Use of geographic information systems to monitor access to condoms and lubricants among female sex workers and men who have sex with men in seven Central American countries, 2007
Background: PSI’s HIV prevention activities in Central America (Belize, Costa Rica, El Salvador, Honduras, Guatemala, Nicaragua, and Panama) focus on delivering the information and products necessary for persons at risk of HIV infection to practice preventive behaviours. In January 2007, PSI started a regional monitoring study on access to condoms and lubricants among female sex workers (FSWs) and men who have sex with men (MSM).
Methods: PSI randomly sampled areas with a concentration of entertainment establishments where FSWs and MSM congregate, and used spatial analysis techniques to evaluate access, defined as the proportion of the target group in entertainment venues who are within 200 meters of a condom/lubricant outlet. In each enumeration area, all meeting venues, pharmacies and commercial outlets (3871 sites in 133 areas) were mapped, numbers of FSW and MSM were estimated, and condom and lubricant availability was assessed.
Results: Access to condoms is high across all countries, with a mean of 94% (range: 85%, Belize to 99%, Honduras) among FSW and 92% (range: 87%, Nicaragua to 99%, Honduras) among MSM. In Belize and Nicaragua there are important differences in access levels between FSW and MSM. Access to lubricants ranges from 32% to 89%, being highest among MSM in 5 out of 7 countries (mean for MSM: 76%, FSW: 73%).
Conclusions: Evidence about the status of condom and lubricant availability among high-risk groups enables social marketers to identify areas in which condom/lubricant access for FSW and MSM needs to be improved. Spatial analysis techniques can estimate access to HIV prevention products among persons at risk for HIV around venues where they congregate, whereas maps of priority intervention areas are valuable tools for targeted condom and lubricant distribution and HIV prevention activities. Subsequent rounds of the study will monitor trends in access and will be linked to behavioural studies among FSW and MSM.
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