We used an Intervention Mapping Approach (IMA) to derive multi-level HIV prevention strategies aiming to develop an HIV prevention intervention program among female sex workers (FSWs). We also aimed at pilot testing the effects of the IMA-based “HIV Prevention and Awareness Program (HIV-PAP)” on safe sex behaviors and its determinants among FSWs in Tabriz, Iran. To develop HIV-PAP, we conducted the six-step process of IMA. At Step 1, in a cross-sectional study, 140 FSWs were face-to-face interviewed. At Step 2, the program matrix was provided based on the importance and variability for identifying priority factors. At Steps 3 and 4, the methods and strategies for behavioral change were selected, and the HIV-PAP program components and materials were developed. At Steps 5 and 6, evaluation (as a pilot testing with Static-Group Comparison design) was conducted applying a pre-experimental study, in which 30 FSWs were assigned to intervention (n = 15) and control (n = 15) groups. The intervention group participated in a two-month long program, and one month later, the initial questionnaires were completed by both groups. The respondents (M age: 33.4 years, SD: 9.7) acquired low score (less than 50%) in negotiating for condom use (49.8%) only, and moderate scores (50–65%) in perceived social support (61.6%) and knowledge (60.5%). Adjusted for other variables, the factors (R² = 32.0%) associated with safe sex behaviors among FSWs were predisposing factors [self-efficacy (β = 0.331), perceived norms (β = 0.945), and perceived barriers (β = 0.258)], condom use negotiation (β = 1.386), and environmental factors (β = 0.333). Our IM-based framework had an adequate fit index (χ² = 130.8, CFI = 0.78). Looking for inter-group comparison after intervention, we found significant mean difference (MD) for knowledge (MD: 2.18; 95% Confidence Interval (CI) − .38 to 4.74, p < 0.05), self-efficacy to use condom (MD: 6.71; 95% CI − 1.85 to 9.29, p < 0.05), perceived risk (MD: 2.03; 95% CI 0.58, to 3.49, p < 0.05), perceived social support (MD: 4.64; 95% CI − 5.37 to 11.31, p < 0.01), and safe sexual behaviors (MD: 7.75; 95% CI − 4.19 to 9.71, p < 0.05). The HIV-PAP showed effectiveness in promoting safe sexual behaviors and their determinants among FSWs. Healthcare providers should better understand the determinants of safe sexual behaviors among FSWs in the settings with legal prohibitions for sex work. In such communities, they should try to either develop or adapt such stage-specific interventions, within which promoting the above-mentioned factors is the core priorities of the program.

我们使用干预映射方法 (IMA) 得出多层次的艾滋病毒预防策略，旨在针对女性性工作者 (FSW) 制定艾滋病毒预防干预计划。我们还旨在试点测试基于 IMA 的“艾滋病毒预防和意识计划 (HIV-PAP)”对伊朗大不里士的 FSW 安全性行为及其决定因素的影响。为了开发 HIV-PAP，我们进行了 IMA 的六步流程。在第一步中，在一项横断面研究中，对 140 名 FSW 进行了面对面访谈。在步骤 2 中，根据确定优先因素的重要性和可变性提供了计划矩阵。在步骤 3 和 4 中，选择了行为改变的方法和策略，并开发了 HIV-PAP 计划的组成部分和材料。在步骤 5 和 6 中，应用实验前研究进行评估（作为静态组比较设计的试点测试），其中 30 名 FSW 被分配到干预组（n = 15）和对照组（n = 15）。干预组参加了为期两个月的项目，一个月后，两组均完成了最初的问卷调查。受访者（M年龄：33.4岁，SD：9.7）仅在安全套使用谈判中得分较低（低于50%）（49.8%），在感知社会支持方面得分中等（50-65%）（61.6%）和知识（60.5%）。调整其他变量后，与 FSW 安全性行为相关的因素 (R ² = 32.0%) 是诱发因素 [自我效能 (β = 0.331)、感知规范 (β = 0.945) 和感知规范 (β = 0.945)。障碍（β = 0.258）]、安全套使用谈判（β = 1.386）和环境因素（β = 0.333）。我们基于 IM 的框架具有足够的拟合指数（χ ² = 130.8，CFI = 0.78）。 寻找干预后的组间比较，我们发现知识的平均差异（MD：2.18；95%置信区间（CI）- .38至4.74，p < 0.05）、使用安全套的自我效能（MD： ：6.71；95% CI − 1.85 至 9.29，p < 0.05），感知风险（MD：2.03；95% CI 0.58，至 3.49，p < 0.05），感知社会支持（MD：4.64；95% CI − 5.37 至11.31，p < 0.01）和安全性行为（MD：7.75；95% CI - 4.19 至 9.71，p < 0.05）。 HIV-PAP 在促进 FSW 安全性行为及其决定因素方面显示出有效性。医疗保健提供者应更好地了解在法律禁止性工作的环境中 FSW 安全性行为的决定因素。在这些社区中，他们应该尝试制定或适应此类针对特定阶段的干预措施，其中促进上述因素是该计划的核心优先事项。