Development and first evaluation of a structural intervention promoting safer sex among MSM who frequent public sex venues (PSVs) in Amsterdam
Issues: Behavioural studies show strong associations between unprotected sex and patronage of PSVs. To influence sexual-risk behaviour of PSV patrons, a multi-component structural intervention to create “safer-sex environments” was developed in a collaboration involving PSVs, local government, the public-health service and Schorer, the national organization for gay lesbian health.
Description: Objectives were formulated in terms of overcoming barriers for safer-sex behaviour, influencing personal and social norms and strengthening commitment to preventive behaviour. The intervention consisted of a set of agreements between Schorer and PSVs concerning the availability of free condoms & lube and the access to health information and outreach work but also about environmental issues including hygiene, sanitary facilities and not showing bareback videos or shows. Implementation of the intervention began in mid-2007. Evaluation of the core component, providing free access to condoms & lube, has been completed.
Lessons learned: Each of the partners need to assume responsibility for its own particular role. Local government’s failure to do its part frustrated the intervention for several years. Skills such as tactful and strategic lobbying of all partners proved to be essential for health promoters in realising all contributions. Preliminary results suggest the positive impact of free access to condoms for a high-risk group of MSM who would otherwise not use condoms. A differential impact was found for the way condoms and lube are offered. Intervention elements should cohere with each other and complement the PSV’s ambience.
Next steps: To further influence personal and social norms and patrons’ commitment to preventive behaviour, new ways of providing health information and outreach will be developed. Securing greater local government involvement is a major challenge. Further evaluation, including a controlled study in Rotterdam, is in progress. Nationwide implementation of the intervention will follow. Additional research will be done on personal and environmental cues for safer-sex behaviour in PSVs.
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