Social-environmental factors and protective sexual behavior among sex workers: the Encontros intervention in Brazil

Am J Public Health. 2010 Apr 1;100 Suppl 1(Suppl 1):S216-23. doi: 10.2105/AJPH.2008.147462. Epub 2009 Sep 17.


Objectives: We sought to determine the association of social-environmental factors with condom use and sexually transmitted infections (STIs) among 420 sex workers participating in an STI/HIV prevention study in Corumbá, Brazil, to inform future intervention efforts.

Methods: Participants provided urine samples for polymerase chain reaction testing of chlamydia and gonorrhea and responded to multi-item scales addressing perceived social cohesion, participation in networks, and access to and management of resources. We conducted multivariate log-linear and negative binomial regression analyses of these data.

Results: Increased social cohesion was inversely associated with number of unprotected sex acts in the preceding week among women (adjusted incidence rate ratio [IRR] = 0.80; P < .01), and there was a marginal association among men (adjusted IRR = 0.41; P = .08). Women's increased participation in social networks was associated with a decrease in frequency of unprotected sex acts (adjusted IRR = 0.83; P = .04), as was men's access to and management of social and material resources (IRR = 0.15; P = .01). Social-environmental factors were not associated with STIs.

Conclusions: The social context within which populations negotiate sexual behaviors is associated with condom use. Future efforts to prevent STI/HIV should incorporate strategies to modify the social environment.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Brazil
  • Condoms / statistics & numerical data
  • Female
  • HIV Infections / prevention & control
  • Health Promotion
  • Humans
  • Male
  • Polymerase Chain Reaction
  • Regression Analysis
  • Sex Work*
  • Sexual Behavior*
  • Sexually Transmitted Diseases / diagnosis
  • Sexually Transmitted Diseases / prevention & control
  • Sexually Transmitted Diseases / urine
  • Social Environment*
  • Surveys and Questionnaires
  • Unsafe Sex
  • Young Adult