Prevention of transmission of human immunodeficiency virus in Africa: effectiveness of condom promotion and health education among prostitutes

Lancet. 1988 Oct 15;2(8616):887-90. doi: 10.1016/s0140-6736(88)92480-4.


Condom use was assessed after a programme of education about the acquired immunodeficiency syndrome and a condom distribution programme in a well-characterised prostitute population in Nairobi. Women received their education at group meetings (barazas) and at individual counselling sessions during which they were given the results of serological tests for the human immunodeficiency virus (group 1) or at barazas only (group 2), or through very little of either (group 3). During the counselling sessions free condoms were distributed. Before either of the programmes started, 10%, 9%, and 7% of groups 1, 2, and 3 women, respectively, reported occasional use of condoms. By November 1986, 80%, 70%, and 58% of groups 1, 2, and 3 women, respectively, reported at least some condom use. The mean frequency of condom use was 38.7 (SD 31.8)%, 34.6 (34.5)%, and 25.6 (29.5)% of sexual encounters in groups 1, 2, and 3 women. 20 of 28 women who were non-condom-users seroconverted compared with 23 of 50 women who reported some use of condoms.

PIP: In some parts of Africa, prostitutes and their clients represent the groups at greatest risk of human immunodeficiency virus (HIV) infection and the major disseminators of the virus. As part of a cohort study of the epidemiology of sexually transmitted diseases in Nairobi, 595 prostitutes have been followed since 1985. At the start of the study, 61% of these prostitutes were infected with HIV. Health education, initially about conventional sexually transmitted diseases and subsequently about acquired immunodeficiency syndrome (AIDS), was a major component of this project. Health education was provided at barazas (general community meetings including lectures, skits, role playing, and discussion) and individual counseling sessions. To evaluate the effectiveness of such health promotion efforts on the prevention of HIV infection, specifically on adoption of condom use, the prostitutes were divided into 3 groups: 1) those who received their health education through both barazas and individual sessions at which the results of serological tests for HIV infection were discussed; 2) those who attended barazas only; and 3) prostitutes who received neither intervention. Condoms were distributed free of charge to all prostitutes who requested them. At the start of the project, only 10%, 7%, and 7% of prostitutes in Groups 1, 2, and 3, respectively, reported some use of condoms. After 6 months in the program, this statistic had increased to 80%, 70%, and 58%, respectively. The mean frequency of condom use was 38.7%, 34.6%, and 25.6% of sexual encounters in Group 1, 2, and 3 women. Any condom use resulted in a 3-fold reduction in risk of seroconversion. 20 of 28 women who were not condom users seroconverted compared with 23 of 50 condom users. Stepwise logistic regression confirmed that group discussion was the factor most significantly associated with condom use.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / epidemiology
  • Acquired Immunodeficiency Syndrome / prevention & control*
  • Acquired Immunodeficiency Syndrome / transmission
  • Adult
  • Contraceptive Devices, Male / statistics & numerical data*
  • Evaluation Studies as Topic
  • Female
  • HIV Seropositivity / epidemiology
  • Health Education / methods*
  • Humans
  • Kenya
  • Male
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors
  • Sampling Studies
  • Sex Work*