Exploring Factors Associated with Sexual Behavior Change among Filipina Commercial Sex Workers: Findings from A Quasi-Experimental Intervention Study

BACKGROUND: Unprotected commercial intercourse is a primary vector in the escalating Southeast Asian HIV epidemic. This has led to an increased interest in promoting safer sex among sexual workers. This study examines the effects of a multilevel Social-Action Based Theory (SABT) intervention to enhance consistent condom use among Filipina commercial sex workers (FCSWs).

METHOD: Four sociodemographically similar Philippine cities were randomly assigned to have FCSWs within each city receive either an SABT intervention based on: 1) peer influence only; 2) FCSW's managers influence only; 3) combined peer/manager influence; or 4) a no intervention (control condition). The outcome variable, consistent condom use, was assessed by a validated six-item scale (Cronbach alpha = .78-.82). Regression analyses were conducted, which used the pooled baseline (N=866) and follow-up (N=808) samples, and which controlled for the clustering of multiple FCSWs at the same workplaces.

RESULTS: Only the combined peer/manager intervention condition produced significantly increased consistent condom users (p<0.05), after adjusting for socio-demographic, cognitive and other variables related to HIV prevention. Mediational analyses showed that the significant intervention effects for increasing consistent condom use were attributable to personal increased perceived HIV risks and emotional and instrumental support from workplaces. Increased consistent condom use was also positively associated with HIV testing (p<0.01).

DISCUSSION: These findings suggest that a successful sexual risk reduction intervention among FCSWs or similar disadvantaged populations must go beyond individual-based intervention strategies, and include others in the at-risk individual's social network.