Objectives: To assess whether individual clinic-based counseling as a supplement to peer education for male and female condom promotion leads to greater use of protection and lower STI prevalence among sex workers in Madagascar already exposed to intensive male condom promotion.
Methods: In two public dispensaries in Madagascar, a total of 901 sex workers were randomly allocated between two alternative male and female condom promotion interventions: peer education only, or peer education supplemented with individual clinic-based counseling. Participants were followed for 12 months. Every two months they made clinic visits, where they were interviewed on condom use. Peer educators counseled all participants on condom use as they accompanied their assigned participants to study visits. Participants assigned to receive the supplemental intervention were counseled by a trained clinician following study interviews. Participants were tested and treated for chlamydia, gonorrhea and trichomoniasis every 6 months. We used logistic regression to assess whether the more intensive intervention was associated with reduced STI prevalence. Use of protection with clients and non-paying partners was assessed by study arm, site, and visit.
Results: There was no statistically significant association between study arm and aggregated STI prevalence. No substantial differences in levels of reported protection were noted between study groups.
Conclusions: This study found little evidence gained from more thorough clinical counseling on male and female condom use. These findings suggest that less clinically intensive interventions like peer education could be suitable for male and female condom promotion in populations already exposed to barrier method promotion.
- female condom
- peer education
- randomized controlled trial
- sex worker