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Research
Results
Dissemination
PASMO Belize
2010
TRaC BELIZE (2010)
                  Tracking Results Continuously


      HIV/AIDS TRaC Study evaluating
      condom use among Female Sex
Workers (FSW) and Men who have sex
  with Men (MSM) in Belize City, Cayo,
Orange Walk, Corozal Town and Stann
                Creek (Second round)
STUDY OBJECTIVES

Monitoring:
Behavior of variables and indicators
through time.

Segmentation:
What     are    the     factors  and
characteristics that   can influence
healthy behaviors.

Evaluation:
Establish the effectiveness of         the
activities of the PASMO Programes.
PASMO’S IMPACT


                                                                *




                                                                      Exposed
                                                            exposed
                                                              Not
PASMO can determine if changes in indicators can be attributed to their program or
    if it is a general change. It can also be determined if it was due to mass media
                                             intervention messages or IPC programs
PASMO’S IMPACT


                         Mitigation effect




               Exposed
     exposed
       Not
Female Sex Workers (FSW)
Belize City
      Place:             Cayo
                         Orange Walk
                         Corozal Town
                         Stann Creek


FSW   Methodology:       2007: Multi stage clustered sample
                         2010: Census
      Sample:            2007= 85      2009=252


      Dates:             Feb 2007 – Aug 2010


      Characteristics:   Venue/fixed    2007= 53% 2009=88%
                         Ambulatory     2007= 37% 2009=12%
FSW that Used Condom in the last Sexual Encounter
                Total Cases used condom                   total cases    used condom
                                            2007 (%)                                    2009 (%)
                   2007         2007                         2009           2009
Belize District      50          50           100             99             55           55.6
Cayo               1             1            100             38             26           68.4
Orange Walk        25           25            100             54             39           72.2
Corozal Town       7             7            100             24             21           87.5
Stan Creek         2             2            100             37             27           73
TOTAL
                        85            85            100            252            168            66.7
2007 (N=82)        2009 (N=252)



                                                                    96.7%
            New client *
                                                            79.9%


                                                                  91.6%
   Occasional client (ns)
                                                               87.2%


                                                                87.7%
      Regular client (ns)                                      85.2%


                                                    62.7%
    Affective partner **
                                           36.7%


                                                   60.1%
Any client or partner***
                                           35.3%
2007 (N=82)         2009 (N=252)



                                                                            5.94
              New clients **
                                                            4.11



                                                                     5.18
      Occasional clients (ns)
                                                                   4.88



                                                  2.99
         Regular clients (ns)
                                                         3.52



                                           1.86
Affective partners (year) ***
                                                    3.31
2007 (N=82)         2009 (N=252)




                                                      44.3%
Lubricant use during last sex **
                                              27.6%




                                                              57.7%
  Lubricant use sometimes last
           month ***
                                              27.6%
2007 (N=82)          2009 (N=252)



                                                           92.9%
Important to get tested (ns)
                                                            95.2%



                                                   75.8%
        Tested last year (ns)
                                            68.5%



                                                            95.7%
       Received results (ns)
                                                             97.0%



                                                   75.6%
       Post counselling (ns)
                                           64.8%
2007 (N=82)       2009 (N=252)




                                                 77.5%
      Carried a condom ***
                                         46.9%




                                                         89.6%
Can find a condom within 10
        minutes (ns)
                                                    84.1%
.
Did not use a   Used a condom
  condom




                             Condom use
                            during last sex
-                                  +
                       Condom use probability

      * = p<.05
                           Condom use
     ** = p<.01
    *** = p<.001          during last sex
ns = non significant
WHICH FACTORS DETERMINE NOT USING
    A CONDOM USE IN FSW WITH ANY CLIENT?




-                                                             +
        Probability of NOT using a condom

               Did not use                       * = p<.05
                                                ** = p<.01
             Condom last sex                   *** = p<.001
                                            ns = not significant
•   Inconsistencies in program activities in 2010 may have affected the success
    in target populations’, knowledge and behavior.

•   Taking into account that FSW report an increase in the number of stable
    partners over the past 12 months program messages should focus on the
    importance of condom use with all partners at every sexual contact.

•   Given the positive segmentation result of FSW carrying a condom linked to
    the increased use of condoms programs should advocate carrying a
    condom and provide supporting materials (e.g. condom cases) to promote
    this behavior.
•   The fall in lubricant use provides an opportunity for addressing the
    component of water based lubricants use in programming. The information
    and materials distributed should underscore the increased risk of not only
    engaging in unprotected sex but that without lubricants. The exposure to
    materials from the IPC activities appears to be successful and should be
    continued.

•   There is a need for sustained activities among the FSW. Continued
    emphasis should be placed on using condoms with all partners and
    changing the perception of condoms making sex less pleasant. In this
    respect, the protective qualities of condoms should be highlighted to clients.
    More research is needed on the appearance, flavor and other consumer
    qualities of the favorite brands of condoms with results of this study serving
    as a basis for possible changes in procurement and distribution policies.
Men who have Sex with Men
         (MSM)
Belize City
      Place:             Cayo
                         Orange Walk
                         Corozal Town
                         Stann Creek


MSM   Methodology:       Respondent Driven Sampling
                         (RDS)
      Sample:            2007= 80   2009=227


      Dates:             Feb 2007 – Aug 2010


      Characteristics:   Gay            2007= 53.8%   2009=72.0%
                         Bisexual       2007= 38.8%   2009=21.5%
                         Heterosexual   2007= 3.8%    2009=4.0%
                         Trans          2007= 3.8%    2009= 2.5%
2007 (N=80)    2009 (N=227)



 Occasional (ns)
                                                      92.1%
                                                 82.3%


     Stable (ns)
                                          69.8%
                                              79.0%


Commercial (ns)
                                      60.7%
                                                      86.1%


       Female *
                                  50.4%
                                              74.3%


Any partner (ns)
                                                   85.4%
                                                79.6%
2007 (N=80)   2009 (N=227)



 Occasional (ns)                                  81.9%
                                                78.1%

     Stable (ns)                              74.7%
                                    56.7%

Commercial (ns)                                    84.8%
                                               74.9%

         Male *                               73.5%
                                    57.0%

    Female (ns)                       61.5%
                                      61.2%

         All (ns)                          72.0%
                                       63.6%
2007 (N=80)   2009 (N=227)




 Occasional (ns)
                                                       2.5
                                                     2.4


        Stable *
                            0.7
                                   1.4


Commercial (ns)
                                     1.6
                                      1.7


    Female (ns)
                                               2.2
                                         1.9
2007 (N=80)     2010 (N=227)

 Occasional                   2.7
    (ns)                      2.7

   Stable *                         3.7
                                          6.1
Commercial      0.1
   *                  0.9

  Female *                  2.0
                      1.0

    Male *                                  6.5
                                                        9.7

  Total (ns)                                      8.6
                                                              10.7
2007 (N=80)         2009 (N=227)




Lubricant use during last sex                  62.5%
            ***
                                                        90.1%



Lubricant use sometimes last                    65.7%
         month ***
                                                        87.9%



    Think that lub + condom                49.4%
        reduce risk (ns)                       58.8%
2007 (N=80)           2009 (N=227)




Knows where to get tested (ns)
                                                       93.2%
                                                    85.2%


          Tested last year (ns)
                                                72.7%
                                                  77.4%


          Received results (ns)
                                                          96.5%
                                                          96.0%


           Post counselling **
                                                71.4%
                                                        91.2%
2007 (N=80)       2009 (N=227)




                                         57.4%
      Carried a condom (ns)
                                          61.7%




                                           65.3%
Can find a condom within 10
        minutes (ns)
                                                 74.3%
.
2007 (N=80)         2009 (N=227)




                                            22.2%
VIVE is their favorite brand *
                                                    38.9%




                                                                    100.0%
    An HIV+ person can look
          healthy **
                                                            87.0%
-                            +
                           Condom use probability

      * = p<.05
                               Condom use
     ** = p<.01
    *** = p<.001              during last sex
ns = non significant
-                                                         +
    Probability of NOT using a condom

           Did not use                       * = p<.05
                                            ** = p<.01
         Condom last sex                   *** = p<.001
                                        ns = not significant
•   Taking into account that MSM report an increase in the number of
    occasional partners over the past 12 months, program messages should
    focus on the importance of condom use with all partners at every sexual
    contact. Program messages should target issues arising out of concurrent
    and multi partnering relationships.

•   Vive Lubricants have not been in the market during the program years.
    Despite this product absence, the use of lubricants both at last sex and
    consistent use significantly increased. This suggests that there is a demand
    for the product and should therefore be considered for reintroduction.
•   Positive health seeking behaviors that include getting tested for HIV with
    post-counseling and seeking treatment for STIs significantly increase.
    Programs should maintain activities that promote these positive goal-
    healthier behaviors.

•   Continued emphasis should be placed on changing the perception of
    condoms making sex less pleasant. In this respect, the protective qualities
    of condoms should be highlighted. More research is needed on the
    appearance, flavor and other consumer qualities of the favorite and other
    brands of condoms with results of this study serving as a basis for possible
    changes in procurement and distribution policies.
Pasmo research

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Pasmo research

  • 2.
  • 3. TRaC BELIZE (2010) Tracking Results Continuously HIV/AIDS TRaC Study evaluating condom use among Female Sex Workers (FSW) and Men who have sex with Men (MSM) in Belize City, Cayo, Orange Walk, Corozal Town and Stann Creek (Second round)
  • 4. STUDY OBJECTIVES Monitoring: Behavior of variables and indicators through time. Segmentation: What are the factors and characteristics that can influence healthy behaviors. Evaluation: Establish the effectiveness of the activities of the PASMO Programes.
  • 5. PASMO’S IMPACT * Exposed exposed Not PASMO can determine if changes in indicators can be attributed to their program or if it is a general change. It can also be determined if it was due to mass media intervention messages or IPC programs
  • 6. PASMO’S IMPACT Mitigation effect Exposed exposed Not
  • 8. Belize City Place: Cayo Orange Walk Corozal Town Stann Creek FSW Methodology: 2007: Multi stage clustered sample 2010: Census Sample: 2007= 85 2009=252 Dates: Feb 2007 – Aug 2010 Characteristics: Venue/fixed 2007= 53% 2009=88% Ambulatory 2007= 37% 2009=12%
  • 9.
  • 10. FSW that Used Condom in the last Sexual Encounter Total Cases used condom total cases used condom 2007 (%) 2009 (%) 2007 2007 2009 2009 Belize District 50 50 100 99 55 55.6 Cayo 1 1 100 38 26 68.4 Orange Walk 25 25 100 54 39 72.2 Corozal Town 7 7 100 24 21 87.5 Stan Creek 2 2 100 37 27 73 TOTAL 85 85 100 252 168 66.7
  • 11. 2007 (N=82) 2009 (N=252) 96.7% New client * 79.9% 91.6% Occasional client (ns) 87.2% 87.7% Regular client (ns) 85.2% 62.7% Affective partner ** 36.7% 60.1% Any client or partner*** 35.3%
  • 12. 2007 (N=82) 2009 (N=252) 5.94 New clients ** 4.11 5.18 Occasional clients (ns) 4.88 2.99 Regular clients (ns) 3.52 1.86 Affective partners (year) *** 3.31
  • 13. 2007 (N=82) 2009 (N=252) 44.3% Lubricant use during last sex ** 27.6% 57.7% Lubricant use sometimes last month *** 27.6%
  • 14.
  • 15. 2007 (N=82) 2009 (N=252) 92.9% Important to get tested (ns) 95.2% 75.8% Tested last year (ns) 68.5% 95.7% Received results (ns) 97.0% 75.6% Post counselling (ns) 64.8%
  • 16. 2007 (N=82) 2009 (N=252) 77.5% Carried a condom *** 46.9% 89.6% Can find a condom within 10 minutes (ns) 84.1%
  • 17. .
  • 18.
  • 19.
  • 20.
  • 21.
  • 22. Did not use a Used a condom condom Condom use during last sex
  • 23. - + Condom use probability * = p<.05 Condom use ** = p<.01 *** = p<.001 during last sex ns = non significant
  • 24.
  • 25. WHICH FACTORS DETERMINE NOT USING A CONDOM USE IN FSW WITH ANY CLIENT? - + Probability of NOT using a condom Did not use * = p<.05 ** = p<.01 Condom last sex *** = p<.001 ns = not significant
  • 26.
  • 27. Inconsistencies in program activities in 2010 may have affected the success in target populations’, knowledge and behavior. • Taking into account that FSW report an increase in the number of stable partners over the past 12 months program messages should focus on the importance of condom use with all partners at every sexual contact. • Given the positive segmentation result of FSW carrying a condom linked to the increased use of condoms programs should advocate carrying a condom and provide supporting materials (e.g. condom cases) to promote this behavior.
  • 28. The fall in lubricant use provides an opportunity for addressing the component of water based lubricants use in programming. The information and materials distributed should underscore the increased risk of not only engaging in unprotected sex but that without lubricants. The exposure to materials from the IPC activities appears to be successful and should be continued. • There is a need for sustained activities among the FSW. Continued emphasis should be placed on using condoms with all partners and changing the perception of condoms making sex less pleasant. In this respect, the protective qualities of condoms should be highlighted to clients. More research is needed on the appearance, flavor and other consumer qualities of the favorite brands of condoms with results of this study serving as a basis for possible changes in procurement and distribution policies.
  • 29. Men who have Sex with Men (MSM)
  • 30. Belize City Place: Cayo Orange Walk Corozal Town Stann Creek MSM Methodology: Respondent Driven Sampling (RDS) Sample: 2007= 80 2009=227 Dates: Feb 2007 – Aug 2010 Characteristics: Gay 2007= 53.8% 2009=72.0% Bisexual 2007= 38.8% 2009=21.5% Heterosexual 2007= 3.8% 2009=4.0% Trans 2007= 3.8% 2009= 2.5%
  • 31. 2007 (N=80) 2009 (N=227) Occasional (ns) 92.1% 82.3% Stable (ns) 69.8% 79.0% Commercial (ns) 60.7% 86.1% Female * 50.4% 74.3% Any partner (ns) 85.4% 79.6%
  • 32. 2007 (N=80) 2009 (N=227) Occasional (ns) 81.9% 78.1% Stable (ns) 74.7% 56.7% Commercial (ns) 84.8% 74.9% Male * 73.5% 57.0% Female (ns) 61.5% 61.2% All (ns) 72.0% 63.6%
  • 33. 2007 (N=80) 2009 (N=227) Occasional (ns) 2.5 2.4 Stable * 0.7 1.4 Commercial (ns) 1.6 1.7 Female (ns) 2.2 1.9
  • 34. 2007 (N=80) 2010 (N=227) Occasional 2.7 (ns) 2.7 Stable * 3.7 6.1 Commercial 0.1 * 0.9 Female * 2.0 1.0 Male * 6.5 9.7 Total (ns) 8.6 10.7
  • 35. 2007 (N=80) 2009 (N=227) Lubricant use during last sex 62.5% *** 90.1% Lubricant use sometimes last 65.7% month *** 87.9% Think that lub + condom 49.4% reduce risk (ns) 58.8%
  • 36. 2007 (N=80) 2009 (N=227) Knows where to get tested (ns) 93.2% 85.2% Tested last year (ns) 72.7% 77.4% Received results (ns) 96.5% 96.0% Post counselling ** 71.4% 91.2%
  • 37. 2007 (N=80) 2009 (N=227) 57.4% Carried a condom (ns) 61.7% 65.3% Can find a condom within 10 minutes (ns) 74.3%
  • 38. .
  • 39. 2007 (N=80) 2009 (N=227) 22.2% VIVE is their favorite brand * 38.9% 100.0% An HIV+ person can look healthy ** 87.0%
  • 40.
  • 41. - + Condom use probability * = p<.05 Condom use ** = p<.01 *** = p<.001 during last sex ns = non significant
  • 42.
  • 43. - + Probability of NOT using a condom Did not use * = p<.05 ** = p<.01 Condom last sex *** = p<.001 ns = not significant
  • 44.
  • 45. Taking into account that MSM report an increase in the number of occasional partners over the past 12 months, program messages should focus on the importance of condom use with all partners at every sexual contact. Program messages should target issues arising out of concurrent and multi partnering relationships. • Vive Lubricants have not been in the market during the program years. Despite this product absence, the use of lubricants both at last sex and consistent use significantly increased. This suggests that there is a demand for the product and should therefore be considered for reintroduction.
  • 46. Positive health seeking behaviors that include getting tested for HIV with post-counseling and seeking treatment for STIs significantly increase. Programs should maintain activities that promote these positive goal- healthier behaviors. • Continued emphasis should be placed on changing the perception of condoms making sex less pleasant. In this respect, the protective qualities of condoms should be highlighted. More research is needed on the appearance, flavor and other consumer qualities of the favorite and other brands of condoms with results of this study serving as a basis for possible changes in procurement and distribution policies.