promoting hiv testing and condom use among filipina

8/3/2019 Promoting HIV Testing and Condom Use Among Filipina

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A report by Raphael Abacan and Aimee Capinpuyan

Promoting HIV Testing and Condom Use Among Filipina

Commercial Sex Workers: Findings from a Quasi-Experimental

Intervention Study


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Introductiony Establishment-based female sex workers have increasingly

contributed to the spread of HIV in Southeast Asia.

y As a result, sexual risk reduction (consistent condom use)and HIV testing have been targeted towards this population.

y Studies on promoting HIV testing and consistent condom usein the commercial sex context have mostly focused on therelationships between psychosocial determinant variables andsexual health related behaviors.

y This gave limited success but scholars have increasinglyturned to the contextual approach in an effort to get betterresults


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Introduction

y Previous research rarely took into consideration the

importance of multi-level contextual factors incorporated

into intervention program designs affect the protective health

practices of FCSWs.

y Social action-based theory (SABT) offers a solution to this.


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Social Action Theory

y Founded by Max Weber

y People vary their actions according to social

contexts and how it will affect other people; when a potential

is not desirable, the action is modified accordinglyy Creating an environment that will promote a desired

resultant action

y SABT predicts health protection behavior is an interaction

among three major domains: (1) the self-regulationcapabilities of the individual; (2) the larger environmental

context; and (3) responses to internal affective states.


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Research Problematique

y Is Social Action a good basis for interventions that aim to

increase HIV testing and condom usage among FCSWs?

y Which type of intervention is the most effective?

y Peer counseling?

y Manager training?

y Both???


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Hypothesis and Tentative Explanations

y The self-regulatory process and contextual factors will be

positively associated with two health behavioral change

outcomes, HIV testing and consistent condom use in FCSWs.

y

Peer couns

eling and educationy Manager Training

y In essence it is all about forming an environment that

positively reinforces them into using condoms and getting

tested for HIV.


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Work environment ---> condom use & HIV testing

DVIV


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1.) Changes in work environment Peer counseling

Manager training

2.)condom use & HIV testing test scores

interviews

clinic samples

CONCEPTS: INDICATORS:


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Measurable Indicators

I. HIV testing

Information was collected by self-report from FCSWs

whether they had been tested for HIV for the past 6 months(yes/no).


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Measurable IndicatorsII. Consistent Condom use

ON A 6-ITEM SCALE, RESPONDENTS WEREASKED, HOW OFTEN DO YOU

1 Never 5 - Always

1. use a condom when engaging in vaginal sex?

2. suggest using a condom to their partner?

3. carry a condom on your person?

4. do not u

se a condom for making more money

?

5. do not use a condom because one is not available?

6. ask a customer to bring a condom when engaging in sex?


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Measurable Indicators

The average score was computed by a summated score

divided by six after a reversed-coded adjustment for two

s

cale items

.

The higher the score was, the more consistently

FCSWs used condoms.


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Methodology

y Randomized quasi-experimental approach

y 4 test sites were randomly chosen from a box (Legaspi, Cebu,

Cagayan de Oro and Ilo-Ilo)

y First site selected was the peer site, the second the manager

training site, the third was the combination site and the fourth

served as the control site which used the usual care system.

y Numbers were drawn with replacement, providing equal

probability for all selected sites


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Methodology

y Staff from the University of the Philippines and UCLA

carried out the interventions

y

Data was

collected by trained interviewers

with languagecompetencies ( also, had to attend a 1-week intensive training

program)

y Face-to-face interviews, via baseline and posttest surveys

were conductedy The participation rates at baseline and posttest assessments

were over 95%, reducing the likelihood for biased participant

pool.


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Methodology

y Quality assurance and quality control

y Monthly meetings of coordinators with FCSW peer

educators re:y delivery of STI prevention messages to other workers in the

establishments

y problems encountered

y Suggestions for alternative interpersonal approach

y 10% random samples of all clinic visits and outcomes during

the previous month by research manager


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Methodology

ResearchManager

Legaspi Site

Coordinator

PeerCounselors

CDO Site

Coordinator

EstablishmentManagers

Cebu Site

Coordinator

PeerCounselors

EstablishmentManagers

Iloilo Site

Coordinators

FCSWs


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Methodology

y Results indicated less than a 3% discrepancy between

findings ofsite coordinator and research manager

y The 5-day intervention training program was followed up

with monthly reinforcement sessions bet. peer educators and

managers.


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Flowchart~


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Descriptive Statistics


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More Descriptive Statistics

Analysis:There was an INCREASE in EVERYTHING except


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Analysis:There was an INCREASE in HIV-related knowledge and AIDS perceived control,

except in


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EvenMore Descriptive Statistics


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PEER EDUCATION

+ HIV testing

- employerssupportive attitude

- willingness to talk to employer re: condom -use

- condom availability in the workplace

- condom use


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MANAGE

R TRAINING

+ HIV testing (BIGGEST INCREASE)

+ condom availability in the workplace+ condom use


- willingness to talk to employer re: condom -use


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PEER EDUCATION +

MANAGER TRAINING

+ condom availability in the workplace

+ condom use

+ employerssupportive attitude+ willingness to talk to employer re: condom -use

- HIV testing


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CONTROL

- HIV testing

- condom availability in the workplace

- condom use


- willingness

to talk to employer re:

condom -use


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Conclusiony Results of the present study provide empirical data that

support SABT, emphasizing and demonstrating theimportance of workplace context on behavior change.

y The manager group had the most significant increase in HIV

testing and condom usagey The attitudes, beliefs and relative status of the establishment

managers, with the development of an infrastructure relatedto promoting healthy practices (such as the loan plan to

FCSWs

for STI medications

previous

ly des

cribed), ledFCSWs to the desirable, protective behavioral actions ofcondom use and HIV testing.


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Conclusion

y The managers attitudes and their emphasis on health proved

to be the most important factor in increasing the positive

responses of the FCSWs

y This result argues persuasively for the importance of

developing management organizations and/or associations

that address and reinforce protective practices in the

workplace.

promoting hiv testing and condom use among filipina

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