Results of a Randomised Trial of Male Condom Promotion Among Madagascar Sex Workers

This article was published in Sexually Transmitted Infections, Vol 81, 2005, a peer review journal for health professionals and researchers in all areas of sexual health.

The objective of this study was to test the effect of supplementing peer promotion of male condom use with clinic based counselling, measured in terms of sexually transmitted infections (STI) prevalence and reported male condom use in Madagascar. 1000 female sex workers in Madagascar were randomised to two study arms: peer education supplemented by individual risk reduction counselling by a clinician (peer + clinic) versus condom promotion by peer educators only (peer only). STI testing was conducted at baseline and 6 months. Behavioural interviews were administered at baseline, 2, 4, and 6 months.

The study concluded that the impact of male condom promotion on behaviour can be heightened through more concentrated counselling on risk reduction. Persistently high STI prevalence despite increases in reported condom use by sex workers supports the need for multi-dimensional control programmes. According to the report, aggregate STI outcome was reduced by 20-30% among women who received clinic based condom counselling as a supplement to peer education. Findings also suggest that individualised counselling by clinicians may further increase sex workers’ condom use with non-paying partners.