St Lucia (2012): TRaC measuring condom use among sexually active youth 16 to 24 years in St Lucia. Round [2].

BACKGROUND St. Lucia is a Caribbean island located between the Caribbean Sea and the North Atlantic Ocean, north of Trinidad & Tobago. With a land span of 616 sq. km, St. Lucia is volcanic and mountainous with some broad fertile valleys. Based on reports from the CIA World Fact Book, St. Lucia's population as of July 2012 is estimated at 162,178 persons, with a male to female ration of 1.06. Of the total population, 67.5% are between the ages of 15 to 64 years, 22.8% are between the ages of 0 to 14 years, and 9.7% are 65 years and older. According to St. Lucia Statistics Office, approximately 20% of the population i s between the ages of 15 and 24 years (around 30,000 people) and of this, 80% of these youth are sexually active. Ninety percent (90%) of this last subgroup has been sexually active within the past month. This leads to an estimated target population size of 22,000 for Population Services International. Saint Lucia is mostly a rural country (only 28% of the population is described as urbanized). Tourism is the main driver of the economy and the manufacturing sector is described as the most diverse in the eastern Caribbean. According to the 2010 St. Lucia UNGASS report, the country'™s HIV/AIDS status is described as a concentrated, low prevalence epidemic. The report also indicates that while current HIV infections continue to be characterized by heterosexual intercourse, in the Saint Lucian context drivers of the epidemic broadly include: transactional sex where no cash is exchanged but gifts are given and support suppl ied; sex for drugs (crack, cocaine) and traditional sex work (exchange of sex for money) primarily by both foreign and local women. Foreign women primarily work in brothels and strip-clubs while local women are known to work in areas frequented by tourists. Trends in HIV transmission have also been linked to increased poverty and social disintegration. The UNGASS report continues to state that further to these broad drivers, there is a hidden but believed to be substantial population of men having sex with men exclusively (MSM) and men having sex with both men and women (MSMW). This is thought to be exacerbating the HIV epidemic and statistical evidence suggests that the behaviors of MSMW have contributed to the feminization of the HIV epidemic in St. Lucia STUDY OBJECTIVES The purpose of the Tracking Results Continuously (TRaC) survey among sexually active youth 16-24 years in St. Lucia is to provide evidence for monitoring and implementation of PSI/SFH HIV prevention Program. The data gathered through the 2012 TRaC survey will be analyzed according to PSI's Performance Framework DESIGN/METHODOLOGY This study design calls for a time location sampling approach. The total sample size will be 530 youth 16 to 24. Data will be aggregated to create dashboard tables. Information from the St. Lucia Government Statistics Department was used to estimate the target population size of 22,000 (this estimate is based on a population size of approximately 30,000 youth 15-24 years with 80% of these youth who are sexually active and 90% of this population sexually active within the past month). œHot spots (i.e. specific locations where youth 16-24 years are known to congregate e.g. community blocks, beaches, clubs, bars, shopping areas, sporting events) will be identified within St. Lucian communities. Personnel at the National AIDS Program and the St. Lucia Planned Parenthood who have worked extensively with the target population will identify all locations and the time that youth are generally found to be congregating at these locations. These well-informed persons will make estimates of the number of youth at each location. St. Lucia is divided into ten (10) parishes both urban and rural. Despite these divisions there are no real distinctions between where the urban and rural youth congregate. Young people in St. Lucia are found at popular community blocks, residential houses, bars, clubs, shopping areas, and sporting events at specific times. Youth who congregate at selected locations will be approached by interviewers and using a systematic random process to participate in the study. For instance, if an interviewer visits a ˜hot spot™ and there are 13 youth at that location the interviewer will assign a number to all persons within the target population age group and select every nth person to interview after choosing a random starting number. If the selected individual does not meet the inclusion criteria which includes being between 16-24 years, has had sexual intercourse in last 30 days and has had more than one sexual partner in the last three (3) months, then another member from the group will be randomly selected. Youth on the street will be selected rather than youth at their homes because information obtained from youth at home may be negatively skewed. A young person at home in St. Lucia would usually be in the presence of their parent or guardian and therefore would be less open about offering information about their sexual behaviour. Youth who are on the street would be more willing to offer the sensitive information required. Care will be taken to ensure that males and females and the respective age groups (i.e. 16-19 years and 20-24 years) are represented from the population. Based on the sample size calculated quotas for males and females will be set to ensure that the sample is representative of the St. Lucia youth population.