title: Promotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial.
abstract: BACKGROUND
  In Latin America, motels rent rooms for commercial and non-commercial sex. We investigated the impact of providing health-education material and condoms on condom use in Managua, Nicaragua.
  
  
  METHODS
  In a randomised controlled trial, in 19 motels, we gave condoms on request, made them available in rooms, or gave condoms directly to couples, with and without the presence of health-education material in the rooms. In a factorial design we assessed condom use directly by searching the rooms after couples had left.
  
  
  RESULTS
  11 motels were used mainly by sex workers and their clients and eight mainly for non-commercial sex. 6463 couples attended the motels in 24 days. On 3106 (48.0%) occasions, at least one used condom was retrieved. Condom use was more frequent for commercial sex than for non-commercial sex (60.5 vs 20.2%). The presence of health-education material lowered the frequency of condom use for commercial sex (odds ratio 0.89 [95% CI 0.84-0.94]) and had no effect on use for non-commercial sex (1.03 [0.97-1.08]). Condom use increased for commercial (1.31 [1.09-1.75]) and non-commercial sex (1.81 (1.14-2.81) if condoms were available in rooms. Directly handing condoms to couples was similarly effective for commercial sex but less effective for non-commercial sex (1.32 [1.03-1.61] vs 1.52 [1.01-2.38]).
  
  
  CONCLUSIONS
  In Latin America, motels are key locations for promoting the use of condoms. Making condoms available in rooms is the most effective strategy to increase condom use, whereas use of health-education material was ineffective. These findings have important implications for HIV-prevention policies.
authors.affiliation: Department of Social Medicine, University of Bristol, UK. m.egger@bristol.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Egger
authors.forename: J
authors.initials: J
authors.lastname: Pauw
authors.forename: A
authors.initials: A
authors.lastname: Lopatatzidis
authors.forename: D
authors.initials: D
authors.lastname: Medrano
authors.forename: F
authors.initials: F
authors.lastname: Paccaud
authors.forename: G D
authors.initials: GD
authors.lastname: Smith
mesh_terms: D017280:Condoms / Q000706:statistics & numerical data*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006266:Health Education / Q000379:methods*; D006798:Housing; D006801:Humans; D009527:Nicaragua; D011477:Sex Work; D014505:Urban Population