Evidence of changes in sexual behaviours among male factory workers in Ethiopia Yared Mekonnen a , Eduard Sanders a , Mathias Aklilu a , Aster Tsegaye a , Tobias F. Rinke de Wit a , Ab Schaap a , Dawit Wolday a , Ronald Geskus b , Roel A. Coutinho b and Arnaud L. Fontanet a,b,c Objective: To assess changes in sexual behaviours among male factory workers in Ethiopia. Design: Open cohort studies in two factories near Addis Ababa. Data and methods: At intake and biannual follow-up visits, data were collected on sexual behaviours including casual sex, sex with commercial sex workers (CSW), condom use, and history of sexually transmitted diseases (STDs) as indicated by genital discharge and genital ulcer. Health education, HIV testing, and counselling were offered to all participants. Results: Between February 1997 and December 1999, 1124 males were enrolled in the two cohort studies. At intake, the prevalence of casual sex in the past year, sex with CSWs, condom use with the last casual partner, history of genital discharge in the past 5 years, and history of genital ulcer in the past 5 years were 9.7, 43.4, 38.8 (Akaki site only), 10.6 and 2.1%, respectively. At the Wonji site, the intake prevalence of casual sex, sex with CSW, and history of genital discharge decreased significantly by calendar year between 1997 and 1999. At both sites combined, between the first and the fourth follow-up visits, there was a decline in the proportion of males reporting recent casual sex (from 17.5 to 3.5%, P , 0.001), sex with CSWs (from 11.2 to 0.75%, P , 0.001), and genital discharge (from 2.1 to 0.6%, P ¼ 0.004). Conclusion: There was a decline over time in risky sexual behaviours reported by cohort participants. Part of this decline occurred independently of cohort interven- tions. & 2003 Lippincott Williams & Wilkins AIDS 2003, 17:223–231 Keywords: HIV, sexual behaviour, genital discharge, genital ulcer, Ethiopia Introduction Changes in sexual behaviours have been advocated to reduce the spread of HIV in the developing world, where heterosexual sex is the most common mode of HIV transmission [1–3]. These changes mainly involve reduction in the number of sexual partners [4,5] and increase in condom use during casual sex [6]. The effectiveness of these changes is supported by data from Thailand and Uganda, where both HIV prevalence estimates and prevalence of risky sexual behaviours decreased in the past decade [6–9]. However, few longitudinal studies have been conducted within the same population group to correlate reduction in behav- Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. From the a Ethio-Netherlands AIDS Research Project (ENARP), Ethiopian Health and Nutrition Research Institute (EHNRI), P.O.Box 1242, Addis Ababa, Ethiopia, the b Divison of Public Health and Environment, Municipal Health Service, Amsterdam, The Netherlands and the c Emerging Diseases Epidemiology Unit, Pasteur Institute, Paris, France. Correspondence to Yared Mekonnen, Ethio-Netherlands AIDS Research Project (ENARP), Ethiopian Health and Nutrition Research Institute (EHNRI), P.O.Box 1242, Addis Ababa, Ethiopia. Fax number: 251 1 756329; e-mail: yared@enarp.com Received: 12 October 2001; revised: 13 September 2002; accepted: 24 September 2002. 10.1097/01.aids.0000042952.95433.30 ISSN 0269-9370 & 2003 Lippincott Williams & Wilkins 223