RESUMO
Increasingly, acquired immunodeficiency syndrome (AIDS) prevention programs have been developed to reach and influence street-based populations. Standard methods of evaluation do not fit the conditions of such programs. This article describes a process and outcome evaluation of an AIDS prevention program for sex workers in which qualitative and quantitative methods were combined in order to mediate research problems endemic to street-based populations. Methods included epidemiological questionnaires, open-ended interviews with participants, and ethnographic field notes. Process evaluation findings show that field staff who were indigenous to the neighborhood and population readily gained access to the community of sex workers and simultaneously became role models for positive behavior change. Outcome findings show that sex workers do feel at risk for AIDS, but usually from clients rather than from husbands or boyfriends. Accordingly, they use condoms more frequently with clients than with steady partners. Increasing condom use among sex workers with their steady partners remains an important challenge for AIDS prevention. Combining qualitative and quantitative research data provided a more comprehensive assessment of how to reach sex workers with effective AIDS risk reduction messages than either method could have provided alone.
PIP: Qualitative and quantitative methods were combined to evaluate the process and outcome of an AIDS prevention program for sex workers in the San Francisco Bay area. 182 women and 43 of their male, noncommercial, steady partners participated in the study over the period July 1, 1989 - June 30, 1990. Mean age was 30 years, 74.2% of women were Black, 16.5% White, and 5.5% Latina. Data were collected for health status, sexual activity, drug use, and serological status for HIV, syphilis, and hepatitis B. Open-ended interviews were conducted and ethnographic field notes taken. The study revealed that while sex workers may fell at risk for HIV and AIDS, perceived risk stems mostly from sex with clients and not from husbands or boyfriends. Condoms are used in this sample far more frequently with clients than with steady partners. Efforts should therefore be made to increase condom use among steady partners. The study also found former sex worker field staff indigenous to the neighborhood and population to be highly effective in recruiting participants and disseminating information. Moreover, these workers became role models for positive behavior change. Combining evaluative approaches proved more effective in determining how to best reach sex workers regarding AIDS risk reduction messages than could either approach independently.
