Berthé Abdramane, Huygens Pierre
Centre Muraz Unité Sciences de l'homme pour l'aide à la décision, à l'action et à l'évaluation des interventions, 01 BP 390, Bobo Dioulasso 01 Burkina Faso.
Sante. 2007 Apr-Jun;17(2):103-9.
Since 1998, researchers in Burkina Faso have enrolled about 760 vulnerable women (sex workers, bar waitresses, pedlars, students, etc.) in an open cohort (the Yerelon cohort) to determine whether adequate management of sexually transmissible infection and exposure to well-designed, well-delivered, and plentiful communication for behaviour change (CBC) can reduce their vulnerability to HIV. This qualitative social anthropology study was conducted to: i) analyse the messages assimilated by the women who follow CBC sessions; ii) determine the impact of these messages on the women's behaviour.
The researchers observed CBC sessions in the clinic, in women's homes and at their places of work for 45 days. They also conducted 37 individual in-depth interviews, 8 group interviews and a focus group, selecting a "reasoned" sample of 80 women from the cohort. The data were entered with Word software and analyzed with the 'Atlas TI' qualitative data analysis software.
This study shows that: i) these vulnerable women have good knowledge of the themes raised during CBC sessions with the Yerelon peer-leaders and are quite able to reproduce the messages. Most can repeat and explain them; ii) the women find the messages presented during CBC, by peers who live similar lives and speak their "language", to be understandable and applicable to them; iii) they learned much about condom use and negotiation, HIV/AIDS, genital herpes, and other STIs. They know for example that condoms have two sides, one lubricated and the other not, and that condoms effectively protect against pregnancy and some STIs; iv) they negotiate condom use better with all types of sexual partners, thus improving their relation to it; v) a large majority report new positive behaviour, selecting clients and partners, and using condoms routinely, taking it off after intercourse themselves. They also now routinely use modern medical care for any STIs; vi) Of 524 women seronegative at inclusion in 2003, only 0.8% became infected in the first three months of the study, and no others in the year that followed.
In Bobo-Dioulasso, Burkina Faso, the communication offered in the CBC programme to vulnerable women by peer-advisers trained by a multidisciplinary team, improved to varying degrees the women's knowledge of the various topics covered. This improvement changed their behaviour positively, leading to routine condom use, especially with occasional partners. This has resulted in low HIV incidence. This model can and must be spread to other vulnerable populations. Admittedly, the free services and products provided in the programme make it harder to perpetuate and disseminate. The promotion of health mutuals is one method to provide funding.
自1998年以来，布基纳法索的研究人员已将约760名易感染艾滋病的女性（性工作者、酒吧女招待、小贩、学生等）纳入一个开放队列（耶雷隆队列），以确定对性传播感染的充分管理以及接触精心设计、有效传递且丰富的行为改变沟通内容（CBC）是否能够降低她们感染艾滋病毒的易感性。开展这项定性社会人类学研究的目的是：i）分析参加CBC课程的女性所吸收的信息；ii）确定这些信息对女性行为的影响。
研究人员在诊所、女性家中及工作场所对CBC课程进行了45天的观察。他们还进行了37次个人深度访谈、8次小组访谈和1次焦点小组访谈，从队列中选取了80名女性的“合理”样本。数据用Word软件录入，并使用“Atlas TI”定性数据分析软件进行分析。
本研究表明：i）这些易感染艾滋病女性对与耶雷隆同伴教育者在CBC课程中提出的主题有充分了解，并且相当能够复述这些信息。大多数人能够重复并解释这些信息；ii）女性认为由生活经历相似且讲她们“语言”的同伴在CBC课程中传达的信息易于理解且适用于她们；iii）她们学到了很多关于避孕套使用与协商、艾滋病毒/艾滋病、生殖器疱疹及其他性传播感染的知识。例如，她们知道避孕套有两面——一面润滑，一面不润滑，并且避孕套能有效预防怀孕和某些性传播感染；iv）她们与各类性伴侣协商使用避孕套的情况更好，从而改善了她们与避孕套使用之间的关系；v）绝大多数女性报告有新出现的积极行为，即挑选客户和伴侣，并常规使用避孕套，性交后自己取下避孕套。她们现在也常规地就任何性传播感染寻求现代医疗护理；vi）在2003年纳入研究时血清学阴性的524名女性中，在研究的前三个月仅有0.8%感染，在随后的一年中无其他人感染。
在布基纳法索的博博迪乌拉索，由多学科团队培训的同伴顾问在CBC项目中向易感染艾滋病女性提供的沟通，在不同程度上提高了女性对所涵盖的各类主题的认识。这种提高对她们的行为产生了积极改变，导致常规使用避孕套，尤其是与临时性伴侣在一起时使用。这使得艾滋病毒感染率较低。这种模式能够且必须推广到其他易感染人群。诚然，该项目中提供的免费服务和产品使得项目的延续和推广更加困难。推广健康互助组织是提供资金的一种方式。
