AEGiS-13IAC: A voucher programme can efficiently target groups with high need for sexual health services, the case of Managua.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

A voucher programme can efficiently target groups with high need for sexual health services, the case of Managua.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC768)

Gorter A, Segura Z, Zuniga E, Torrentes R, Sandiford P
A. Gorter, Inst Centroamericano de la Salud (ICAS), Apartado Postal 2691, Managua, Nicaragua, Tel.: +505-2700252, Fax: +505-2770178, E-mail: agorter@ibw.com.ni

BACKGROUND: Nicaragua is still at an early stage of the AIDS epidemic, when strategies directed at groups with high rates of sexually transmitted infections (STI) are highly cost effective.

METHODS: In 1995 a programme was designed to increase uptake of health services by sex workers (SW) of Managua, their partners and regular clients. The essential idea is to increase uptake by regularly giving vouchers to these groups entitling them to free care from any one of a variety of private, charity and public clinics contracted in advance by competitive tender. Vouchers are distributed at the prostitution sites and also via SW to partners/clients. Quality is monitored and only the best clinics are contracted. The cycle of rounds is repeated every 4 to 6 months.

RESULTS: In 8 rounds 8,484 vouchers were distributed, of which 3,396 (40%) were used by 2,065 SW. Each round on average 425 SW participated (of about 1,150 SW in Managua, turnover is high). Prevalence of gonorrhoea in all SW dropped from 10% in the first to 7.9% in the last round. SW who used vouchers repeatedly tended to be those with a much higher initial prevalence: SW who used a voucher 4 or more times had an initial prevalence of 14.5% (which dropped to 8.4%) compared to those who only used a voucher once and had a prevalence of 7.5% (difference p>0.005). Incidence in all repeating users decreased from 279/1000 persons-years to 75/1000 persons-years (73%). During the last round vouchers were distributed to partners/clients. Of 1,731 vouchers distributed 224 (13%) were redeemed with 52% of these men having one or more STI, indicating that the programme is further targeted by the clients/partners themselves, who self-select if in medical need.

CONCLUSIONS: A voucher programme can efficiently target groups with high rates of STI. Those more in need of medical attention tend to make more use of the vouchers.

Keywords: AEGIS, Health Services Needs and Demand, Prevalence, Prostitution, Demography, Acquired Immunodeficiency Syndrome, Gonorrhea, Incidence, Ambulatory Care Facilities, Biological Transport, Protein Transport, Nicaragua, Human, Male
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