20th International AIDS Conference - Melbourne, Australia


THAC0302 - Oral Abstract Session

Are combination prevention interventions effective? The impact of combination prevention on increasing condom use among female sex workers in Central America

Presented by Jorge Rivas (Guatemala).

J. Rivas1, S. Lungo2, S. Ruether3, K. Anfinson4, A. Cabrera2, R. Firestone5

1Panamerican Social Marketing Organization PASMO, Research, Guatemala, Guatemala, 2Panamerican Social Marketing Organization PASMO, Guatemala, Guatemala, 3Population Services International, Washington DC, United States, 4Population Services International, Guatemala, Guatemala, 5Population Services International, Research, Washington DC, United States

Background: A growing body of research has shown that no one single prevention strategy will be sufficient for controlling the HIV pandemic. Under the USAID Combination Prevention Program in Central America, PASMO and partners seek to reduce HIV risk behaviors among key populations at risk, including female sex workers (FSWs) by offering a package of services:
1) Behavioral interventions, including interpersonal communications, group interventions, mass media, and online outreach in addition to access to condoms and water-based lubricants;
2) Biomedical services such as HIV testing and counseling (HTC), screening and diagnosis for sexually transmitted infections; and,
3) Structural interventions, including referrals for family planning services, legal support for gender-based violence or human rights violations, and treatment for alcohol and drug abuse.
We conducted a mid-term evaluation to determine program effectiveness by looking for associations between exposure to different components of the intervention and HIV risk behaviors.
Methods: In 2012, PASMO conducted behavioral surveys in Guatemala, El Salvador, Nicaragua, Costa Rica, Panama and Belize with female sex workers. Time location sampling was used to recruit 3293 FSWs after listing all venues in identified hot zones where FSWs gather. We created statistically equivalent controls of exposed and non-exposed respondents using coarsened exact matching, matching on SES, age, length of time working as a FSW, and education. Average treatment effects for HIV testing and condom use outcomes were estimated by country with logistic regression.
Results: In El Salvador, the combination of IPC, biomedical and the structural components showed a positive impact on consistent condom use with regular partners (OR: 2.30, CI:1.12-4.73). In Panama and Costa Rica the combination of IPC and biomedical components was also found to be positively associated with condom use with regular partners. (OR:2.35, CI:1.09-5:08; OR:3.54, CI:2.00-6.29, respectively).
Conclusions: Findings suggest Combination Prevention strategies can contribute to condom use with regular partners among FSWs in Central America. Multiple interventions and services allow target groups to address deeper factors that influence their behaviors. Programs should continue offering combination prevention interventions and services to FSW.

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