Persistent high levels of sexually transmitted infection (STI) in Madagascar indicate current prevention strategies are inadequate. STI/HIV prevention based in social venues may play an important role in reaching individuals at risk of infection. We identified venues where people meet sexual partners and measured the need and potential for venue-based prevention.
Interviews were conducted in 7 Madagascar towns with 1) community informants to identify social venues, 2) individuals socializing at a sample of venues to assess sexual behavior among venue patrons, and 3) venue representatives to assess the potential for venue-based intervention.
Community informants identified numerous venues (range: 67-211 venues, depending on the town); streets, bars, and hotels were most commonly reported. Among 2982 individuals socializing at venues, 78% of men and 74% of women reported new sexual partnership or sex trade for money, goods, or services in the past 4 weeks and 19% of men and 18% of women reported symptoms suggestive of STI in the past 4 weeks. STI symptom levels were disproportionately high among respondents reporting either sex trade or new sexual partnership in the past 4 weeks. Twenty-eight percent of men and 41% of women reported condom use during the last sex act with a new partner. Although 24% to 45% of venues had hosted STI/HIV interventions, interventions were deemed possible at 73% to 90% venues according to 644 interviews with venue representatives.
Venue-based intervention is possible and would reach a spectrum of populations vulnerable to STI/HIV including sex workers, their clients, and other high-risk populations.
"Using a well-developed system for rapid community assessments, Weir and colleagues (2003) mapped the linkages among places where people meet new sex partners and places where people drink alcohol. Studies that have used Weir’s PLACE methodology show a consistent overlap among drinking behaviors and sexual risks in alcohol-serving venues (Figueroa et al. 2007; Khan et al. 2008). For example, in Zimbabwe, 47 percent of women ages 15–19 years surveyed at night clubs and other drinking places had two or more sex partners in a 1-year period compared with less than 5 percent of young women surveyed outside of drinking places (Singh et al. 2009). "
[Show abstract][Hide abstract] ABSTRACT: Alcohol use is associated with risks for sexually transmitted infections (STIs), including HIV/AIDS. People meet new sex partners at bars and other places where alcohol is served, and drinking venues facilitate STI transmission through sexual relationships within closely knit sexual networks. This paper reviews HIV prevention interventions conducted in bars, taverns, and informal drinking venues. Interventions designed to reduce HIV risk by altering the social interactions within drinking environments have demonstrated mixed results. Specifically, venue-based social influence models have reduced community-level risk in U.S. gay bars, but these effects have not generalized to gay bars elsewhere or to other populations. Few interventions have sought to alter the structural and physical environments of drinking places for HIV prevention. Uncontrolled program evaluations have reported promising approaches to bar-based structural interventions with gay men and female sex workers. Finally, a small number of studies have examined multilevel approaches that simultaneously intervene at both social and structural levels with encouraging results. Multilevel interventions that take environmental factors into account are needed to guide future HIV prevention efforts delivered within alcohol-serving establishments.
Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 03/2010; 33(3):184-94. · 0.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The control of curable STIs in countries with high disease burden has been hampered by the lack of accessible STI laboratory services. Rapid tests that are sensitive, specific and easy to use have the potential to increase the specificity of syndromic management of STIs in symptomatic patients and increase access to screening of asymptomatic infection to prevent the development of long-term complications and to interrupt the chain of transmission of STIs in the population. Although most rapid tests for chlamydia and gonorrhoea have sub-optimal sensitivity, and are neither simple nor affordable, some rapid syphilis tests have been shown to have acceptable performance. These can be deployed to increase access to screening in settings where testing is not previously possible or where laboratory services are inconsistent. With more political commitment and technological advances made possible by increased funding and public and private product development partnerships, there is much optimism in the near future for point of care tests for STIs that can improve patient management and disease control. The WHO estimates that more than 380 million new cases of sexually transmitted chlamydia, gonorrhea, syphilis and trichomoniasis occur worldwide every year . An equal or greater number of viral sexually transmitted infections (STIs) such as those caused by herpes simplex virus and human papilloma virus also occur every year but efforts to estimate the annual incidence of these infections on a global basis have been limited.
The Open Infectious Diseases Journal 01/2009; 3(1):156-163. DOI:10.2174/1874279300903020156
[Show abstract][Hide abstract] ABSTRACT: Incarcerated women report multiple vulnerabilities and, yet, are under-represented in research. This study used focus-group methodology to explore high-risk sexual behaviors, drug use, and victimization among female offenders in St. Louis. Inmates of the St. Louis Medium Security Institution (MSI) were invited to participate in one of five focus groups between May and September 2005 in preparation for an NIH/NINR HIV-prevention intervention study among female offenders in Drug Court. The focus group sample of 30 women was 70% African-American, with a mean age of 36 years. Results indicated that oral sex was the most common sex trade activity. Consistent with the literature, condom usage was described as irregular. In terms of drug use, participants reported that crack was most commonly used, with binges often lasting for several days. Regarding victimization, women frequently reported sexual abuse in childhood, and some described abusive relationships as adults. Participants also reported being beaten and raped by customers, which led to their concealing knives in purses and razors under the tongue. Consequently, perpetrated violence, including murder, was reported as protection against further violence. These findings confirm the vulnerability of this population of women who are at high risk for HIV. Effective HIV-prevention interventions are needed to assist these incarcerated women in making lifestyle changes during incarceration and sustaining them after release.
Journal of Urban Health 07/2009; 86(5):810-7. DOI:10.1007/s11524-009-9381-4 · 1.90 Impact Factor
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