Evidence of diffusion from a targeted HIV/AIDS intervention in the Dominican Republic

The diffusion potential of a targeted HIV/AIDS intervention that enlisted p eer educators to disseminate 'safer sex' messages and condoms among female commercial sex workers and their clients was evaluated in the Dominican Rep ublic. Levels of interurban interaction potential were ascertained that lin ked the targeted city of La Romana with the proximate cities of San Pedro d e Macoris and Guaymate. Weekly service statistics generated over an 8-month period were analysed to establish activity areas for the peer educators. D ata were entered and analysed using a geographic information system and int erurban linkages were established. Project out comes were examined via a se ries of three cross-sectional Knowledge, Attitudes and Practices (KAP) surv eys conducted among convenience samples of commercial sex workers at the st art of the intervention and at 4 and 8 months. The results attest to a high degree of interconnectivity between the targeted and proximate cities, and a pattern of interurban mobility that links commercial sex workers, client s and establishments in all three cities. The examination of project outcom es revealed statistically significant changes in condom use in the targeted city of La Romana among commercial sex workers, as well as among their cou nterparts interviewed in the proximate cities of San Pedro de Macoris and G uaymate. These data suggest a diffusion effect. It is concluded that a targ eted intervention may influence proximate cities within a relatively compre ssed period of time. The findings suggest the importance of considering geo graphic diffusion principles, such as urban hierarchies, regional nodes and transportation linkages, when designing HIV/AIDS prevention efforts. It al so has important implications in the selection of control sites when conduc ting experimental studies of HIV/AIDS interventions.