Population Council, New Delhi, Delhi, India.
Catalyst Management Services, Bengaluru, Karnataka, India.
PLoS One. 2020 Jul 1;15(7):e0235094. doi: 10.1371/journal.pone.0235094. eCollection 2020.
Between 2014 and 2017, a program aimed at reducing HIV risk and promoting safe sex through consistent use of condoms sought to work through addressing social and economic vulnerabilities and strengthening community-led organizations (COs) of female sex workers (FSWs). This study examines if the program was effective by studying relationship between strengthening of COs, vulnerability reduction, and sustaining of consistent condom use behavior among FSWs.
We used a longitudinal study design to assess the change in outcomes. A three-stage sampling design was used to select FSWs for the study. Panel data of 2085 FSWs selected from 38 COs across five states of India was used to examine the change in various outcomes from 2015 (Survey Round 1) to 2017 (Survey Round 2). The CO level program pillar measuring institutional development assessed performance of COs in six domains critical for any organization's functionality and sustainability: governance, project management, financial management, program monitoring, advocacy and networking, and resource mobilization. Overall, 32 indicators from all these domains were used to compute the CO strength score. A score was computed by taking mean of average dimension scores. The overall score was divided into two groups based on the median cutoff; COs which scored below the median were considered to have low CO strength, while COs which scored above or equal to median were considered to have high CO strength. Multivariable regression modeling techniques were used to examine the effect of program pillars on outcome measures.
Analyses showed a significant improvement in the strength of the COs over time; percentage of COs having high strength improved from 50% in 2015 to 87% in Round 2. The improvement in CO's strength increased financial security (Adjusted Odds Ratio [AOR]: 2.18, p<0.01), social welfare security (AOR: 1.71, p<0.01), and socio-legal security (AOR: 2.20, p<0.01) among FSWs. Further, improvement in financial security led to significant increase in consistent condom use with client among FSWs (AOR: 1.69, p<0.01) who were members of COs having high strength. Sustained consistent condom use was positively associated with young age (<30 years), ability to negotiate with clients for condom use, membership in self-help groups, high self-efficacy, self-confidence, and client solicitation in streets and brothels.
Improving financial security and strengthening FSW led CO can improve sustained and consistent condom use. In addition, the program should focus on enhancing ability of FSWs to negotiate with clients for condom use, promote membership in self-help groups and target FSWs who are 30 years or older, and soliciting from homes to sustain consistent condom use across all FSWs.
2014 年至 2017 年期间，一项旨在通过坚持使用安全套来降低 HIV 风险和促进安全性行为的项目，旨在通过解决社会和经济脆弱性问题并加强女性性工作者（FSW）的社区领导组织（COs）来实现这一目标。本研究通过研究 COs 的强化、脆弱性降低以及 FSW 持续使用安全套行为之间的关系，来检验该项目的有效性。
我们使用纵向研究设计来评估结果的变化。采用三阶段抽样设计选择 FSW 进行研究。使用来自印度五个邦的 38 个 CO 的 2085 名 FSW 的面板数据，从 2015 年（调查第一轮）到 2017 年（调查第二轮），检查各项结果的变化。衡量 CO 机构发展的项目支柱，评估 CO 在六个对任何组织的功能和可持续性都至关重要的领域的表现：治理、项目管理、财务管理、项目监测、宣传和网络以及资源动员。总的来说，从所有这些领域中使用了 32 个指标来计算 CO 实力得分。通过取平均维度得分的平均值来计算得分。根据中位数的截断值将总分分为两组；得分低于中位数的 CO 被认为 CO 实力较弱，而得分高于或等于中位数的 CO 被认为 CO 实力较强。使用多变量回归模型技术来检验项目支柱对结果衡量标准的影响。
分析表明，CO 的实力随着时间的推移有了显著提高；具有高 CO 实力的 CO 的比例从 2015 年的 50%提高到第二轮的 87%。CO 实力的提高增加了 FSW 的财务安全性（调整后的优势比 [AOR]：2.18，p<0.01）、社会福利安全（AOR：1.71，p<0.01）和社会法律安全（AOR：2.20，p<0.01）。此外，FSW 所在 CO 的财务安全性的提高与客户持续使用安全套的情况呈正相关（AOR：1.69，p<0.01），这些 CO 是 CO 成员。持续使用安全套与年轻（<30 岁）、与客户协商使用安全套的能力、加入自助团体、高自我效能感、自信以及在街头和妓院招揽客户等因素呈正相关。
提高财务安全性和加强 FSW 领导的 CO 可以提高持续和一致的 condom 使用。此外，该项目应侧重于提高 FSW 与客户协商使用 condom 的能力，促进自助团体的参与，并针对 30 岁或以上的 FSW，从家庭中招募人员，以维持所有 FSW 持续使用 condom。
