[health menu] XI International Conference on AIDS
July 7-12, 1996

Levine William C., Higueras G., Revollo R.,
Vega J, Aliaga A, Tinajeros F, Garnica M.,
Lewis J., Ugarteche J., Kaune V., Estenssoro M.,
Wright-Deaguero L., Pareja R., Negron E., Posner J.,
Ransom R., Melgar M, Kuritsky J.
Proyecto Contra SIDA, La Paz Health Dept.
National Secretariat of Health
CIES, La Paz, Bolivia

Johns Hopkins Univ/CCP, Baltimore
Center for Disease Control, Atlanta, USA


Rapid Decline in Sexually Transmitted disease Prevalence Among Brothel-based Sex Workers in La Paz, Bolivia: The Experience of Proyecto Contra SIDA, 1992-1995


Efforts to decrease sexually transmitted diseases (STDs) among female sex workers (FSWs) have been most successful in countries responding to massive HIV epidemics (e.g., Thailand), and in intensive research settings (Projet SIDA, Zaire). Proyecto Contra SIDA/Bolivia was designed to avert an HIV epidemic by rapidly reducing STD prevalence among FSWs in a resource-poor setting with low HIV prevalence and no effective public STD services.


STD clinical and lab training and STD care, based in public facilities, and clinic and community-level behavioural assessments began in 1992. In collaboration with a local NGO, intensive community-level behavioural interventions began in 1993. As the project expanded, an increasing proportion of the 100-150 brothel FSWs seen at the clinic weekly received lab tests and on-site treatment. In 1994, project and health department clinical services were integrated under a common protocol. Trends in gonorrhoea, syphilis (RPR titer >1:8), genital ulcers, and condom use were assessed with the x2 test for trend.


From 2/92- 8/95, the number of brothel FSWs tested increased from about 15 to 50 per month (once every 3 months per FSW). The median number of sex partners of women tested did not change significantly over time (about 32 per month). STD prevalence declined and self-reported condom use ("always" or "almost always" use) increased:

1992 1993 1994 1995 p-value
Gonorrhoea, % 21.2 26.4 18.2 9.5 <0.001
Syphilis, % 15.0 11.7 4.5 7.4 0.003
Genital ulcer disease, % 3.9 5.2 3.3 1.5 0.030
Condom use, % 35.5 35.6 61.6 73.5 <0.001

HIV seroprevalence remained <1% throughout this period.


This HIV/STD prevention model is now being replicated in other cities in Bolivia. Proyecto Contra SIDA/Bolivia is an example of how a program of intensive clinical and behavioural interventions for FSWs can be developed rapidly, adapted to existing public health services, and result in a rapid decline in STD prevalence.

William C. Levine
Division of STD Prevention
Centers for Disease Control and Prevention (MS E02)
Atlanta, GA, USA 30333
Tel: 404-639-8371; Fax: 404-639-8610
Email: WCL2@cpsstdl.em.cdc.gov

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Created: July 16, 1996
Last modified: July 17, 1996

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