Introduction Targeting most at-risk populations is an essential component of HIV prevention strategies. Peer education programmes have been found to increase HIV knowledge, condom use and safer sex behaviours among female sex workers in Africa and men who have sex with men elsewhere. The authors aimed to evaluate the impact of a peer-driven intervention on male sex workers who sell sex to men in Mombasa, Kenya.
Methods Using time-venue sampling, a baseline survey of 425 male sex workers was conducted in late 2006, after which, 40 peer educators were trained in HIV prevention, basic counselling skills and distribution of condoms and lubricants. A follow-up time-venue survey of 442 male sex workers was conducted in early 2008, and pre- and post-intervention changes were examined. The impact of peer educator exposure on HIV knowledge and condom use was analysed.
Results Positive changes in HIV prevention behaviours were observed, including increases in consistent use of condoms with both male clients (35.9%–50.2%, p<0.001) and non-paying male partners (27.4%–39.5%, p=0.008). Exposure to peer educators (AOR=1.97, 95% CI 1.29 to 3.02) and ever having been counselled or tested for HIV (AOR=1.71, 95% CI 1.10 to 2.66) were associated with consistent condom use in multivariate analysis. Peer educator contact was also associated with improved HIV knowledge and use of water-based lubricants.
Conclusions Peer outreach programming reached highly stigmatised male sex workers in Mombasa, resulting in significant, but limited, improvements in HIV knowledge and prevention behaviours. Improved peer coverage and additional prevention initiatives are needed to sufficiently mitigate HIV transmission.
- Sex workers
- men who have sex with men
- peer education
- behavioural science
- commercial sex
- substance misuse
- women issues
- vaginal infections
- infectious disease
- antiretroviral therapy
- genital infection
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Funding This study was funded by the President's Emergency Plan for AIDS Relief through the Office of HIV/AIDS, Bureau of Global Health, US Agency for International Development (USAID), through the Population Council's Horizons Program cooperative agreement of Award No. HRN-A-00-97-00012-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.
Competing interests None.
Ethics approval This study was conducted with the approvals of the Kenyatta National Hospital Ethics and Review Committee and by the Population Council's Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
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