What Works for Women and Girls

collective commitment approach that involved sex workers, managers, owners, deejays,and other establishment employees in workshops and meetings in order to strengthenrelationships and collective commitment for condom use. Second, environmental cues,such as 100% condom posters and stickers and glass bowls with condoms, as well asother awareness-raising activities. Third, confidential clinical services for sex workers(who were required by law at the time of the study to attend monthly STI checks),that included training for health workers and Ministry of Health inspectors on ethicalprocedures and HIV, among other things, and the establishment of sex worker peereducator pre- and post-test counseling. Use of condoms and adherence to the programwas measured against five study elements: visibility of condoms in the establishment,stocks of at least 100 condoms, attendance of sex workers at monthly STI checks, andlack of positive STI diagnoses among sex workers (no individual STI results wereshared with establishment owners. In Puerto Plata only, a regional government policywas established that required condom use between sex workers and their clients thatwas communicated to all participating sex establishment owners in the city. It was alsocommunicated to owners in both cities that they had the ultimate responsibility forcondom use, not the sex workers that worked for them. NGO staff and regional publichealth officials met with establishment owners on a quarterly basis in both cities toassess adherence. In both cities, intensified education was provided by the NGO toestablishments that were lagging and award certificates were given to those that showedadherence with the strategy. In Puerta Plata, establishment owners were subject tograduated sanctions, such as notifications, fines, and closing, for lack of adherence.(Kerrigan et al., 2004: 2). Data collected showed that consistent condom use with newclients significantly increased in Santo Domingo, from 75% to 94%. In Puerta Plata, therate increased from 96% to 98%. Significant overall declines in the STI rates of bothapproach sites were observed. Furthermore, an association was found between higherrates of consistent condom use and higher levels of exposure to the workshops. Lastly,levels of compliance with the policies was found to be significantly higher in the PuertaPlata site which implemented government sanctions for non-compliance in addition tothe community approach. In Puerta Plata, the rate of consistent condom use by regularand nonpaying partners rose significantly, from 13% to over 28%. Sex workers in PuertaPlata reported a significantly increased ability to reject unsafe sex, from 50% to 79%.In Puerta Plata, there was a significant decrease from over 28% to less than 17% of oneor more STIs (Kerrigan et al., 2006; Kerrigan et al., 2004). (Gray III) (condom use, sexworkers, Dominican Republic) [See footnote]A study of 310 sex workers in China found that among sex workers who perceivedsupport for condom use from “my boss” was correlated with higher rates of condomuse. Sex workers with access to condoms and who agreed with the statement, “If Irefuse to serve a customer who does not want to use a condom, my boss will supportme” and whose manager encourages health check-ups reported more condom use. Sexworkers who reported this support were 1.7 times more likely to report overall consis-84 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS