Antigua (2012): TRaC measuring condom use among female Spanish-speaking sex workers in Antigua. Round 3.

Background: According to the UNGASS 2010 Country Progress Report, at the end of December 2009 there were a reported eight hundred and fifteen (815) persons who tested positive for HIV, and another one hundred and twenty-six (126) persons with advance HIV. Of these persons, ninety-eight (98) received and continued Anti-Retro-viral Treatment (ART). The report indicates that the determinants of the epidemic include multiple sex partners, sex workers, sex tourism, unprotected sex and underlying psycho-social and economic factors. These psycho-social economic factors include an increase in migrant labour populations, mobility among native Antiguans, and transactional sex among the youth, all of which are driven by poverty or the pressure of a fashionable consumer lifestyle. With a conservative estimate, there are between 1300 and 1700 Spanish-speaking sex workers in Antigua, based on the results from the August 2008 Baseline and 2009 Round 2 PSI TRaC among Spanish-speaking Sex Workers in Antigua. These studies showed that 77% consistently use condoms with their clients in 2008, while 72% consistently use condoms with their clients in 2009. This means that over twenty percent of Sex Workers in each year engage in risky sexual behavior. Further, it was discovered that a very high percent (99.5%-2008 and 83%-2009) of sex workers in both years demonstrated incorrect condom use thereby exacerbating the risk of the transmission of HIV. Another significant improvement noted was the share of respondents who reported carrying a condom at the time of survey. In 2008, be 8% reported carrying a condom, but that percentage subsequently increased to 43% in 2010. The number of respondents who use female condoms with their clients also increased from 10% in the baseline study to 52% in follow-up. Taken together, these findings seem to suggest an overall decline in the engagement of risky sexual behaviors among Spanish-speaking Sex Workers which may have a positive impact on the risk of HIV transmission in Antigua/Barbuda. STUDY OBJECTIVES: This study is the third wave of the TRaC Survey. This survey aims to answer three fundamental questions related to segmentation, monitoring and evaluation of populations. 1. Segmentation. By each risk/behavior combination, which opportunity, ability, and motivation (OAM) constructs and population characteristics are significantly correlated with consistent condom use during the past thirty (30) days. Similar analysis will also be done with correct condom use if data allows it. 2. Monitoring. What are the levels and trends are evident in other key behavior, risk, OAM constructs, and exposure to PSI/SFH activities? (i.e. availability, knowledge, self efficacy, locus of control, threat, belief, outcome expectation, exposure) 3. Evaluation. Is exposure to PSI/SFH activities leading to changes in OAM, risk, and behavior? Specifically, the research objectives are to identify and describe the segments of the target population in terms of: a. Correct and Consistent Condom Use STUDY DESIGN/METHODOLOGY Round I of this study employed an RDS approach; however, this methodology was unsuccessful. Unfortunately, very few distributed coupons translated into use. This is because many sex workers harbor a high level of suspicion toward authorities, which is compounded with a fear of being deported. This may have caused many sex workers to believe that this coupon was a trick to detain and deport them. Measures were put in place to assure the females that this was not true. Once we assuaged their fears and confirmed that this was not a trick by members within their target population, we did see a minimal increase in the number of persons responding to the coupons. Nonetheless, most females who did contact interviewers to set up a time to meet never showed. Reasons proffered were they forgot, were no longer interested, or were busy. Based on this past experience, a time-location sampling approach was selected for Round II and Round III of the study. The total sample size will be 560 Spanish speaking sex workers. Data will be aggregated to create dashboard tables. PSI/SFH will identify the number of physical sites within St. John and neighboring communities where the target population can be found. Next, PSI/SFH will ascertain the size of the target population found at these identified sites at different days and time slots. This will allow PSI/SFH to determine the times and days where there is the maximum number of the target group members present. Based on data from the mapping exercise conducted in Round II of the study this information will be presented to key informants to verify that this is still true. Once the target population size at each location has been validated the list will be updated as necessary. Upon the successful completion of the updated list, all the sites and the number of persons estimated in the target population will be included in a table format (see Table 1). If there is cause to...