Designing a Program for Prevention of Sexually Transmitted Infections by Promoting Condom Use in Tabriz Female Sex Workers Using Intervention Mapping Approach

Abstract

Introduction: AIDS and other sexually transmitted diseases are important occupational hazards of sex work. Preventing infection among female sex workers improves both their health and reduces HIV and sexually transmitted diseases transmission. Covert sex work combined with poor use of preventive and health-promoting services can lead to diseases such as hepatitis, sexually transmitted diseases, and especially AIDS. Given the spread of AIDS and the onset of the third wave of AIDS in the country, which has led to an increase in sexually transmitted infections, and considering the involvement of female sex workers in the spread of the disease and limited studies in this area, it seems that designing an intervention program for prevention of sexually transmitted diseases is necessary. Therefore, the purpose of this study was to design a health promotion program for prevention of sexually transmitted infections in female sex workers. Methods: The sampling method was census. All women with active records in Tabriz Vulnerable Women's Counseling Centers (n= 140) who were satisfied participated in this study. Data were collected through standard and researcher-made questionnaires including mental health constructs, predisposing factors (knowledge, attitude, perceived risk, perceived norms, self-efficacy), enabling factors (condom use skills, condom negotiation, access to resources and its usability), reinforcing factors (perceived social support), behavioral and environmental factors (physical environment, social environment, economic environment, political environment) were collected. Then the results of the data were analyzed using the software SPSS v.23. Method of conducting a pilot study Methods: In this pre-test, 30 women were selected and divided into two groups of 15 intervention and control. A group of women were invited to participate in the training by written or telephone letter, and were urged to attend the program for a few hours on specified days, with intervention scheduled for each day for a specified time in the schedule. One month after the end of the training sessions for both groups, the questionnaire was completed and the results were analyzed. Mean and standard deviation indices, Kolmogorov-Smirnov test for data normality and t-test for determination of binomial variables were used. Pearson and Spearman correlation coefficient tests were used to determine the relationship between variables. P value less than 0.05 was considered significant and regression-based path analysis was used to provide a suitable pattern for the population under study. Results: The most important variables affecting enabling factors were condom use skill, perceived barriers and self-efficacy and the most important variables affecting social support were condom use negotiation. According to the pre-test results, there was a statistically significant difference in the mean perceived risk score after the intervention between the intervention and control groups and in the other means there was no significant difference between the intervention and control groups. According to the results of paired t-test, there was a statistically significant decrease in social support scores from pre-intervention (mean= 32, standard deviation= 11.16) to perceived social support after intervention (mean= 40.91 and standard deviation= 345/9) observed. In the other cases there was no statistically significant decrease. Conclusion: The women in this study had relatively low health status, and interventional efforts to increase and improve their health status seemed necessary. Environmental factors, perceived norms, knowledge and perceived risk are the most important determinants of healthy sexual behaviors in prostitutes. Therefore, it can be strengthened by improving the negotiation of condom use and self-efficacy in these women, as well as increasing their knowledge and attitude towards constant condom use and ways to prevent STDs. In addition, the intervention program should be run on a sufficient sample size, and then the program will be evaluated and any necessary modifications to the program made.