The UALE Project: decline in the incidence of HIV and sexually transmitted infections and increase in the use of condoms among sex workers in Guatemala

To assess the impact of a multilevel sexually transmitted infections (STI)/HIV prevention and treatment intervention on the incidence of STIs and HIV, the use of condoms, and HIV knowledge among sex workers (SWs). An open-enrolment cohort of 1554 SWs attending STI clinics integrated within the primary health care system of Escuintla, Guatemala. They were offered 6 monthly STI/HIV screening, condom promotion, education, and community-based interventions. We evaluated trends in condom use, HIV-related knowledge, and STI/HIV incidence using generalized estimating equations. For over three and a half years, there was a significant increase in the proportion of consistent condom use from the baseline visit through the third follow-up visit (94.29%-99.11% with new clients and 90.36%-97.22% with regular clients) and in HIV-related knowledge (95.99%-97.22%). Except for syphilis, we observed a significant decline in gonorrhoea, chlamydia, trichomoniasis, and candidiasis in each follow-up visit, from 11.30 per 100 person-years, 10.71 per 100 person-years, 6.88 per 100 person-years, and 8.23 per 100 person-years in the first follow-up visit to 6.44 per 100 person-years, 6.21 per 100 person-years, 4.81 per 100 person-years, and 6.17 per 100 person-years in the third follow-up visit, for each STI, respectively. HIV global incidence was 0.41 per 100 person-years, and it significantly declined from 1.85 per 100 person-years (2005) to 0.42 per 100 person-years (2008). Although a longer follow-up would be needed, the results suggest that the intervention was feasible and has been shown to be effective in reducing STI and HIV incidence and in increasing condom use with clients and HIV-related knowledge.