The challenge of promoting safe sex at sites where persons meet new sex partners in Jamaica: results of the Kingston PLACE randomized controlled trial

Abstract

Summaryobjective To determine whether a site-based Priorities for Local AIDS Control Efforts (PLACE) HIV prevention intervention in Kingston, Jamaica increased condom use among persons with new or multiple sex partners.methods A total of 147 sites where persons go to meet new sex partners were grouped into 50 geographic clusters and randomized to receive or not receive a multilevel PLACE prevention intervention. Baseline cross-sectional surveys of sites and patrons at sites were conducted in 2005 to determine the nature of social activities at sites to better plan the intervention and to ensure that the two arms of the trial were similar. The intervention was delivered by 50 trained outreach workers between January and June 2006. After the intervention two cross-sectional surveys were conducted to assess the extent of intervention implementation and to estimate the proportion of patrons at sites with recent new or concurrent partnerships and inconsistent condom use.results Characteristics of sites and patrons were similar for most variables at intervention and control sites at both baseline and post-intervention. A total of 1535 patrons (723 men, 812 women) were interviewed at intervention sites and 1324 patrons (661 men, 663 women) at control sites 6-9 months after the intervention. There were no significant differences between intervention and control groups in the proportions of men (37.8% and 31.6%) and women (24.6% and 22.6%) who reported new or multiple relationships in the past year and inconsistent condom use. There was no significant difference in the proportion of men or women showing a condom at interview, having a HIV test in the past 12 months or being exposed to the intervention.conclusions An intent-to-treat analysis did not show any intervention effect. This was probably because of difficulty in implementing the intervention, the extent of patron mixing among sites, the intensity of national education campaigns, delay in conducting the post-intervention survey and evidence of other interventions at some control sites.

Targeting condom distribution at high risk places increases condom utilization-evidence from an intervention study in Livingstone, Zambia

“…However, a randomised controlled trial conducted in Kingston, Jamaica, where venues where people met new sexual partners were randomised to a site-based intervention (including on-site HIV testing, condom promotion, and peer education), found no significant differences in reporting of number of partners or consistent condom use between guests in intervention and control venues. However, there were several factors that possibly could explain the lack of impact: implementation difficulties (condoms and educational materials not always being available in the intervention venues), spill-over effects due to patrons visiting both intervention and control venues, national HIV prevention campaigns, time-gap between the intervention and the post-intervention survey, and other interventions being run in some of the control venues [14]. …”

Reaching key populations through key venues: Insights from the Jamaica HIV Prevention Program

“…Since 2002, the Ministry of Health in Jamaica has conducted outreach to high-risk venues [ 11 ]. The Jamaica PLACE strategy, first implemented in the parishes of St James [ 11 , 12 ] and Kingston & St Andrew [ 13 , 14 ] [ 6 ], has been extended to all parishes. Implementation focused on urban areas and “vulnerable communities” identified based on a rough algorithm that took into account population density, poverty, literacy, known sex work, violence, and reported HIV/AIDS cases.…”

HIV and sexually transmitted infections at the borderlands: situational analysis of sexual health in the Brazilian Amazon

“…The Priorities for Local AIDS Control Efforts (PLACE) method characterises public venues where people meet new sexual partners,9 10 whereas other types of situational analyses define the target population(s) based on high-risk group (self-) identification. The present study was part of a comprehensive situational analysis of sexual health (SASH) conducted in the Alto Solimões region of the Brazilian State of Amazonas.…”