Evidence of Changes in Sexual Behaviors Among Male Factory Workers in Ethiopia

Heterosexual contact is the most common form of HIV transmission in the developing world. Messages about reducing the number of partners and using condoms during casual sex have effected changes in risky behavior, the authors noted, citing data from Thailand and Uganda, where both HIV prevalence estimates and prevalence of risky sexual behaviors have decreased over the past decade. However, the report said, few longitudinal studies have been undertaken to correlate risk reduction with lower incidence rates of HIV and STDs among the same population group.

The current study assesses changes in sexual behaviors among Ethiopian male factory workers, using open cohort studies in two factories near Addis Ababa. Nearly 16 years after the HIV epidemic began in Ethiopia, recent surveillance data suggest a decline in HIV prevalence among young pregnant women who live in the inner city of Addis Ababa. The authors hypothesized that the decline might be related to intervention programs that have been conducted in the country since 1987. However, political instability has constrained the programs, and no longitudinal studies have been conducted to evaluate their effectiveness. "In this paper, we present the first evidence of change in sexual behaviors among male factory workers who participated in a cohort study on HIV incidence and disease progression in Ethiopia," they explained.

Between February 1997 and December 1999, the investigators collected data on 1,124 males regarding casual sex, sex with commercial sex workers (CSWs), condom use, and history of STDs as indicated by genital discharge and genital ulcer. The two cohort sites are a fiber-products factory in Akaki, a suburb of Addis Ababa, and Wonji, a sugar estate southeast of Addis Ababa. The studies are ongoing, expected to last 8 to 10 years.

At enrollment in the studies, 77.8 percent of participants were 30 or older, and 80.1 percent reported they were married. At intake, the prevalence of casual sex in the past year was 9.7 percent; past sex with commercial sex workers, 43.4 percent (no time frame specified); condom use with the last casual partner, 38.8 percent (Akaki site only); genital discharge within the past five years, 10.6 percent; and genital ulcer within the past five years, 2.1 percent. HIV prevalence was 11.2 percent in Akaki and 6.9 percent in Wonji. Participants were offered health education, HIV testing and counseling.

From 1997-1999, at both sites, between the first and fourth biannual follow-up visits, researchers saw a decline in the proportion of males reporting recent casual sex, sex with CSWs, and genital discharge. Changes in rates of HIV incidence were not statistically significant, but the incidence of STDs declined in relation to the decline in casual sex. The authors attributed part of the decline in risky behaviors to prevention interventions for workers who participated in the study. Part of the decline may also be due to more general interventions that helped reduce risky behaviors in the surrounding community.

"In conclusion," Mekonnen and colleagues wrote, "this study provides substantial evidence that risky sexual behaviors and the incidence of STDs have decreased in this cohort of factory workers provided with health education and HIV testing and counseling. This program offers an encouraging view of the interventions that can be offered to developing countries to minimize the spread of HIV infection."

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