April 28, 2003
The authors propose an innovative method that shifts the focus from risky people to risky places. This method, called PLACE (Priorities for Local AIDS Control Efforts), systematically identifies places where new sexual partnerships are formed and identifies areas where people with high rates of new partner acquisition can be reached without either assigning or defining membership in groups that can carry stigma. The focus is on new partnerships because rates of new partner acquisition are a major force driving HIV and other STD epidemics. The authors evaluated PLACE assessment in four urban applications in South Africa.
The first application was in a township in Cape Town (population 80,000) in the Western Cape Province and was then subsequently implemented in the Eastern Cape Province townships of East London (population 100,000) and Port Elizabeth (population 60,000). The protocol was also tested in the business district of Port Elizabeth (population 12,000). Interviewers asked over 250 informants per area to identify public sites where people meet new sexual partners, whereby such sites were mapped and visited. A knowledgeable person onsite was interviewed about the site and its patrons, and individuals socializing at sites were interviewed about their sexual behavior.
More than 200 sites in each township and 64 sites in the central business district were identified and visited. Township sites shared some similarities, with more than 75 percent being small local drinking places, called shebeens, which typically had fewer than 30 patrons during busy times. In the business district, sites were more likely to have 100+ patrons and bars, taverns, bottle stores, nightclubs, streets and hotels replaced the informal shebeens.
Although the partner acquisition rates in this study cannot be generalized to the entire township population, estimating the proportion of people participating in these place-based networks is important. The sites described in this study are likely to be the last setting prior to sex accessible for prevention efforts in the township. The PLACE studies highlight that AIDS prevention messages and condoms were unavailable at sites where their impact could be largest.
Due to limited resources for HIV prevention programs and monitoring and evaluation of AIDS prevention, there exists an urgent need for pragmatic methods in selecting where to focus public health interventions. The authors concluded, "any scale-up of prevention programs requires methods that are feasibly implemented at low cost in a reasonable period of time by non-professional staff. The PLACE approach appears to be such a method. Gaps in AIDS prevention were quickly identified as well as priority sites for condom distribution and AIDS education."
04.11.03; Vol. 17; No. 6: P. 895-903; Sharon S. Weir; Charmaine Pailman; Xoli Mahlalela; Nicol Coetee; Farshid Meidany; J. Ties Boerma