Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya

BackgroundSince 2000, peer-mediated interventions among female sex workers (FSW) in Mombasa Kenya have promoted behavioural change through improving knowledge, attitudes and awareness of HIV serostatus, and aimed to prevent HIV and other sexually transmitted infection (STI) by facilitating early STI treatment. Impact of these interventions was evaluated among those who attended peer education and at the FSW population level.MethodsA pre-intervention survey in 2000, recruited 503 FSW using snowball sampling. Thereafter, peer educators provided STI/HIV education, condoms, and facilitated HIV testing, treatment and care services. In 2005, data were collected using identical survey methods, allowing comparison with historical controls, and between FSW who had or had not received peer interventions.ResultsOver five years, sex work became predominately a full-time activity, with increased mean sexual partners (2.8 versus 4.9/week; P < 0.001). Consistent condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; P < 0.001) as well as the likelihood of refusing clients who were unwilling to use condoms (OR = 4.9, 95%CI = 3.7–6.6). In 2005, FSW who received peer interventions (28.7%, 145/506), had more consistent condom use with clients compared with unexposed FSW (86.2% versus 64.0%; AOR = 3.6, 95%CI = 2.1–6.1). These differences were larger among FSW with greater peer-intervention exposure. HIV prevalence was 25% (17/69) in FSW attending ≥ 4 peer-education sessions, compared with 34% (25/73) in those attending 1–3 sessions (P = 0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498) in 2005 (P = 0.36).ConclusionPeer-mediated interventions were associated with an increase in protected sex. Though peer-mediated interventions remain important, higher coverage is needed and more efficacious interventions to reduce overall vulnerability and risk.

[1]  M. Rekart,et al.  Sex-work harm reduction , 2005, The Lancet.

[2]  David Sanders,et al.  Implementation Research Is Needed to Achieve International Health Goals , 2006, PLoS medicine.

[3]  R. Kaul,et al.  Associations of Sexual Risk Taking Among Kenyan Female Sex Workers After Enrollment in an HIV-1 Prevention Trial , 2005, Journal of acquired immune deficiency syndromes.

[4]  G. Satten,et al.  Effect of interventions to control sexually transmitted disease on the incidence of HIV infection in female sex workers , 2001, AIDS.

[5]  T. Grey,et al.  Results of a randomised trial of male condom promotion among Madagascar sex workers , 2005, Sexually Transmitted Infections.

[6]  C. Beyrer,et al.  Decreasing incidence of HIV and sexually transmitted diseases in young Thai men: evidence for success of the HIV/AIDS control and prevention program , 1998, AIDS.

[7]  Raj Ram Gopal,et al.  Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial , 2003, The Lancet.

[8]  P. Layde,et al.  Utility of Behavioral Changes as Markers of Sexually Transmitted Disease Risk Reduction in Sexually Transmitted Disease/HIV Prevention Trials , 2002, Journal of acquired immune deficiency syndromes.

[9]  C.G.A. Mcgregor.  Progress on Global Access to HIV Antiretroviral Therapy , 2006 .

[10]  Alan E. Greenberg,et al.  Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, Côte d'Ivoire, 1991–1998 , 2002, AIDS.

[11]  J. Bryce,et al.  Evidence-based public health: moving beyond randomized trials. , 2004, American journal of public health.

[12]  S. Aral,et al.  Measuring outcomes of behavioural interventions for STD/HIV prevention , 1996, International journal of STD & AIDS.

[13]  R. Kaul,et al.  Reduced HIV risk-taking and low HIV incidence after enrollment and risk-reduction counseling in a sexually transmitted disease prevention trial in Nairobi, Kenya. , 2002, Journal of acquired immune deficiency syndromes.

[14]  T. Mastro.  Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, Côte d'Ivoire, 1991-1998, by Ghys et al. , 2003, AIDS.

[15]  M. Barrett,et al.  Determinants of inconsistent condom use with female sex workers among men attending the STD clinic in Singapore , 2004, Sexually Transmitted Infections.

[16]  G. Dallabetta,et al.  sti declines among sex workers and clients following outreach, one time presumptive treatment, and regular screening of sex workers in the Philippines , 2006, Sexually Transmitted Infections.

[17]  B. van Benthem,et al.  Factors associated with HIV-1 infection among sex workers of Addis Ababa, Ethiopia , 2001, AIDS.

[18]  A. V. Kirsanova,et al.  A randomized social network HIV prevention trial with young men who have sex with men in Russia and Bulgaria , 2005, AIDS.

[19]  M. Merson,et al.  Effectiveness of HIV prevention interventions in developing countries. , 2000, AIDS.

[20]  J. Saba,et al.  Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial , 1998, AIDS.

[21]  G. Dallabetta,et al.  Sexually Transmitted Infection Control with Sex Workers: Regular Screening and Presumptive Treatment Augment Efforts to Reduce Risk and Vulnerability , 2003, Reproductive health matters.

[22]  S. Moses,et al.  Focused peer-mediated educational programs among female sex workers to reduce sexually transmitted disease and human immunodeficiency virus transmission in Kenya and Zimbabwe. , 1996, The Journal of infectious diseases.

[23]  M. Hobbs,et al.  Prostate-Specific Antigen to Ascertain Reliability of Self-Reported Coital Exposure to Semen , 2006, Sexually transmitted diseases.

[24]  I. Coulibaly,et al.  HIV prevention among vulnerable populations: outreach in the developing world. , 1999, AIDS.

[25]  G. Dallabetta,et al.  Part time female sex workers in a suburban community in Kenya: a vulnerable hidden population , 2002, Sexually transmitted infections.

[26]  A. Outwater,et al.  Preventing HIV infection through peer education and condom promotion among truck drivers and their sexual partners in Tanzania, 1990-1993 , 2000, AIDS care.

[27]  S. Luchters,et al.  A prospective study assessing the effects of introducing the female condom in a sex worker population in Mombasa, Kenya , 2006, Sexually Transmitted Infections.

[28]  R. Anderson,et al.  Impact and Process Evaluation of Integrated Community and Clinic-Based HIV-1 Control: A Cluster-Randomised Trial in Eastern Zimbabwe , 2007, PLoS medicine.

[29]  M. Boily,et al.  The impact of HIV epidemic phases on the effectiveness of core group interventions: insights from mathematical models , 2002, Sexually transmitted infections.

[30]  Human Development Reports , 2000, A Concise Encyclopedia of the United Nations.

[31]  L. Marum,et al.  Evidence for population level declines in adult HIV prevalence in Kenya , 2006, Sexually Transmitted Infections.