Post Intervention Survey Report: HIV/AIDS/STI Knowledge, Attitude & Practice (KAP) Survey Among Commercial Sex Workers, Military and Youth in Port Loko, Sierra Leone

This 40-page evaluation shares results from a baseline and post-intervention survey carried out to shape, and then assess, a communication-centred project launched in January 2001 by American Refugee Committee (ARC) International in Port Loko, Sierra Leone. The goal was to address HIV/AIDS and sexually-transmitted infections (STIs) among "core transmitters" of HIV such as commercial sex workers, military personnel, youth, ex-combatants, and transport workers. The central activities of the project consisted of information, education, and communication (IEC) materials, behaviour change communication (BCC) campaigns, condom distribution, and STI treatment. Posters, billboards, newsletters, tabloids, and radio jingles were used to spread HIV/AIDS and STI prevention messages. Outreach was carried out through events and educational workshops.

Excerpts from the Executive Summary follow:

"Baseline Survey

In March 2001, a baseline survey of knowledge, attitudes, and behaviours regarding HIV/AIDS and sexually transmitted infections (STIs) was conducted by the American Refugee Committee (ARC International) in the city of Port Loko, Maforki Chiefdom, Port Loko District in the Northern Province of Sierra Leone, in order to develop an effective HIV/AIDS and STI prevention project in Port Loko.

To gather baseline information, ARC interviewers surveyed a total of 940 individuals identified as being at particularly high risk of HIV infection due to their categorisation in the following four groups: military, commercial sex workers (CSWs), youth and ex-combatants. Survey questions explored people's knowledge and attitudes about methods of transmission and prevention of HIV and STIs, as well as their practices in relation to risk behaviours.

In general, baseline knowledge about transmission and prevention was quite low among the population surveyed, and personal concern about becoming infected with HIV was low. While 60% of both the military and commercial sex workers at baseline had ever used a condom, only a quarter of the youth had ever done so. The use of a condom at last sexual encounter ranged from 38% and 39% of commercial sex workers and military respectively to 16% of both male and female youth, which pointed towards the need for dramatic behaviour changes in the target groups.

The baseline survey findings were used to make recommendations to design an effective HIV/AIDS/STI prevention project. Additionally, a number of objectives were set for the project:

• Increase the target populations' knowledge of 3 or more correct means of HIV/AIDS transmission from 10% of respondents to 40% of respondents in two years.
• Increase the target populations' knowledge of 3 or more effective means of avoiding AIDS from 6% of respondents to 26% of respondents in two years.
• Increase the target populations' knowledge of 3 or more sources of condoms from 12% of respondents to 32% of respondents in two years.
• Increase the reported use of condoms during last sexual intercourse among target populations from 26% of respondents to 41% of respondents in two years.

Post-Intervention Survey

ARC has been performing HIV/AIDS and STI sensitisation in the Port Loko community since 2001, putting into action the recommendations made from the baseline survey results. A post intervention survey was conducted by ARC from June 9th to June 19th 2003 to measure changes in the target populations regarding knowledge, attitudes, and behaviours surrounding HIV/AIDS and STIs. The survey results are an integral component of ARC's programme monitoring and evaluation, and will enable ARC to further refine and improve its programme.

The post-intervention survey instrument was identical to the baseline survey instrument, with the addition of a small number of questions regarding participation in ARC activities and awareness of ARC educational materials. A total of 956 interviews were performed among the high-risk target populations of ARC's interventions: military, CSWs, youth and ex-combatants.

Survey results indicated a dramatic rise in levels of knowledge of HIV/AIDS transmission and prevention, surpassing each knowledge objective set by ARC. As a total sample, the proportion of respondents able to cite three or more correct routes of AIDS transmission rose from 1 in 10 to 1 in 2; the percentage able to describe three or more effective means of avoiding AIDS increased from 6% to 54%; and the percentage able to name three or more condom sources increased from 12% to 56%. Levels of knowledge were even higher among specific sub-groups, with military and CSW respondents demonstrating the highest levels of knowledge: 75% of military respondents were able to cite three or more correct routes of transmission; and 81% of CSWs were capable of naming three or more sources of condoms. However, levels of knowledge among the youth lagged consistently behind: for example, only 32% of male youth respondents could correctly name three or more routes of AIDS transmission.

Condom use behavior across all sub-groups has experienced a significant increase from baseline, with those respondents reporting condom use at last sexual intercourse doubling from 26% to 53%, exceeding ARC¡¦s objective. Again, military and CSW respondents report the highest condom use behaviour (both with 68% use at last sexual intercourse, and 82% and 83% reporting having ever used a condom, respectively), while male youth report the lowest levels of condom use, with only 37% condom use at last intercourse and 50% having ever used a condom.

Despite increases in knowledge and condom use behaviour, levels of concern about becoming infected with HIV remain fairly low for all groups surveyed. Military respondents continue to demonstrate the highest level of concern about AIDS, with 49% reportedly worrying "a lot" about AIDS, though this percentage is similar to the baseline survey. The percentage of respondents not worried about AIDS remains highest among CSWs at 53%, which is unchanged from baseline. Also of concern, only 22% of female youth report worrying "a lot" about AIDS (a 13 percentage point decrease from baseline).

Despite increases in knowledge, negative attitudes about people living with HIV/AIDS persist at much the same levels as were found at baseline, with 49% of the total sample believing people with AIDS should be isolated or reported. It is interesting to note, however, that the proportion believing people with AIDS should be counseled or treated has increased significantly from 56% to 72% of respondents. This apparent inconsistency of beliefs suggests that much work still needs to be done to decrease the stigma surrounding HIV/AIDS..."

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