Our previous research efforts focused on STD and HIV prevention for Commercial sex workers (CSWs) and manager/supervisors of establishments which employ them in Philippines. Based on the sucessful results of individual and organization based approaches consisting of peer education and organization change (including educational policy regarding STD prevention and condom use), an expanded program is being conceptualized in our current intervention sites in the southern Philippines. The expanded effort is directed toward high-risk groups outside the commercial Sex establishments and Social Hygiene Clinics where we have successfully implemented organizational changes leading to significant reductions in STD. Included in the cxpanded effort are male clients of CSWs from high-risk communities, military/police, indussrial workers, and taxicab drivers. The expanded efforts will also include high-risk communities, community officials and health care personnel. The objective-of this comprehensive intervention is to build an exploratory model to examine the value expectancies, community norms and values, and social influences on the behaviors and attitudes associated with safer sexual practices. A theoretical/conceptual model consisting of self- efficacy, self-esteem, communication of condom use between client and worker, and intention to use condoms has been developed to examine the relationship between endogenous and exogenous variables. Four, two group quasi-experimental designs wlll be employed with intervention efforts for CSWs and managers as a standard across all four sites. Specifically, interventions will be implemented separately for health workers, industries, high-risk communities, military/police and taxi/pedicab drivers in one of four sites with a second site serving as a control. Approximately 7,000 individuals will participate in the intervention activities. A series of bivariate and multivariate procedures will be used to examine the effects of the intervention including the use of use of structural equation modeling to examine the causal structure between endogenous and exogenous variables. The outcome variables also include type of STD and cost per prevented STD case. In addition, qualitative analyses will be used to identify the process by which the interventions become institutionalized thus maintaining long term effects in the community.
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