Introduction
In Lebanon, HIV is concentrated among men who have sex with men (MSM)1. In the general population, prevalence has remained low (<0.1%). By comparison, prevalence among MSM is estimated to be 12% and this vulnerable group has become a priority for HIV prevention and treatment in the last few years1,2.
Lebanon made successful commitments in achieving the 90-90-90 global HIV targets by 2020 in line with the 3rd Sustainable Development Goal: 90% of the population knowing their HIV status, 90% on sustained anti-retroviral therapy (ART) and 90% with suppressed viral load3. In 2019, a test, treat, retain cascade (TTRC) showed that 94.7% of people living with HIV (PLHIV) know their status, 64.5% are retained in ART and 59.3% are virally suppressed4. These rates are in contrast with the majority of the countries of the Eastern Mediterranean Region (EMR) where 34% of PLHIV know their status, 18% are retained in ART and 15% are virally suppressed5.
Several internationally recognized best practices have been adopted in Lebanon including voluntary HIV testing, implementing harm reductions measures for high-risk populations and training healthcare workers to expand community-based HIV prevention measures focused on increasing HIV knowledge and reducing high-risk behaviors among key populations. Voluntary testing can be done at laboratories, private and public hospitals, or voluntary and confidential testing (VCT) centers. The VCT free service provides informative brochures about sexually transmitted infections (STIs) such as HIV/AIDS including how to test for HIV, seek counselling throughout the testing process, and refer to health care and social services. These services target key populations, youth, premarital couples, and blood donors.
According to the National AIDS Program (NAP), 70 VCT centers are currently providing HIV related services. Healthcare workers, peer educators, outreach workers and volunteers in these VCT centers and in other centers (socio-medical centres, primary health care (PHC) centres,…) are trained by the NAP through workshops that aim to provide HIV prevention information, skills and supplies (information, education and communication materials, condoms,…) as well as links to HIV testing, treatment and other services, based on globally recommended best practices for HIV prevention implemented by the World Health Organization (WHO).
Globally, sexual education programs targeting youth in schools, clinics, or community settings are effective interventions to reduce sexual risk taking6,7. A review of 83 experimental and quasi-experimental studies assessing programs using 6 aspects of sexual behavior as criteria concluded that such programs were far more likely to have positive rather than negative impact on behavior6. Education programs successfully delayed initiation of sex in 42% of studies, reduced the frequency of sex in 29% of studies, decreased the number of sexual partners in 35% of studies, increased condom use in 48% of studies, increased contraceptive use in 40% of studies, reduced sexual risk taking in 50% of studies, and had significant positive impacts on pregnancy rates and STI rates. For all these criteria of sexual behavior, the remaining studies found no significant impact of the intervention rather than a negative impact. These programs are thought to contribute to behavioral change by influencing psychosocial mediating factors such as knowledge, perceived risk, values and attitudes, perception of peer norms, self-efficacy, and others7. Most programs significantly increased knowledge including methods of prevention for HIV, STIs, and pregnancy. Only half of the eligible studies significantly increased perceived risk, while more than 60% of studies were effective in improving the measured values and attitudes. Perceptions about peer sexual behavior were significantly improved in 40% of the 29 eligible studies7. The majority of programs had a positive impact on parent communication, intention to abstain or restrict sex, and intention to increase condom use.
Sexual education is absent in the official curriculum of schools and universities and relies mainly on initiatives from community centres staff who are trained by the NAP. In 2018, the NAP in Lebanon developed a series of training material targeting health care professionals and social workers involved in the delivery of life-saving sexual health services. Constraints to verbalize sexual experiences and professionals’ reluctance to discuss sexual issues with patients are some of the major recorded barriers for the successful delivery of these services8. Therefore, there is a clear need to strengthen knowledge of professionals but also bridge the communication gap with beneficiaries.
The main objective of this report is to evaluate this intervention among healthcare workers who are in touch with the different communities. The specific objectives were to compare pre-intervention and post-intervention knowledge about HIV, STIs and stigma and discrimination towards PLHIV.