Abstract :
[fr] The prevalence of HIV/AIDS in Ecuador has been increasing since it was first reported in 1984. In 2009, the National AIDS Program reported 21,810 HIV/AIDS cases and the worker population was amongst the most affected groups. The present 3-phase research project used the infrastructure provided by Ecuadorian companies to assess workers’ HIV/AIDS transmission and prevention measures knowledge, risk behavior and educational needs (Phase I), to develop an innovative HIV/AIDS educational video (Phase II), and to measure the impact of the video one month after intervention in the same companies (Phase III).In the first phase of the project, a cross-sectional study was conducted on 115 companies and 1732 workers stratified by province (Pichincha, Guayas and Azuay) and working sector (commerce, manufacturing and real estate). Based on the validated “Behavioral Surveillance Survey – Adult questionnaire” developed by Family Health International, we found a prevalence of lack of knowledge about HIV transmission of 49.1% (95% CI: 46.6-51.6). It was higher among males (OR = 1.73 [1.39–2.15]), older subjects (OR = 1.35 [1.02–1.77]), subjects with lower education level (OR = 3.72 [2.44–5.65]), manual labor workers (OR = 2.93 [1.82–4.73]) and subjects without previous exposure to HIV intervention programs (OR = 2.26 [1.79–2.86]). The prevalence of incorrect knowledge about HIV prevention measures amounted 32.9% (95%CI: 30.6-35.2), being higher among individuals with lower education level (OR = 2.28 [1.52–3.43]), married subjects (OR = 1.34 [1.07–1.68]), manual labor workers (OR = 1.80 [1.34–2.42]) and subjects not previously exposed to HIV intervention programs (OR = 1.44 [1.14–1.83]). When considering risk behavior, among the 1,561 sexually active participants, 311 (19.9%) reported having sexual intercourse with commercial sexual partners and 25.9% of them did not use a condom during the last sexual intercourse. Frequency of condom use over the last 12 months distributed as follows: never (13.9%), sometimes (11.1%), almost every time (11.5%) and every time (63.5%). Significant risk factors related to condom use frequency were: female gender (OR = 4.56 [1.45-14.4]); older age (OR = 1.07 [1.03-1.1]), lower education level (OR = 4.69 [1.95-11.3]) and married workers living with spouses (OR = 7.66 [3.08-19.1]). Having a commercial sexual partner was also found to have a very negative impact on condom use with casual sexual partners.On the basis of the salient findings of the cross-sectional study, we developed in Phase II of the project an HIV/AIDS educational video specifically designed for companies. The video features a brief story, similar to a short soap opera with genuine actors. Experts explanations and advices and posters with key messages were also included. The video was reviewed, scored, improved and validated by two focus groups (workers and experts). The 16-min. long video was found to keep the interest of the audience, easy to understand and followed by a narrative section on HIV prevention messages. Its ultimate appropriateness and impact on company workers will have to be assessed on the long term. In Phase III of the project (97 companies and 1189 workers), we evaluated the impact of the educational video in the same companies that participated in Phase I. Lack of knowledge about HIV transmission decreased significantly by 15.9 ± 23.4% after the video intervention (P<0.0001). Subjects with low education level demonstrated a greater improvement than subjects with high education level (P=0.033), and likewise for manual labor workers as compared to other workers (P=0.027). Lack of knowledge of HIV prevention measures decreased significantly by 10.1 ± 22.6% (P<0.0001) but no covariate turned out to influence the improvement. There was also a reported positive impact of the video on sexual behavior. The average proportion of workers having unprotected intercourse with sex workers decreased by 19.3 ± 31.4% (P<0.0001). Females improved more than males (75.5 ± 39.9 vs. 18.1 ± 31.6%). Interestingly, married subjects reported a better improvement than non-married ones (34.1 ± 37.7 vs. 2.4 ± 32.4, P <0.0001).The present study evidenced the lack of HIV knowledge and consistent condom use with commercial sexual partners among company workers in Ecuador. It further questioned the efficacy of existing HIV/AIDS prevention programs and shed light on risk factors and target groups to be accounted for in developing new educational tools. The innovative video developed in this project convincingly improved HIV transmission and prevention measures knowledge and condom use with high-risk sexual partners in company workers. It should therefore be recommended and implemented in other companies to enhance HIV/AIDS prevention strategies in Ecuador.
