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133rd Annual Meeting & Exposition
December 10-14, 2005
Donald Morisky, ScD1, Chi Chiao, MSc, MSPH2, Rhonda K. Rosenberg, PhD3, Nisha Farrell, BS4, and Robert Malow, PhD4. (1) Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, CHS 26-070, Los Angeles, CA 90095-1772, (2) Department of Community Health Sciences, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, (3) Research Assistant Professor, Stempel School of Public Health, Florida International University, AIDS Prevention Program, Biscayne Bay Campus, AC1 260, 3000 NE 151st Street, Miami, FL 33181, (4) Robert Stempel School of Public Health/ AIDS Prevention Program, Florida International University, 3000 N.E. 151 Street, ACI-260, North Miami, FL 33181, 305-761-7472, Farrelln@fiu.edu
Background: Second-hand effects of a sexual partner's substance use on protective sexual behavior are understudied. In the case of clients of female commercial sex workers (FCSWs), structural determinants come into play as establishments set the context for condom use. Our study of Filipino FCSWs reports on personal, situational, and environmental factors in the relationship between alcohol use, unprotected sex and sexually transmitted infection (STI).
Methods: Subjects (n=1,114) were FCSWs and recruited from entertainment-related establishments on 4 southern Philippine islands. Alcohol/substance use and condom use were self-reported with STIs determined by local Social Hygiene Clinics. Bivariate analyses with Chi-square tests for categorical variables and F tests for continuous variables examined multi-level risk factors in two situations: FCSW alcohol use prior to sexual transaction and customer intoxication. Multinomial logistic regression with robust estimates evaluated the predictive value of ecological models of alcohol use proximal to transaction.
Results: Customer intoxication was the dominant situational factor in the STI risk of FCSWs, and was independent of FCSW prior use. Sex with intoxicated customers increased the likelihood of drinking with customers, using illicit drugs, and the quantity of sexual activity. Ecological models were significant with type of workplace predicting FCSW alcohol use prior to transaction.
Conclusions: This comparison of multi-level determinants points to the pressing need to move beyond individual levels of change in HIV/AIDS prevention research. Our previous peer-based interventions, designed with participatory components involving FCSWs and establishment managers, have demonstrated that structural change is possible, even in commercial sex and bridge populations.
Learning Objectives: At the conclusion of this session, the participant will be able to
Keywords: HIV Risk Behavior, Sex Workers
Presenting author's disclosure statement:
I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.
The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA