and structural intervention, is a pilot 100% condom project implemented in ten brothels in Santo Domingo, Dominican Republic. The objectives of this pilot project were to validate terminology, materials and design the 100% condom intervention, and to design and pre-test behavior change and communication material. The second is an individual and couple level intervention conducted with commercial sex workers from ten participating brothels and their steady partners. The objectives of this intervention were to hold communication and HIV prevention workshops with regular partners of sex workers, develop materials and health talks for the sex workers through COIN's health messengers and hold theater presentations regarding HIV prevention and steady partners. Accomplishments COIN attained support from the MOH for implementation of the 100% condom use policy. The MOH has agreed to enforce this policy in all brothels, but concrete actions are still pending. Several brothel owners have also committed to adhere to the program's regulations. Some of the program's materials have already been produced. Constraints The main constraint faced by this project was the delay in the process of reviewing, approval and signing of the letter of agreement. The project was supposed to initiate in January, but due to a delay implementation began three months later. More time is needed in order to better assess the process and impact of the 100% condom pilot project. |
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