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High-Risk Sexual Behavior at Social Venues in Madagascar

Khan, Maria R. PhD*†‡§; Rasolofomanana, Justin R. MD; McClamroch, Kristi J. PhD*†¶; Ralisimalala, Andriamampianina MD; Zafimanjaka, Maurice G. MSc, MBA*; Behets, Frieda PhD; Weir, Sharon S. PhD*†

Sexually Transmitted Diseases: August 2008 - Volume 35 - Issue 8 - p 738-745
doi: 10.1097/OLQ.0b013e3181724383

Background: Persistent high levels of sexually transmitted infection (STI) in Madagascar indicate current prevention strategies are inadequate. STI/HIV prevention based in social venues may play an important role in reaching individuals at risk of infection. We identified venues where people meet sexual partners and measured the need and potential for venue-based prevention.

Methods: Interviews were conducted in 7 Madagascar towns with 1) community informants to identify social venues, 2) individuals socializing at a sample of venues to assess sexual behavior among venue patrons, and 3) venue representatives to assess the potential for venue-based intervention.

Results: Community informants identified numerous venues (range: 67-211 venues, depending on the town); streets, bars, and hotels were most commonly reported. Among 2982 individuals socializing at venues, 78% of men and 74% of women reported new sexual partnership or sex trade for money, goods, or services in the past 4 weeks and 19% of men and 18% of women reported symptoms suggestive of STI in the past 4 weeks. STI symptom levels were disproportionately high among respondents reporting either sex trade or new sexual partnership in the past 4 weeks. Twenty-eight percent of men and 41% of women reported condom use during the last sex act with a new partner. Although 24% to 45% of venues had hosted STI/HIV interventions, interventions were deemed possible at 73% to 90% venues according to 644 interviews with venue representatives.

Conclusions: Venue-based intervention is possible and would reach a spectrum of populations vulnerable to STI/HIV including sex workers, their clients, and other high-risk populations.

Among this venue-based sample, high-risk sexual partnerships were common, whereas condom use prevalence was low. Venue-based STI/HIV prevention is possible and would reach difficult-to-access populations who are vulnerable to infection.

From the *MEASURE Evaluation Project, University of North Carolina, Chapel Hill, North Carolina; †Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina; ‡National Development and Research Institutes, New York, New York; §Public Health Solutions, New York, New York; ∥Institut National De Santé Publique et Communautaire (INSPC), Antananarivo, Madagascar; and ¶Department of Epidemiology and Biostatistics, University at Albany, SUNY, Albany, New York

The authors thank Jocelyne Andriamiadana and Wendy G. Benazerga at USAID, Madagascar, for their guidance in identifying priority study areas, planning the fieldwork, and helping to organize dissemination of study results; Kathleen Van Damme for her invaluable support during initiation of study activities; and all interviewing team members for their diligence.

Supported by the USAID/MEASURE Evaluation Project under the terms of Cooperative Agreement HRN-A-00-97-00018-00. Maria Khan was supported as a postdoctoral fellow in the Behavioral Sciences training in Drug Abuse Research program sponsored by Medical and Health Research Association of New York City, Inc. and the National Development and Research Institutes, Inc. with funding from the National Institute on Drug Abuse (5T32 DA07233).

Correspondence: Maria R. Khan, PhD, National Development and Research Institutes, 71 West 23rd Street, New York, NY 10010. E-mail:

Received for publication November 2, 2007, and accepted February 22, 2008.

© Copyright 2008 American Sexually Transmitted Diseases Association