The authors are Lori Dorman, Pamela Derish and Judith Cohen. Lori Dorman is a doctoral candidate in the Department of Social and Administrative Health Sciences, school of Public Health, University of California, Berkeley. She is also with the Marin Institute of the Prevention of Alcohol and Other Drug Problems. Pamela Derish and Judith Cohen are with the Association for Women’s AIDS Research and Education (AWARE), University of California, San Francisco. The project that produced the paper was funded by a grant from the American Foundation of AIDS Research (AmFAR) and the authors have no reason to bias results and findings of the study.
The article is peer-reviewed and was published in the journal of Health Education Quarterly, Vol. 19(1), in spring 1992. Overview of Study This paper evaluated the Acquired immunodeficiency syndrome (AIDS) prevention program among sex workers in the San Francisco Bay Area. It is unclear what mechanisms in these programs enable people to change their behavior since not enough evaluations of AIDS intervention programs exist. The study aimed to answer five questions using process and outcome evaluation. Quantitative and qualitative methods were combined to gain access to the difficult street-based community of sex workers.
The mean age for women was 30 years with three-fourths of them were black. Upon entry it was found that 7% were infected with human immunodeficiency virus (HIV) and 17% were infected with syphilis which is correlated with crack cocaine use. Former sex workers were selected as field staff to conduct the experiment. They were well-accepted in the environment of the study and became role models. “The literature on diffusion of innovations emphasizes the importance of role models being “near pears” (Bandura 1987, p3). Data
The data included epidemiological data, open-ended interviews, and ethnographic field notes of outreach and outing activities. The data was collected between July 1, 1989 and June 30, 1990. Methods Used Both quantitative and qualitative methods were used due to the difficulty of the environment where sex workers operate. This difficulty was due to their high-mobility, constantly shifting environment, economic and educational disadvantages of target groups, and illegal behaviors of prostitution and drug use. Methods used included questionnaires, open-ended interviews, and ethnographic field notes.
Process Evaluation: Two factors were found important for successful recruitment. First, ease and free level of participation was exercised with no outside pressure to participate which freed the movement of participants in and out of the program. The use of former prostitute field workers who were members of the target population made them indigenous to the life of sex workers. These two factors created mutual trust between field staff and participants. Gaining access to the community at risk and understanding the context of risk behavior are necessary to successful AIDS prevention (Becker & Joseph 1988).
Outcome Evaluation Sex workers confirmed the fact that they feel at risk for AIDS. However AIDS was not their first concern as it came after money and drugs. Sex workers also demonstrated their knowledge about transmission of AIDS and intentions to avoid exposing themselves to HIV. Ninety-four percent of sex workers used condoms with customers while only 25% did it with boyfriend or steady partners. Claims The article claims that indigenous field workers were effective to reach the hidden population of sex workers and became role models towards AIDS prevention.
Qualitative methods such as open-ended interview and ethnographic field notes were found useful because they provide the flexibility during data collection and allow approach to participants based on their terms. Supporting Evidence Evidence based Practice (EBP) was utilized in this paper and four main steps were followed. The first step was formulating the questions which were completed within our study as five questions were defined before the execution of the experiment. The second step involved finding evidence to answer the questions stated in step one.
This was handled in the study by using epidemiological data, open-ended interviews, and ethnographic field notes. The third step involved appraisal and analysis of the data for validity, applicability and reliability. In our study, the data was statistically analyzed and found to be significant. The last step in EBP was the application of findings and evaluating the acceptance. The study applied its findings by building trust with participants and encouraging them to prevent the infection with AIDS.
Applicability to Advanced Generalist Practice The findings of the study are applicable within global perspective. The use of indigenous field workers was found to be an effective way to reach the difficult to reach sex worker environment which could be applied anywhere. They soon became role models and their suggestions concerning AIDS prevention were accepted. The combination between quantitative and qualitative methods to complement one another and better formulate the other to achieve significant findings was proved to be very effective.
Conclusion Quantitative methods of epidemiological survey provide limited responses according the questions crafted in the questionnaire. Qualitative methods are used to explore how AIDS prevention can be integrated in the individual behavior. Qualitative findings could be used to add more specific questions and refine existing questions and categories of response. Questions should focus on the sexual behaviors in both working and private lives in future research. References Bandura A. 1987.
Perceived Self-efficacy in the exercise of control over AIDS infection. Paper presented at the NIMH/NIDA Research Conference on Women and AIDS; Promoting Health Behaviors, Bethesda, MD, September, 1987. Becker MH, Joseph JG. (1998). AIDS and behavioral change to reduce risk – A review. American Journal of Public Health 78:394 – 410. Dorfman, L. , Derish,P. & Cohen, J. (1992). Hey Girlfriend: An Evaluation of AIDS Prevention among Women in the Sex Industry. Health Education & Behavior, Vol. 19, No. 1, 25-40.