Pilot HIV-Risk Reduction Behavioral Intervention for Commercial Sex Workers in Yerevan, Armenia

The project’s purpose was to pilot-test a theory-based culturally appropriate HIV-risk reduction behavioral intervention with a cohort of Armenian female commercial sex workers (FCSW).  The goal of the intervention was to favorably change in Armenian FCSWs HIV-risk and protective behaviors (with condom use as a primary focus) through provision of appropriate information and development of their motivation and capacity to maintain or adopt low-risk/protective behaviors.  Evaluation of the results utilized a randomized control trial (RCT) design to assess the outcomes of the project at baseline, as well as after three and six months following the intervention.

Between October 2006-July 2007 the collaborative US-Armenian staff prepared the study materials, hired and trained the staff, and rented and equipped the project site.  The field work took place from August 2007 to July 2008.  Of 168 self-identified street FCSWs screened by outreach workers, 120 met eligibility criteria, provided informed consent, completed baseline assessments and were randomized to study groups (54-intervention, 66-control).  At baseline, the intervention and control groups were comparable in terms of sociodemographic characteristics, psychosocial mediators linked to HIV-preventive behaviors and sexual behaviors.  Of the 54 participants assigned to the HIV intervention group, 49 completed the 3-month assessment and 48 completed the 6-month assessment.  Of the 66 participants allocated to the waitlist control group, 58 completed the 3-month assessment and 50 the 6-month assessment.  At each assessment, trained surveyor administered face-to-face interviews with the participants in a private room.  The interviews lasted approximately 30-40 minutes.

An Armenian Health Educator who was trained by professional health educator from Emory University conducted the two-hour intervention based on multiple models of behavior change.  Women randomized to the control group (n=66) were offered the same intervention after the 6-month follow-up assessment was complete.

It was one of the first randomized, controlled trials performed with commercial sex workers, a difficult to reach population.  The Armenian research team gained valuable experience in rigorous and ethical evaluation methods and cutting-edge HIV-prevention theory.  The results suggest that theory of behavior change developed in industrialized societies can help guide interventions internationally, if targeted appropriately.  This study demonstrated that behavioral interventions can be effective even among disempowered, HIV high-risk populations.  The project resulted in lower HIV-risk for Armenian FCSWs.  Findings suggest that a similar program should be incorporated into national HIV prevention strategies.  Similar interventions could be recommended for other Caucasian nations where commercial sex workers operate within similar social and political structures.