March 13, 2003
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.
"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."
01.24.03; Vol. 17; No. 2: P. 223-231; Yared Mekonnen; Eduard Sanders; Mathias Aklilu; Aster Tsegaye; Tobias F. Rinke de Wit; Ab Schaap; Dawit Wolday; Ronald Geskus; Roel A. Coutinho; Arnaud L. Fontanet