Targeting condom distribution at high risk places increases condom utilization-evidence from an intervention study in Livingstone, Zambia

Ingvild Fossgard Sandøy, Cosmas Zyaambo, Charles Michelo, Knut Fylkesnes, Ingvild Fossgard Sandøy, Cosmas Zyaambo, Charles Michelo, Knut Fylkesnes

Abstract

Background: The PLACE-method presumes that targeting HIV preventive activities at high risk places is effective in settings with major epidemics. Livingstone, Zambia, has a major HIV epidemic despite many preventive efforts in the city. A baseline survey conducted in 2005 in places where people meet new sexual partners found high partner turnover and unprotected sex to be common among guests. In addition, there were major gaps in on-site condom availability. This study aimed to assess the impact of a condom distribution and peer education intervention targeting places where people meet new sexual partners on condom use and sexual risk taking among people socializing there.

Methods: The 2005 baseline survey assessed the presence of HIV preventive activities and sexual risk taking in places where people meet new sexual partners in Livingstone. One township was selected for a non-randomised intervention study on condom distribution and peer education in high risk venues in 2009. The presence of HIV preventive activities in the venues during the intervention was monitored by an external person. The intervention was evaluated after one year with a follow-up survey in the intervention township and a comparison township. In addition, qualitative interviews and focus group discussions were conducted.

Results: Young people between 17-32 years of age were recruited as peer educators, and 40% were females. Out of 72 persons trained before the intervention, 38 quit, and another 11 had to be recruited. The percentage of venues where condoms were reported to always be available at least doubled in both townships, but was significantly higher in the intervention vs. the control venues in both surveys (84% vs. 33% in the follow-up). There was a reduction in reported sexual risk taking among guests socializing in the venues in both areas, but reporting of recent condom use increased more among people interviewed in the intervention (57% to 84%) than in the control community (55% to 68%).

Conclusions: It is likely that the substantial increase in reported condom use in the intervention venues was partially due to the condom distribution and peer education intervention targeting these places. However, substantial changes were observed also in the comparison community over the five year period, and this indicates that major changes had occurred in overall risk taking among people socializing in venues where people meet new sexual partners in Livingstone.

Trial registration: ClinicalTrials.gov NCT01423357.

Figures

Figure 1
Figure 1
Proportion of respondents reporting having used a condom with the previous new partner.

References

    1. Grassly NC, Garnett GP, Schwartlander B, Gregson S, Anderson RM. The effectiveness of HIV prevention and the epidemiological context. Bull World Health Organ. 2001;79(12):1121–1132.
    1. Wilson D, Halperin DT. "Know your epidemic, know your response": a useful approach, if we get it right. Lancet. 2008;372(9637):423–426. doi: 10.1016/S0140-6736(08)60883-1.
    1. Weir SS, Morroni C, Coetzee N, Spencer J, Boerma JT. A pilot study of a rapid assessment method to identify places for AIDS prevention in Cape Town, South Africa. Sex Transm Infect. 2002;78(Suppl 1):i106–i113.
    1. Sandøy IF, Kvåle G, Michelo C, Fylkesnes K. Antenatal clinic-based HIV prevalence in Zambia: declining trends but sharp local contrasts in young women. Trop Med Int Health. 2006;11(6):917–928. doi: 10.1111/j.1365-3156.2006.01629.x.
    1. 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;355(9221):2101–2105. doi: 10.1016/S0140-6736(00)02376-X.
    1. Kerrigan D, Ellen JM, Moreno L, Rosario S, Katz J, Celentano DD, Sweat M. Environmental-structural factors significantly associated with consistent condom use among female sex workers in the Dominican Republic. AIDS. 2003;17(3):415–423. doi: 10.1097/00002030-200302140-00016.
    1. Yang C, Latkin C, Luan R, Nelson K. Condom use with female sex workers among male clients in Sichuan Province, China: the role of interpersonal and venue-level factors. J Urban Health. 2010;87(2):292–303. doi: 10.1007/s11524-009-9431-y.
    1. Ko NY, Lee HC, Hung CC, Chang JL, Lee NY, Chang CM, Lee MP, Chang HT, Ko WC. Effects of structural intervention on increasing condom availability and reducing risky sexual behaviours in gay bathhouse attendees. AIDS Care. 2009;21(12):1499–1507. doi: 10.1080/09540120902923022.
    1. Ibanez GE, Van Oss Marin B, Villarreal C, Gomez CA. Condom use at last sex among unmarried Latino men: an event level analysis. AIDS Behav. 2005;9(4):433–441. doi: 10.1007/s10461-005-9015-0.
    1. Sandøy IF, Siziya S, Fylkesnes K. Lost opportunities in HIV prevention: programmes miss places where exposures are highest. BMC Public Health. 2008;8:31. doi: 10.1186/1471-2458-8-31.
    1. Central Statistical Office [Zambia] Zambia 2010 Census of Population and Housing. Preliminary Population Figures. Lusaka: Central Statistical Office; 2011.
    1. Pope C, Ziebland S, Mays M. In: Qualitative research in health care. 3. Pope CM, editor. N: Blackwell Publishing; 2006. Analysing qualitative data.
    1. Weir SS, Tate JE, Zhusupov B, Boerma JT. Where the action is: monitoring local trends in sexual behaviour. Sex Transm Infect. 2004;80(2):63–68.
    1. Figueroa JP, Weir SS, Byfield L, Hall A, Cummings SM, Suchindran CM. The challenge of promoting safe sex at sites where persons meet new sex partners in Jamaica: results of the Kingston PLACE randomized controlled trial. Trop Med Int Health. 2010;15(8):945–954. doi: 10.1111/j.1365-3156.2010.02556.x.
    1. Gregson S, Adamson S, Papaya S, Mundondo J, Nyamukapa CA, Mason PR, Garnett GP, Chandiwana SK, Foster G, Anderson RM. Impact and process evaluation of integrated community and clinic-based HIV-1 control: a cluster-randomised trial in eastern Zimbabwe. PLoS Med. 2007;4(3):e102. doi: 10.1371/journal.pmed.0040102.
    1. Milburn K. A critical review of peer education with young people with special reference to sexual health. Health Educ Res. 1995;10(4):407–420. doi: 10.1093/her/10.4.407.
    1. Fritz K, McFarland W, Wyrod R, Chasakara C, Makumbe K, Chirowodza A, Mashoko C, Kellogg T, Woelk G. Evaluation of a Peer Network-Based Sexual Risk Reduction
    1. Kim CR, Free C. Recent evaluations of the peer-led approach in adolescent sexual health education: A systematic review. Perspect Sex Reprod Health. 2008;40(3):144–151. doi: 10.1363/4014408.
    1. Maticka-Tyndale E, Barnett JP. Peer-led interventions to reduce HIV risk of youth: a review. Eval Program Plann. 2010;33(2):98–112. doi: 10.1016/j.evalprogplan.2009.07.001.
    1. Makasa M, Fylkesnes K, Michelo C, Kayeyi N, Chirwa B, Sandøy IF. Declining Syphilis Trends in Concurrence With HIV Declines Among Pregnant Women in Zambia: Observations Over 14 Years of National Surveillance. Sexually Transmitted Diseases. 2011. (Publish Ahead of Print)
    1. Bello G, Simwaka B, Ndhlovu T, Salaniponi F, Hallett TB. Evidence for changes in behaviour leading to reductions in HIV prevalence in urban Malawi. Sex Transm Infect. 2011;87(4):296–300. doi: 10.1136/sti.2010.043786.
    1. Gregson S, Garnett GP, Nyamukapa CA, Hallett TB, Lewis JJC, Mason PR, Chandiwana SK, Anderson RM. HIV decline associated with behavior change in Eastern Zimbabwe. Science. 2006;311(5761):664–666. doi: 10.1126/science.1121054.
    1. Sandøy IF, Michelo C, Siziya S, Fylkesnes K. Associations between sexual behaviour change in young people and decline in HIV prevalence in Zambia. BMC Public Health. 2007;7:60. doi: 10.1186/1471-2458-7-60.
    1. Hallett TB, Aberle-Grasse J, Bello G, Boulos LM, Cayemittes MP, Cheluget B, Chipeta J, Dorrington R, Dube S, Ekra AK. et al.Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti. Sex Transm Infect. 2006;82(Suppl 1):i1–i8.

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