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Sex Transm Infect. Apr 2005; 81(2): 166–173.
PMCID: PMC1764680

Results of a randomised trial of male condom promotion among Madagascar sex workers

Abstract

Objectives: To test the effect of supplementing peer promotion of male condom use with clinic based counselling, measured in terms of STI prevalence and reported male condom use.

Methods: 1000 female sex workers in Madagascar were randomised to two study arms: peer education supplemented by individual risk reduction counselling by a clinician (peer + clinic) versus condom promotion by peer educators only (peer only). STI testing was conducted at baseline and 6 months. Behavioural interviews were administered at baseline, 2, 4, and 6 months.

Results: At baseline, women in the peer only arm had prevalences of 16.0%, 23.6%, and 12.1% for chlamydia, gonorrhoea, and trichomoniasis respectively, with an aggregate prevalence of 38.2%. Baseline STI prevalences for the peer + clinic arm were slightly lower and 34.1% in aggregate. At 6 months, aggregate STI prevalence increased in the peer only arm to 41.4%, whereas the aggregate prevalence diminished slightly to 32.1% in the peer + clinic arm. In logistic regression analyses, the estimated odds ratios (ORs) for chlamydia, gonorrhoea, trichomoniasis, and aggregate STI were 0.7 (95% confidence interval 0.4 to 1.0), 0.7 (0.5 to 1.0), 0.8 (0.6 to 1.2), and 0.7 (0.5 to 0.9) respectively, comparing the peer + clinic arm with the peer only arm. The logistic regression OR for reported condom use with clients in the past 30 days increased from 1.1 at 2 months to 1.8 at 6 months, comparing the peer + clinic arm with the peer only arm, and was 1.4 overall (1.1 to 1.8). Adjustment for baseline factors changed the regression results little.

Conclusions: The impact of male condom promotion on behaviour can be heightened through more concentrated counselling on risk reduction. Persistently high STI prevalence despite increases in reported condom use by sex workers supports the need for multidimensional control programmes.

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Selected References

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  • Community-level HIV intervention in 5 cities: final outcome data from the CDC AIDS Community Demonstration Projects. Am J Public Health. 1999 Mar;89(3):336–345. [PMC free article] [PubMed]
  • Nuwaha F, Faxelid E, Höjer B. Predictors of condom use among patients with sexually transmitted diseases in Uganda. Sex Transm Dis. 1999 Oct;26(9):491–495. [PubMed]
  • Polacsek M, Celentano DD, O'Campo P, Santelli J. Correlates of condom use stage of change: implications for intervention. AIDS Educ Prev. 1999 Feb;11(1):38–52. [PubMed]
  • Estébanez P, Fitch K, Nájera R. HIV and female sex workers. Bull World Health Organ. 1993;71(3-4):397–412. [PMC free article] [PubMed]
  • Leonard L, Ndiaye I, Kapadia A, Eisen G, Diop O, Mboup S, Kanki P. HIV prevention among male clients of female sex workers in Kaolack, Senegal: results of a peer education program. AIDS Educ Prev. 2000 Feb;12(1):21–37. [PubMed]
  • Varga CA. The condom conundrum: barriers to condom use among commercial sex workers in Durban, South Africa. Afr J Reprod Health. 1997 Mar;1(1):74–88. [PubMed]
  • Wojcicki JM, Malala J. Condom use, power and HIV/AIDS risk: sex-workers bargain for survival in Hillbrow/Joubert Park/Berea, Johannesburg. Soc Sci Med. 2001 Jul;53(1):99–121. [PubMed]
  • Karim QA, Karim SS, Soldan K, Zondi M. Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers. Am J Public Health. 1995 Nov;85(11):1521–1525. [PMC free article] [PubMed]
  • Egger M, Pauw J, Lopatatzidis A, Medrano D, Paccaud F, Smith GD. Promotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial. Lancet. 2000 Jun 17;355(9221):2101–2105. [PubMed]
  • Walden VM, Mwangulube K, Makhumula-Nkhoma P. Measuring the impact of a behaviour change intervention for commercial sex workers and their potential clients in Malawi. Health Educ Res. 1999 Aug;14(4):545–554. [PubMed]
  • Voeten Helene A C M, Egesah Omar B, Ondiege Mark Y, Varkevisser Corlien M, Habbema J Dik F. Clients of female sex workers in Nyanza province, Kenya: a core group in STD/HIV transmission. Sex Transm Dis. 2002 Aug;29(8):444–452. [PubMed]
  • Ngugi EN, Wilson D, Sebstad J, Plummer FA, Moses S. Focused peer-mediated educational programs among female sex workers to reduce sexually transmitted disease and human immunodeficiency virus transmission in Kenya and Zimbabwe. J Infect Dis. 1996 Oct;174 (Suppl 2):S240–S247. [PubMed]
  • Wong ML, Chan KW, Koh D. A sustainable behavioral intervention to increase condom use and reduce gonorrhea among sex workers in Singapore: 2-year follow-up. Prev Med. 1998 Nov-Dec;27(6):891–900. [PubMed]
  • Behets FM-TF, Andriamiadana J, Randrianasolo D, Rasamilalao D, Ratsimbazafy N, Dallabetta G, Cohen MS. Laboratory diagnosis of sexually transmitted infections in women with genital discharge in Madagascar: implications for primary care. Int J STD AIDS. 2002 Sep;13(9):606–611. [PubMed]
  • Leutscher Peter D C, Behets Frieda, Rousset Dominique, Ramarokoto Charles-Emile, Siddiqi Omar, Ravaoalimalala Elisabeth V, Christensen Niels O, Migliani René Sexual behavior and sexually transmitted infections in men living in rural Madagascar: implications for HIV transmission. Sex Transm Dis. 2003 Mar;30(3):262–265. [PubMed]
  • Behets FM, Andriamahenina R, Andriamiadana J, May JF, Rasamindrakotroka A. High syphilis and low but rising HIV seroprevalence rates in Madagascar. Lancet. 1996 Mar 23;347(9004):831–831. [PubMed]
  • Behets F, Andriamiadana J, Rasamilalao D, Ratsimbazafy N, Randrianasolo D, Dallabetta G, Cohen M. Sexually transmitted infections and associated socio-demographic and behavioural factors in women seeking primary care suggest Madagascar's vulnerability to rapid HIV spread. Trop Med Int Health. 2001 Mar;6(3):202–211. [PubMed]
  • Ford N, Koetsawang S. A pragmatic intervention to promote condom use by female sex workers in Thailand. Bull World Health Organ. 1999;77(11):888–894. [PMC free article] [PubMed]
  • Behets Frieda M T F, Rasolofomanana Justin Ranjalahy, Van Damme Kathleen, Vaovola Georgine, Andriamiadana Jocelyne, Ranaivo Adeline, McClamroch Kristi, Dallabetta Gina, Van Dam Johannes, Rasamilalao Désiré, et al. Evidence-based treatment guidelines for sexually transmitted infections developed with and for female sex workers. Trop Med Int Health. 2003 Mar;8(3):251–258. [PubMed]
  • Steen Richard, Dallabetta Gina. Sexually transmitted infection control with sex workers: regular screening and presumptive treatment augment efforts to reduce risk and vulnerability. Reprod Health Matters. 2003 Nov;11(22):74–90. [PubMed]
  • Davies Stephen C, Otto Brad, Partohudoyo Sutaryo, Chrisnadarmani VAMA, Neilsen Graham A, Ciaffi Laura, Patten Jane, Samson Ehe T, Sutama I Nyoman. Sexually transmitted infections among female sex workers in Kupang, Indonesia: searching for a screening algorithm to detect cervical gonococcal and chlamydial infections. Sex Transm Dis. 2003 Sep;30(9):671–679. [PubMed]
  • Geary Cynthia Waszak, Tchupo Jean-Paul, Johnson Laura, Cheta Claude, Nyama Tiburce. Respondent perspectives on self-report measures of condom use. AIDS Educ Prev. 2003 Dec;15(6):499–515. [PubMed]
  • Fishbein M, Pequegnat W. Evaluating AIDS prevention interventions using behavioral and biological outcome measures. Sex Transm Dis. 2000 Feb;27(2):101–110. [PubMed]
  • Gollub EL, French P, Latka M, Rogers C, Stein Z. Achieving safer sex with choice: studying a women's sexual risk reduction hierarchy in an STD clinic. J Womens Health Gend Based Med. 2001 Oct;10(8):771–783. [PubMed]
  • Kalichman SC, Williams E, Nachimson D. Brief behavioural skills building intervention for female controlled methods of STD-HIV prevention: outcomes of a randomized clinical field trial. Int J STD AIDS. 1999 Mar;10(3):174–181. [PubMed]
  • Artz L, Macaluso M, Brill I, Kelaghan J, Austin H, Fleenor M, Robey L, Hook EW., 3rd Effectiveness of an intervention promoting the female condom to patients at sexually transmitted disease clinics. Am J Public Health. 2000 Feb;90(2):237–244. [PMC free article] [PubMed]
  • Elwy A Rani, Hart Graham J, Hawkes Sarah, Petticrew Mark. Effectiveness of interventions to prevent sexually transmitted infections and human immunodeficiency virus in heterosexual men: a systematic review. Arch Intern Med. 2002 Sep 9;162(16):1818–1830. [PubMed]
  • Sánchez Jorge, Campos Pablo E, Courtois Barry, Gutierrez Lourdes, Carrillo Carlos, Alarcon Jorge, Gotuzzo Eduardo, Hughes Jim, Watts Douglas, Hillier Sharon L, et al. Prevention of sexually transmitted diseases (STDs) in female sex workers: prospective evaluation of condom promotion and strengthened STD services. Sex Transm Dis. 2003 Apr;30(4):273–279. [PubMed]
  • Hearst Norman, Chen Sanny. Condom promotion for AIDS prevention in the developing world: is it working? Stud Fam Plann. 2004 Mar;35(1):39–47. [PubMed]

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