Asamoah-Adu A, Weir S, Pappoe M, Kanlisi N, Neequaye A, Lamptey P
Ministry of Health, Accra, Ghana.
AIDS. 1994 Feb;8(2):239-46. doi: 10.1097/00002030-199402000-00012.
To assess the short- and long-term impact of a 6-month pilot intervention program on condom use among prostitutes in Accra, Ghana.
The 4-year prospective study follows-up cohorts enrolled in the intervention in 1987 and 1988, comparing condom use in 1991 with that among a comparison group not enrolled in the intervention.
The community-based intervention was initiated in Accra, Ghana in 1987.
Self-identified female prostitutes who volunteered participation.
The educational intervention used local health workers to train and support selected prostitutes to be health educators and condom distributors to their peers.
Self-reported condom use with clients.
Reported condom use increased dramatically between 1987 and 1988 during the first 6 months of the intervention. In 1991, after 3 years of program relapse, 107 (43%) of the 248 women who had enrolled in 1987 or 1988 were still in prostitution and located for interview. Their level of condom use in 1991 was higher than pre-enrollment but similar to use among prostitutes never enrolled. Sixty-four per cent of those followed-up reported always using condoms with clients in 1991. These 'always users' were more likely to have maintained informal contact with project staff, know that HIV can be transmitted by healthy clients, and report that clients frequently initiate condom use.
Findings support the development of long-range educational strategies that recognize the career longevity of prostitutes, available channels for informal program diffusion, individual changes in condom use over time, and the role of clients in condom negotiation.
评估一项为期6个月的试点干预项目对加纳阿克拉妓女使用避孕套的短期和长期影响。
这项为期4年的前瞻性研究对1987年和1988年参与干预的队列进行随访，将1991年的避孕套使用情况与未参与干预的对照组进行比较。
1987年在加纳阿克拉启动了基于社区的干预措施。
自愿参与的自我认定的女性妓女。
教育干预利用当地卫生工作者培训并支持选定的妓女成为健康教育者和向同行分发避孕套的分发者。
与客户使用避孕套的自我报告情况。
在干预的前6个月，1987年至1988年期间报告的避孕套使用情况显著增加。1991年，在项目复发3年后，1987年或1988年登记的248名女性中有107名（43%）仍在从事卖淫活动并被找到接受访谈。她们1991年的避孕套使用水平高于登记前，但与从未登记的妓女的使用情况相似。64%的随访对象报告在1991年总是与客户使用避孕套。这些“总是使用者”更有可能与项目工作人员保持非正式联系，知道艾滋病毒可由健康客户传播，并报告客户经常主动提出使用避孕套。
研究结果支持制定长期教育策略，该策略应认识到妓女的职业寿命、项目非正式传播的可用渠道、随着时间推移个人在避孕套使用方面的变化以及客户在避孕套谈判中的作用。
