PEER was conducted among commercial sex workers (CSWs) in Haiti to investigate the context in which condom use decision-making takes place. Key findings include:

• A typology of venues where sex is sold
• Detailed understanding of the social and economic context in which sex work takes place, and how sex workers live their lives, including routes of entry into sex work
• Better understanding of risk and trust, e.g. the role of current or ex-clients as trusted partners, used for emotional and financial support, pleasure and longer term economic gain
• Understanding the detailed drivers and barriers to condom use, e.g. CSWs may see 15 clients a day and attempt consistent condom use, but alcohol and drugs often impair their ability to maintain a ‘no condom, no love’ strategy
• The central role of condoms as a risk mitigation strategy, and the many barriers both in terms of negotiating use and securing access, e.g. shortages during carnival time, and an unpleasant smell distracting clients
• CSWs’ prime motivation: finding effective methods to support their children, whilst minimising risk of both infection and stigmatization.
  

PSI Haiti used the study to identify ‘emotional hooks’ to use in their programmes. They saw that a successful intervention would need to seem ‘young, clever, street smart, entrepreneurial, ambitious, competent and self-reliant’. Rather than focussing on health-related messages, they focused Condomania (the name of the intervention) around a promise that, ‘the products, skills and knowledge under Condomania will help you take control today, to secure your future, and will be more effective at securing your and your children’s future than going it alone’. Findings helped PSI Haiti to target outreach activities; develop appropriate messages and materials; and understand the real motivations and constraints faced by sex workers. Shannon Bledsoe, PSI Haiti Country Director, reported that ‘PEER really helped us to understand the environment that sex workers are living and working in’.

Link to full report.