A structural intervention promoting safer sex atPublic Sex Venues in Amsterdam starting in 2000International partner meeting MexicoBackground

Rising STIs figures amongst MSM in Amsterdam> syfilis> gonorrhea

Evidence for more Unprotected Anal Intercourse (UAI)

Reports of patrons about changing safer-sex norms at PSVs

Limited availibility of condoms and lube at PSVs> having to pay for it> having to ask for it

Choosing directions & objectives (1)International partner meeting Mexico

Basics of behavior change (Ellis etal., 2003)

Awareness of the problem, motivation to act & having the knowledge and skills to do so> individual determinants

To improve the possibility of acting barriers in the social environment should be removed, and support and reinforcement should be given

> structural determinants

So:

Next to Individual prevention, Structural prevention should be implemented setting-based community based

Choosing directions & objectives (2)International partner meeting MexicoObjectives formulated included (based on Fishbeins model):

Overcoming barriers for safer-sex behaviour influencing personal and social norms about safer sex strengthening committment to preventive beahviour at PSVs

To meet this objectives a phased intervention was developed

Fase 0: initiative and preperationCode of Practice: a set of agreementsFormalizing the agreement

Fase 1: implementation ofFree availibility of condoms and lubeAccess to health information & outreachHygiene & sanitary facilities

Fase 2: Further influencing social norms and commitment to preventive behaviour

Results & further planningInternational partner meeting MexicoResults:

Agreements between Schorer and various PSVs

Participating PSVs implemented & financed free condom & lube distribution on their premesis

Several PSVs improved their hygiene and sanitary facilities

Development of a Safe Sex Zone logo, written material & dispensers for condoms and lube

Planning:

Monitoring implementation agreements

Seeking participation of more PSVs

Programmed outreach & peer-led interventions >> social norms

Facilitating / stimulation more public financing of condoms and/or lowering the costs for PSVs

Lessons learnedInternational partner meeting Mexico

Community-based structural interventions depend heavily on the involvement of partners

Lobbying of partners is time-consuming and (a) essential (skill) for health promoters

Starting top-down initiatives are sometimes necessary for starting up bottom-up development

Free condom distribution improves condom use at PSVs (posterpresention)