China's hidden role in malaria control and elimination in Africa.

BACKGROUND: Insufficient funding is hindering the achievement of malaria elimination targets in Africa, despite the pressing need for increased investment in malaria control. While Western donors attribute their inaction to financial constraints, the global health community has limited knowledge of China's expanding role in malaria prevention. This knowledge gap arises from the fact that China does not consistently report its foreign development assistance activities to established aid transparency initiatives. Our work focuses on identifying Chinese-funded malaria control projects throughout Africa and linking them to official data on malaria prevalence. By doing so, we aim to shed light on China's contributions to malaria control efforts, analysing their investments and assessing their impact. This would provide valuable insights into the development of effective financing mechanisms for future malaria control in Africa. METHODS: Our research used AidData' s recently released Global Chinese Development Finance Dataset V.2.0 providing comprehensive coverage of all official sector Chinese development financing across Africa, from which we identify 224 Chinese-funded malaria projects in Sub-Saharan Africa (SSA) committed between 2002 and 2017. We conducted an analysis of the spending patterns by year, country and regions within Africa and compared it with data on population-adjusted malaria prevalence, sourced from the Malaria Atlas Project. RESULTS: Chinese-financed malaria projects Africa mainly focused on three areas: the provision of medical supplies (72.32%), the construction of basic health infrastructure (17.86%) and the deployment of anti-malaria experts (3.57%). Moreover, nearly 39% of the initiatives were concentrated in just four countries: the Democratic Republic of Congo, Central African Republic, Uganda and Liberia. Additionally, China's development financing amount showed a weak negative correlation (-0.2393) with population-weighted malaria prevalence. We concluded that the extent and direction of China's support are not adequately tailored to address malaria challenges in different countries. CONCLUSION: With China's increasing engagement in global health, it is anticipated that malaria control will continue to be a prominent priority on its development assistance agenda. This is attributed to China's vast expertise in malaria elimination, coupled with its substantial contribution as a major producer of malaria diagnostics and treatments.

Chinese health funding in Africa: The untold story.

The motivations behind China's allocation of health aid to Africa remain complex due to limited information on the details of health aid project activities. Insufficient knowledge about the purpose of China's health aid hinders our understanding of China's comprehensive role in supporting Africa's healthcare system. To address this gap, our study aimed to gain better insights into China's health aid priorities and the factors driving these priorities across Africa. To achieve this, we utilized AidData's Chinese Official Finance Dataset and adhered to the Organisation for Economic Co-operation and Development (OECD) guidelines. We reclassified all 1,026 health projects in Africa, originally categorized under broad 3-digit OECD-DAC sector codes, into more specific 5-digit CRS codes. By analyzing the project count and financial value, we assessed the shifting priorities over time. Our analysis revealed that China's priorities in health aid have evolved between 2000 and 2017. In the early 2000s, China primarily allocated aid to basic health personnel and lacked diversity in sub-sectors. However, after 2004, China shifted its focus more toward basic infrastructure and reduced emphasis on clinical-level staff. Furthermore, China's interest in addressing malaria expanded both in scale and depth between 2006 and 2009. This trend continued in 2012 and 2014 when China responded to the Ebola outbreak by shifting its focus from basic infrastructure to infectious diseases. In summary, our findings demonstrate the changes in China's health aid strategy, starting with addressing diseases already eliminated in China and gradually transitioning towards global health security, health system strengthening, and shaping the governance mechanisms.

Spatial and spatio-temporal epidemiological approaches to inform COVID-19 surveillance and control: a systematic review of statistical and modelling methods in Africa.

OBJECTIVE: Various studies have been published to better understand the underlying spatial and temporal dynamics of COVID-19. This review sought to identify different spatial and spatio-temporal modelling methods that have been applied to COVID-19 and examine influential covariates that have been reportedly associated with its risk in Africa. DESIGN: Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: Thematically mined keywords were used to identify refereed studies conducted between January 2020 and February 2022 from the following databases: PubMed, Scopus, MEDLINE via Proquest, CINHAL via EBSCOhost and Coronavirus Research Database via ProQuest. A manual search through the reference list of studies was also conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Peer-reviewed studies that demonstrated the application of spatial and temporal approaches to COVID-19 outcomes. DATA EXTRACTION AND SYNTHESIS: A standardised extraction form based on critical appraisal and data extraction for systematic reviews of prediction modelling studies checklist was used to extract the meta-data of the included studies. A validated scoring criterion was used to assess studies based on their methodological relevance and quality. RESULTS: Among 2065 hits in five databases, title and abstract screening yielded 827 studies of which 22 were synthesised and qualitatively analysed. The most common socioeconomic variable was population density. HIV prevalence was the most common epidemiological indicator, while temperature was the most common environmental indicator. Thirteen studies (59%) implemented diverse formulations of spatial and spatio-temporal models incorporating unmeasured factors of COVID-19 and the subtle influence of time and space. Cluster analyses were used across seven studies (32%) to explore COVID-19 variation and determine whether observed patterns were random. CONCLUSION: COVID-19 modelling in Africa is still in its infancy, and a range of spatial and spatio-temporal methods have been employed across diverse settings. Strengthening routine data systems remains critical for generating estimates and understanding factors that drive spatial variation in vulnerable populations and temporal variation in pandemic progression. PROSPERO REGISTRATION NUMBER: CRD42021279767.

The economic efficiency of aid targeting.

How efficient is the targeting of foreign aid to populations in need? A long literature has focused on the impacts of foreign aid, but much rarer are studies that examine how such aid is allocated within countries. We examine the extent to which donors efficiently respond to exogenous budget shocks by shifting resources toward needier districts within a given country, as predicted by theory. We use recently geocoded data on the World Bank's aid in 23 countries that crossed the lower-middle income threshold between 1995 and 2010 and thus experienced sharp aid reductions. We measure locations' need along a number of dimensions, including nighttime lights emissions, population density, conflict exposure, and child mortality. We find little evidence that aid project siting is increasingly concentrated in worse-off areas as budgets shrink; the only exception appears to be a growing share of funding in more conflict-affected areas. We further analyze the relationship of health aid to child mortality measures in six key countries, again finding little evidence of efficient responses to budget shocks. Taken together, these results suggest that large efficiency gains may be possible in the distribution of aid from the World Bank and other donors.

Spatial and spatio-temporal epidemiological approaches to inform COVID-19 surveillance and control: a review protocol.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that cause coronavirus disease 2019 (COVID-19) have afflicted millions worldwide. Understanding the underlying spatial and temporal dynamics can help orient timely public health policies and optimize the targeting of non-pharmaceutical interventions and vaccines to the most vulnerable populations, particularly in resource-constrained settings. The review systematically summarises important methodological aspects and specificities of spatial approaches applied to COVID-19 in Africa. METHODS: Thematically selected keywords will be used to search for refereed studies in the following electronic databases PubMed, SCOPUS, MEDLINE, CINHAL, and Coronavirus Research Database from January 2020 to February 2022. Two independent reviewers will screen the title, abstracts, and full texts against predefined eligibility criteria based on the study's characteristics, methodological relevance, and quality. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 procedures will be adhered to during the reporting process. DISCUSSION: COVID-19 modeling remains in its infancy, and research is needed to characterize uncertainty and validate various modeling regimes appropriately. It is anticipated that the review will aid spatial, spatio-temporal modeling decisions necessary for mitigating the current and future pandemics. SYSTEMATIC REVIEW REGISTRATION: CRD42021279767.

The effectiveness of national-level containment and closure policies across income levels during the COVID-19 pandemic: an analysis of 113 countries.

Despite heterogeneity in income levels, countries implemented similarly strict containment and closure policies to mitigate the COVID-19 pandemic. This research assesses the effectiveness of these containment and closure policies, which we defined as larger decreases in mobility and smaller COVID-19 case and death growth rates. Using daily data for 113 countries on mobility and cumulative COVID-19 case and death counts over the 130 days between February 15, 2020 and June 23, 2020, we examined changes in mobility, morbidity, and mortality growth rates across the World Bank's income group classifications. Containment policies correlated with the largest declines in mobility in higher income countries. High-income countries also achieved lower COVID-19 case and death growth rates than low-income countries. This study finds better epidemiological outcomes of containment and closure policies for higher income countries than lower income countries. These findings urge policymakers to consider contextual differences, including levels of economic activity and the structure of the economy, when crafting policies in response to public health emergencies.

The Influence of Marginalization on Cultural Attitudes and Trash Disposal Practices in Esfuerzo de Paraíso of the Dominican Republic: A Qualitative Interview Study.

The inadequate management of municipal solid waste (MSW) in fast-developing nations is a major public health problem. Trash collection is often inconsistent, leaving residents to use unsafe disposal methods such as incineration or unregulated dumping. The issue is especially pronounced in marginalized communities, where public service provision is scarce. Past research has identified factors that perpetuate harmful disposal practices. The current study expanded on previous work by exploring how individuals' perceptions of political, spatial, and economic marginalization affected their agency with regards to waste management. Researchers focused on a marginalized community in the Dominican Republic known as Esfuerzo de Paraíso. There, they conducted semi-structured interviews to explore residents' perceptions of marginalization at the individual, interpersonal, community, and institutional levels, and its effects on their agency. A qualitative coding process revealed that most community members were discontent with their trash disposal practices, but that long-standing marginalization left them feeling ill equipped to generate change at the individual level. Interviewees believed that change should be initiated at the community level and implemented with the support of institutional-level actors, namely the municipal government. Residents did not identify any non-governmental organizations as possible sources of help, which may suggest a limited view of institutional support networks.

Methods for estimating economic benefits of surgical interventions in low-income and middle-income countries: a scoping review.

OBJECTIVES: Studies indicate that many types of surgical care are cost-effective compared with other health interventions in low-income and middle-income countries (LMICs). However, global health investments to support these interventions remain limited. This study undertakes a scoping review of research on the economic impact of surgical interventions in LMICs to determine the methodologies used in measuring economic benefits. DESIGN: The Arksey and O'Malley methodological framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist were used to review the data systematically. Online databases were used to identify papers published between 2005 and 2020, from which we selected 19 publications that quantitatively examined the economic benefits of surgical interventions in LMICs. RESULTS: Majority of publications (79%) reported the use of disability-adjusted life-years (DALYs) to assess economic impact. In comparison, 21% used other measures, such as the value of statistical life or cost-effectiveness ratios, or no measure at all. 31% were systematic or retrospective reviews of the literature on surgical procedures in LMICs, while 69% either directly assessed economic impact in a specific area or evaluated the need for surgical procedures in LMICs. All studies reviewed related to the economic impact of surgical procedures in LMICs, with most about paediatric surgical procedures or a specific surgical specialty. CONCLUSION: To make informed policy decisions regarding global health investments, the economic impact must be accurately measured. Researchers employ a range of techniques to quantify the economic benefit of surgeries in LMICs, which limits understanding of overall economic value. We conclude that the literature would benefit from a careful selection of methods, incorporating age and disability weights based on the Global Burden of Disease weights, and converting DALYs to dollars using the value of statistical life approach and the human capital approach, reporting both estimates.

Childhood health and the changing distribution of foreign aid: Evidence from Nigeria's transition to lower-middle-income status.

With sustained economic growth in many parts of the developing world, an increasing number of countries are transitioning away from the most subsidized development finance as they exceed income and other qualification requirements. Cross-country evidence suggests that Development Assistance Committee (DAC) donors view the crossing over of the World Bank's International Development Association (IDA) eligibility threshold to signal that a country needs less aid, with subsequent reductions in both IDA and other donors' concessional funding. Within the health sector, it is particularly important to understand the implications of these status changes for children under five years of age since improving early childhood health is critical to fostering health and social and economic development. Therefore, we examine the implications of the IDA transition by measuring the extent t which World Bank commitments-including both IDA and IBRD-are directed to infant and child health needs in Nigeria. Ordinary Least Squares (OLS) models were used in a difference-in-differences (DID) strategy to compare World Bank IBRD/IDA lending before and after the crossover to regions with varying initial levels of under-five and infant need. We find that the infant need orientation of World Bank aid has increased post-crossover. Conversely, alignment of World Bank commitments to regional child needs appears to have diminished after Nigeria crosses the IDA threshold. However, these effects are statistically insignificant and therefore provides inconclusive evidence. This research addresses an important policy question because the transition away from concessional funding mechanisms will result in difficult tradeoffs in allocating limited health resources; without providing conclusive evidence that crossover results in changes in need-based allocation, it does offer an essential path for future research. These results are directly relevant to policy debates about what we know and do not know about aid in transition and health. This research's value is especially important in the Sustainable Development Goal (SDG) era in understanding how donor exits could derail progress in health improvement.

Pulling the purse strings: Are there sectoral differences in political preferencing of Chinese aid to Africa?

OBJECTIVE: China is emerging as an increasingly important player in the global development space, but may be less bound to compacts that aim to curb political preferencing and therefore may produce less yield in terms of impact toward Sustainable Development Goals. This research tests the hypothesis that the disproportionate aid allocation to the birth regions of the current African political leaders that applies to some sectors more than others. DESIGN: We applied a two-part model to first estimate the probability that a region receives an aid project. Then when at least one aid project is present in a leader's birth region, we estimated the mean amount of aid the region received. SETTING: This analysis covers 699 subnational units (first administrative level) across 44 African countries over 2000-2014. These administrative units were compiled into a region year panel resulting in 10,485 observations. RESULTS: Birth regions of the current political leader are significantly more likely than the average of all of the regions to receive education (1.3 percentage points), social infrastructure and services (1.2 percentage points), and energy aid (1.7 percentage points). No significant association was found between aid flows to the birth region of the current political leader in the agriculture, communication, education, government, health or transportation sectors. Within the education sector, the coefficients for birth region are positive in both parts and statistically significant. Both the probability of aid allocation and the amount of aid conditional on any projects increase in the birth region of the current political leader. CONCLUSIONS: This sector-specific analysis provides a more nuanced picture of Chinese aid than previous analyses that determine the presence of political preference according to aggregate aid flows. The sectors where political preferencing exists are also those sectors that are typically associated with limited counterfactual-based program evaluation. We present evidence that demonstrates the importance of disaggregating aid flows in order to support a new policy framework designed to target the Sustainable Development Goals.

The impact of an insecticide treated bednet campaign on all-cause child mortality: A geospatial impact evaluation from the Democratic Republic of Congo.

OBJECTIVE: To test the impact of a nationwide Long-Lasting Insecticidal Nets [LLINs] distribution program in the Democratic Republic of Congo [DRC] on all-cause under-five child mortality exploiting subnational variation in malaria endemicity and the timing in the scale-up of the program across provinces. DESIGN: Geospatial Impact Evaluation using a difference-in-differences approach. SETTING: Democratic Republic of the Congo. PARTICIPANTS: 52,656 children sampled in the 2007 and 2013/2014 DRC Demographic and Health Surveys. INTERVENTIONS: The analysis provides plausibly causal estimates of both average treatment effects of the LLIN distribution campaign and geospatial heterogeneity in these effects based on malaria endemicity. It compares the under-five, all-cause mortality for children pre- and post-LLIN campaign relative to children in those areas that had not yet been exposed to the campaign using a difference-in-differences model and controlling for year- and province-fixed effects, and province-level trends in mortality. RESULTS: We find that the campaign led to a 41% decline [3.7 percentage points, 95% CI 1.3 to 6.0] in under-5 mortality risk among children living in rural areas with malaria ecology above the sample median. Results were robust to controlling for household assets and the presence of other health aid programs. No effect was detected in children living in areas with malaria ecology below the median. CONCLUSION: The findings of this paper make important contributions to the evidence base for the effectiveness of large scale-national LLIN campaigns against malaria. We found that the program was effective in areas of the DRC with the highest underlying risk of malaria. Targeting bednets to areas with greatest underlying risk for malaria may help to increase the efficiency of increasingly limited malaria resources but should be balanced against other malaria control concerns.

Health aid projects have both expanded and constrained the capacity of health facilities to deliver malaria services to under-five children in Malawi.

OBJECTIVE: This article examines the potential pathways health aid may use to influence the availability of malaria services at a facility level and the utilisation of malaria services for children under five in Malawi. METHODS: This work is grounded in a health services research theoretical model and combines a subnational census of health services available at Malawi health facilities with individual-level data on health service utilisation and the Government of Malawi's official source of data about health aid allocation at a child-level (n=2171). Logistic and multinomial logistic models were used to assess the relationship between health aid, malaria service readiness and malaria service utilisation. Models were adjusted for predisposing, enabling and need factors and accounted for the complex relationship using a mediation approach. RESULTS: The evidence presented suggests that health aid translates into increased diagnostic capacity, but not overall or training readiness. Results indicate that increasing aid projects in a region boost its facilities' diagnostic readiness, increasing each facility's relative likelihood of having a medium level of diagnostic readiness by 12% (relative risk (RR)=1.118; 95% CI 1.060 to 1.179) and its likelihood of having a high level of readiness by 23% (RR=1.230; 95% CI 1.161 to 1.303), but decreasing its readiness to provide training by 8% (RR=0.925; 95% CI 0.879 to 0.974). CONCLUSION: The results of this research highlight the fact that health aid is working to increase malaria diagnostic capacity at a facility level, but that increasing facility readiness to implement the diagnostic tests has been neglected.

Taking the health aid debate to the subnational level: the impact and allocation of foreign health aid in Malawi.

OBJECTIVE: Cross-national studies provide inconclusive results as to the effectiveness of foreign health aid. We highlight a novel application of using subnational data to evaluate aid impacts, using Malawi as a case study. DESIGN: We employ two rounds of nationally representative household surveys (2004/2005 and 2010/2011) and geo-referenced foreign aid data. We examine the determinants of Malawi's traditional authorities receiving aid according to health, environmental risk, socioeconomic and political factors. We use two approaches to estimate the impact of aid on reducing malaria prevalence and increasing healthcare quality: difference-in-difference models, which include traditional authority and month-of-interview fixed effects and control for individual and household level time-varying factors, and entropy balancing, where models balance on health-related and socioeconomic baseline characteristics. General health aid and four specific health aid sectors are examined. RESULTS: Traditional authorities with greater proportions of individuals living in urban areas, more health facilities and greater proportions of those in major ethnic groups were more likely to receive aid. Difference-in-difference models show health infrastructure and parasitic disease control aid reduced malaria prevalence by 1.20 (95% CI -0.36 to 2.76) and 2.20 (95% CI 0.43 to 3.96) percentage points, respectively, and increased the likelihood of individuals reporting healthcare as more than adequate by 12.1 (95% CI 1.51 to 22.68) and 14.0 (95% CI 0.11 to 28.11) percentage points. Entropy balancing shows similar results. CONCLUSIONS: Aid was targeted to areas with greater existing health infrastructure rather than areas most in need, but still effectively reduced malaria prevalence and enhanced self-reported healthcare quality.

Parental Involvement in a School-Based Child Physical Activity and Nutrition Program in Southeastern United States: A Qualitative Analysis of Parenting Capacities.

BACKGROUND: Parent involvement varies widely in school-based programs designed to promote physical activity and healthy nutrition, yet the underlying factors that may limit parent's participation and support of learned behaviors at home are not well understood. METHOD: We conducted a qualitative study that consisted of one focus group (n = 5) and 52 in-depth interviews among parents whose children participated in a school-based physical activity and nutrition (PAN) promotion program in Williamsburg, Virginia, United States. We sought to identify factors that enabled or constrained parent's support of and involvement in children's programs and to understand the underlying factors that contribute to family success in making dietary and physical activity changes at home. RESULTS: Parents identified their physical and mental health, self-confidence, time, and decision making as underlying "capacities" in the family health pattern. When strengthened, these capacities encourage healthful family behavior and support of school-based PAN programs. Families that succeeded in adopting lessons learned from school-based PAN programs identified four primary strategies for success: shared goals, meal planning, modeling of good behaviors, and collective activities. CONCLUSIONS: Interventions that aim to improve child nutrition and physical activity and the broader family health environment should consider underlying capacities of parents and the importance of joint goals and activities.

Child body mass index, obesity, and proximity to fast food restaurants.

Objectives. Using a sample of elementary and middle school students, we examined the associations between body mass index (BMI), obesity, and measures of the proximity of fast food and full service restaurants to students' residences. We controlled for socioeconomic status using a novel proxy measure based on housing values. Methods. We used BMI and obesity measures based on height and weight data collected as part of a school health assessment along with geocoded data on addresses of residences and food establishments. We constructed a proxy measure of socioeconomic status from public records of residential property assessments. These data were used to estimate logistic regression models of overweight and ordinary least squares models of BMI. Results. Students residing in homes with higher assessment values were significantly less likely to be obese, and had significantly lower BMIs. Upon controlling for socioeconomic status and other characteristics, the associations of BMI and obesity with proximity to food service establishments were reduced. Nonetheless, students who resided within one-tenth or one-quarter of a mile from a fast food restaurant had significantly higher values of BMI. The proximity of full service restaurants to residences did not have a significant positive association with either BMI or overweight. Conclusion. Public health efforts to limit access to fast food among nearby residents could have beneficial effects on child obesity. Public data on property value assessments may serve as useful approximations for socioeconomic status when address data are available.

Improving Surveillance of Sexually Transmitted Diseases through Geocoded Morbidity Assignment.

OBJECTIVES: We assessed the added value of using a geocoder to improve sexually transmitted disease (STD) surveillance data and decision support through redistribution of inaccurately assigned morbidity in Richmond, Virginia. METHODS: Virginia initiated geocoding of STD data as a data quality tool in 2002. Geocoded output files were assessed and discordant proportions of reported gonorrhea and chlamydia morbidity were reassigned appropriately for the city of Richmond, Chesterfield County, and Henrico County (2002 to 2006). We used Chi-square analysis to compare assignment proportions and calculated crude odds ratios for 2006 data to estimate increased case reassignment likelihood. RESULTS: From 2002 to 2006, 149,229 cases of gonorrhea and chlamydia were reported within the Commonwealth of Virginia. Of the reported morbidity, 81% of cases (n=120,875) were successfully geocoded; 7% (n=8,461) of geocoded addresses were reassigned. Approximately 76% (n=6,412) of all reassigned cases occurred within Richmond and Chesterfield and Henrico counties. In 2006, 84% (n=654) of reassigned cases in this tri-city/county area were initially reported as Richmond morbidity. Data quality improvements reduced Richmond's artificially inflated morbidity by 18% and increased Chesterfield and Henrico morbidity by 17% and 55%, respectively. Richmond morbidity was three times more likely to be reassigned than Chesterfield cases (odds ratio [OR] = 2.93, 95% confidence interval [CI] 2.21, 3.90), and two times more likely than Henrico cases (OR=2.12, 95% CI 1.63, 2.76). Richmond's number one national rank for STD rates was reduced beginning in 2002. CONCLUSIONS: Declining rates of STDs were statistically associated with geocoded morbidity reassignments. Implementation of this data quality business process has improved epidemiologic analyses, prevention planning, and assessment of resource allocations. The reduction in Richmond's national STD rankings is indicative of the effect geocoding can have on surveillance data.

Providing Mailing Cost Reimbursements: The Effect on Reporting Timeliness of Sexually Transmitted Diseases in Virginia.

OBJECTIVES: We investigated the effect of providing mailing cost reimbursements to local health departments on the timeliness of the reporting of sexually transmitted diseases (STDs) in Virginia. METHODS: The Division of Disease Prevention, Virginia Department of Health, provided mailing cost reimbursements to 31 Virginia health districts from October 2002 to December 2004. The difference (in days) between the diagnosis date (or date the STD paperwork was initiated) and the date the case/STD report was entered into the STD surveillance database was used in a negative binomial regression model against time (as divided into three periods-before, during, and after reimbursement) to estimate the effect of providing mailing cost reimbursements on reporting timeliness. RESULTS: We observed significant decreases in the number of days between diagnosis and reporting of a case, which were sustained after the reimbursement period ended, in 25 of the 31 health districts included in the analysis. We observed a significant initial decrease (during the reimbursement period) followed by a significant increase in the after-reimbursement phase in one health district. Two health districts had a significant initial decrease, while one health district had a significant decrease in reporting timeliness in the period after reimbursement. Two health districts showed no significant changes in the number of days to report to the central office. CONCLUSION: Providing reimbursements for mailing costs was statistically associated with improved STD reporting timeliness in almost all of Virginia's health districts. Sustained improvement after the reimbursement period ended is likely indicative of improved local health department reporting habits.

An assessment of sites where persons go to meet sexual partners in St. James, Jamaica, using the PLACE method.

OBJECTIVE: The objective of this study was to assess sexual behavior of persons at risk of HIV infection. GOAL: The goal of this study was to identify sites where HIV prevention is needed. STUDY DESIGN: Customers at sites where persons meet new sex partners in St. James, Jamaica, were surveyed. RESULTS: Of 421 sites, 282 men and 200 women (random sample, 23 sites) and 320 men and 265 women (special sample, 26 sites) were interviewed. Over one fourth of men and 14% (special) and 4% (random) of women had one or more new sex partners in the last 4 weeks. Seventy-eight percent of men reported condom use at last sex with a new partner compared with 66% of women. Approximately 50% of respondents reported condom use at last sex with a regular partner. CONCLUSION: Sites at which people meet new sex partners were diverse with significant opportunities for prevention. Commercial and transactional sex are features at many sites.