title: The impact of peer outreach on HIV knowledge and prevention behaviours of male sex workers in Mombasa, Kenya.
abstract: BACKGROUND
  Targeting most at-risk populations is an essential component of HIV prevention strategies. Peer education programmes have been found to increase HIV knowledge, condom use and safer sex behaviours among female sex workers in Africa and men who have sex with men elsewhere. The authors aimed to evaluate the impact of a peer-driven intervention on male sex workers who sell sex to men in Mombasa, Kenya.
  
  
  METHODS
  Using time-venue sampling, a baseline survey of 425 male sex workers was conducted in late 2006, after which, 40 peer educators were trained in HIV prevention, basic counselling skills and distribution of condoms and lubricants. A follow-up time-venue survey of 442 male sex workers was conducted in early 2008, and pre- and post-intervention changes were examined. The impact of peer educator exposure on HIV knowledge and condom use was analysed.
  
  
  RESULTS
  Positive changes in HIV prevention behaviours were observed, including increases in consistent use of condoms with both male clients (35.9%-50.2%, p<0.001) and non-paying male partners (27.4%-39.5%, p=0.008). Exposure to peer educators (AOR=1.97, 95% CI 1.29 to 3.02) and ever having been counselled or tested for HIV (AOR=1.71, 95% CI 1.10 to 2.66) were associated with consistent condom use in multivariate analysis. Peer educator contact was also associated with improved HIV knowledge and use of water-based lubricants.
  
  
  CONCLUSIONS
  Peer outreach programming reached highly stigmatised male sex workers in Mombasa, resulting in significant, but limited, improvements in HIV knowledge and prevention behaviours. Improved peer coverage and additional prevention initiatives are needed to sufficiently mitigate HIV transmission.
authors.affiliation: Population Council, Box 17643-00500, Nairobi, Kenya. sgeibel@popcouncil.org
authors.forename: Scott
authors.initials: S
authors.lastname: Geibel
authors.forename: Nzioki
authors.initials: N
authors.lastname: King'ola
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D008297:Male; D060386:Sex Workers; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D016896:Treatment Outcome