RESUMO
BACKGROUND: Sexually transmitted infection (STI)/HIV prevention programs, which do not modify social structural contexts that contribute to risk of STI/HIV may fail to bring about improvements in health, particularly among groups who experience discrimination and exclusion from public life. We conducted a multilevel intervention with sex workers, including improved clinical care and community-mobilizing strategies to modify social structural factors that shape sexual behavior, to improve condom use and reduce incident STI. METHODS: We followed 420 sex workers participating in the Encontros intervention in Corumbá, Brazil, between 2003 and 2005. We estimated the effect of the intervention on incident chlamydia and gonorrhea infections and condom use using generalized estimating equations and inverse probability weighting by comparing those who actively engaged in the intervention activities (exposed) with those who were less engaged (unexposed). We also determined the association of participation on reported social cohesion and participation in networks. RESULTS: Exposed participants had significantly higher odds of reporting consistent condom use with regular clients (odds ratio [OR]: 1.9, 95% confidence interval:1.1-3.3) and nonsignificantly increased odds with both new clients (OR: 1.6, 0.9-2.8) and nonpaying partners (OR: 1.5, 0.9-1.5). The odds of an incident STI were nonsignificantly reduced for exposed participants compared with unexposed (OR: 0.46, 0.2-1.3). Participation was significantly associated with increased perceived cohesion and participation in networks. CONCLUSION: This prospective study provides evidence that multilevel interventions with mobilizing strategies to modify aspects of the social environment can improve condom use, reduce STIs, and increase social cohesion and participation in networks among sex workers.
Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Profissionais do Sexo , Infecções Sexualmente Transmissíveis/prevenção & controle , Meio Social , Adolescente , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sexo Seguro , Trabalho Sexual , Comportamento SexualRESUMO
Community mobilisation among sex workers is recognised as an important HIV/STI prevention strategy. However, factors such as poverty and stigma often negatively influence participation in activities that attempt to mobilise around a common identity of 'sex workers'. A qualitative study was conducted to explore the relationship between social identity and participation among 24 sex workers enrolled in an HIV/STI prevention intervention research project with a community mobilisation component. The relationship between social identity and participation was found to be a dynamic process in which participation in project clinic and community-based activities was motivated by three overlapping strategies: participation for psycho-social and health benefits; participation to improve individual status; and participation to change group status. Rather than mobilising around a 'sex worker identity', we conclude that projects with a community mobilisation approach may be more effective if they facilitate space for critical self-reflection and opportunities for collective action with an emphasis on acceptance and solidarity.