How to promote condom use in Hostales in Lima: An experimental approach

Abstract

Background:
Perú has the third highest rate of unintended pregnancies in Latin America and the Caribbean, and STI rates are growing rapidly. New strategies to address these issues are urgently needed. Condom distribution policies have shown success in other countries. Hostales (hourly-rented lodgings for couples) hold promise as a location to anchor such a policy. These spaces, albeit common, have not been well researched. Basic information about hostales is needed to properly design an effective strategy involving them.

Elements of such a policy, such as what condom is provided and at what cost, can have a large effect on its efficacy. Previous studies have mainly used self-reported measures to assess condom usage under similar circumstances. However, due to social desirability and recall bias, this has proved unreliable. New methods are needed.

The objectives of this thesis are to:
1. Describe hostales in Lima. Identify their characteristics, services, distribution, clientele and what purpose they serve in Peruvian Society.
2. Assess the impact of a hostal-anchored condom distribution policy. Determine the effects of brand and type of condom, and that of different levels of discount.
3. Design and evaluate new research methods. Establish hostales, not only as a place for policy making, but also as a place to conduct field experiments using physical trace measures.

Methods:
This thesis takes a multimethod approach. I designed and implemented two field experiments set in two different hostales. The first experiment assessed the effects of seven types and brands of condoms (n = 423), and the second one assessed three different levels of discount (n = 207). Instead of relying on self-reported use measures, after a couple left the hostal, I searched their room for used condoms.
To assess their feasibility as a policy setting and to better understand the popularity, distribution, clientele, and inner workings of these businesses, I conducted sixteen interviews with hostal owners and staff; I georeferenced and photographed 114 hostales in 4 km2 in southern Lima and carried out a quantitative visual analysis of their facades and street signs. Finally, I conducted an exploratory analysis of the waste materials left in the room by the 630 couples participating in the experiments using a unobtrusive physical trace measures framework.

Results:
Hostales are widespread and extremely popular. They can be found across Lima but tend to cluster in commercial areas. Around half of the surveyed hostales where found on Google Maps, which makes it a fallible source of information about them. They are almost entirely oriented toward providing people with a place to have sex. Most operate similarly but differ greatly in style, size, prices, and services. Although the age and socioeconomic status of hostal clientele varies widely, between one-fourth and one-fifth of them appear to be sex workers and their clients. Visitors generally spend just a few hours in them. The staff and owners of hostales were generally positive towards a free condom distribution policy.

Providing generic, state-sponsored condoms did not generate a significant increase in condom use. However, the odds of condom usage increased by up to double when commercial-brand condoms (Piel and Durex) were provided. The type of condom provided did not seem to have an effect. That said, Durex – Extra Thin performed noticeably worse than the other type and brand combinations. This is likely due to its bright red wrapper, which is difficult to see under the red lights used in the hostal but also appears to generate an avoidance response in the clients. Free condom provision in rooms increase the odds of usage substantially, whereas discounts do not appear to significantly increase condom purchase and use in hostales.

Hostales have been prove to be a suitable place to conduct further research. They congregate large groups of people about to have sex, several of which belong to at-risk groups (i.e., sex workers) or are in an at-risk state (i.e., drunk). The way in which they operate allows for the design of different potential studies in the future.

Conclusions:
Through a series of novel and reliable methods to study social phenomena and establish causal relationships in sexual health research, this thesis shows that a condom distribution policy in hostales can considerably improve contraceptive use, under the right circumstances. Additionally, it establishes hostales as a subject for research and a potentially important place to anchor sexual health policies for groups that are otherwise difficult to reach.

Date of Award	21 Feb 2024
Original language	English
Awarding Institution	University of Bath
Supervisor	Melanie Channon (Supervisor) & Eleonora Fichera (Supervisor)