Côté Anne-Marie, Sobela François, Dzokoto Agnes, Nzambi Khonde, Asamoah-Adu Comfort, Labbé Annie-Claude, Mâsse Benoit, Mensah Joyce, Frost Eric, Pépin Jacques
Centre for International Health, University of Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4.
AIDS. 2004 Apr 9;18(6):917-25. doi: 10.1097/00002030-200404090-00009.
To delineate the population attributable fraction (PAF) of transactional sex in prevalent cases of HIV infection in the male adult population of Accra, Ghana.
Cross-sectional study of clients who visited a sex worker (SW), of boyfriends of SW and of male personnel in prostitution venues. A questionnaire was administered and urine obtained for detection of anti-HIV antibodies. The PAF of prevalent HIV acquired from SW was calculated using a combination of data from this survey of clients, from on-going SW surveys, the national HIV surveillance system and the national census.
HIV prevalence was 4.9% (8/162) among clients of mobile SW, 15.8% (53/335) among clients of home-based SW, 17.5% (10/57) among personnel and 32.1% (9/28) among boyfriends. A condom was used in 90% of intercourses, according to clients. Non-use of a condom was clustered in selected locations and independently associated with older age of client, frequency of intercourse with SW in the last year and current urethritis. Among the male population of Accra aged 15-59 years, 84% of prevalent cases of HIV were attributable to transactional sex. A sensitivity analysis showed that under various assumptions PAF varied between 47% and 100%.
In Accra, approximately four-fifths of prevalent cases of HIV in adult males were acquired from SW. Comprehensive interventions providing education, condoms and treatment for sexually transmitted diseases for SW and their clients should be approached as other public health priorities and provided in all cities, large and small, of West Africa.
确定在加纳阿克拉成年男性人群中，商业性行为在艾滋病毒感染现患病例中的人群归因分数（PAF）。
对光顾性工作者（SW）的嫖客、性工作者的男性伴侣以及卖淫场所男性工作人员进行横断面研究。发放问卷并采集尿液以检测抗艾滋病毒抗体。利用本次嫖客调查、正在进行的性工作者调查、国家艾滋病毒监测系统和全国人口普查的数据，计算从性工作者处感染艾滋病毒现患病例的PAF。
流动性工作者的嫖客中艾滋病毒感染率为4.9%（8/162），上门服务性工作者的嫖客中为15.8%（53/335），场所工作人员中为17.5%（10/57），性工作者男友中为32.1%（9/28）。据嫖客称，90%的性交使用了避孕套。未使用避孕套的情况集中在特定地点，且与嫖客年龄较大、过去一年与性工作者性交频率以及当前尿道炎独立相关。在阿克拉15 - 59岁的男性人群中，84%的艾滋病毒现患病例归因于商业性行为。敏感性分析表明，在各种假设下，PAF在47%至100%之间变化。
在阿克拉，成年男性中约五分之四的艾滋病毒现患病例是从性工作者处感染的。应将为性工作者及其嫖客提供教育、避孕套和性传播疾病治疗的综合干预措施作为其他公共卫生重点事项来对待，并在西非所有大、小城市实施。
