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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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Hypothesis and Tentative Explanations
Work environment ---> condom use & HIV testing
DVIV
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Hypothesis and Tentative Explanations
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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More Descriptive Statistics
Analysis:There was an INCREASE in EVERYTHING except
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More Descriptive Statistics
Analysis:There was an INCREASE in EVERYTHING except
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More Descriptive Statistics
Analysis:There was an INCREASE in EVERYTHING except
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More Descriptive Statistics
Analysis:There was an INCREASE in EVERYTHING except
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More Descriptive Statistics
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
- employerssupportive attitude
- 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
- employerssupportive attitude
- 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.