BACKGROUND: This study is a supplemental inquiry utilizing data from a large-scale, quasi-experimental, HIV prevention intervention with establishment-based commercial sex workers (CSWs) and their managers in the Philippines. Prior studies demonstrate that workplace policies and practices, such as mandatory condom use, the provision of condoms, and ongoing health education workshops, are associated with condom use among CSWs. The aim of this study is to analyze which manager and/or establishment characteristics may be related to the development and maintenance of a workplace sexual health policy supportive of condom use, and other HIV risk reduction behaviors. The data used in our analyses are from structured, face-to-face, follow-up interviews, among all managers of participating establishments (N=135)
METHODS: Our theoretical framework utilizes Bronfenbrenner's ecological systems model. This posits that among CSWs, HIV risk behaviors are related to individual practices, workplace norms, and organizational policies. Based on the literature, we identified manager and establishment characteristics that we hypothesized are related to workplace policies that support HIV protective behavior. We developed a sexual health policy index consisting of 11 items as our outcome variable. We utilized both bivariate and multivariate analysis of variance.
FINDINGS: The significant variables in our bivariate analyses (establishment type, number of employees, amount of bar fine, manager age, and membership in manager association) were entered into a multivariate regression model. The model was significant (p<.01), and predicted 46% of the variability related to sexual health policy within the establishment. The significant predictors were number of employees and establishment type.
IMPLICATIONS: In addition to individually-focused CSW interventions, HIV prevention programs should target managers and establishment policies. Future HIV prevention programs may need to focus on helping smaller establishments in particular, with less employees and lower bar fines, to build capacity and develop sexual health policy guidelines.