Behets Frieda M-T, Van Damme Kathleen, Rasamindrakotroka Andry, Hobbs Marcia, McClamroch Kristi, Rasolofomanana Justin Ranjalahy, Raharimalala Leonardine, Dallabetta Gina, Andriamiadana Jocelyne
Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC 27599-7435, USA.
Sex Health. 2005;2(2):77-84. doi: 10.1071/sh04040.
Too little is known about the many women who generate income in Madagascar by trading sex.
Clinical and laboratory exams were offered to 493 non-care seeking female sex workers (SWs) in Antananarivo and 493 in Tamatave. SWs were recruited by peers in their community; they were interviewed, counselled and treated for sexually transmitted infections (STIs) at recruitment and re-evaluated 2 months later.
One hundred and eighty six (38%) of the SWs in Antananarivo and 113 (23%) in Tamatave did not complete primary school (P < 0.0001). The incidence rates per person per month in Antananarivo and Tamatave, respectively, were 0.09 and 0.08 for gonorrhoea; 0.05 and 0.03 for chlamydia; 0.24 and 0.15 for trichomoniasis; 0.07 and 0.05 for syphilis. At follow-up, consistent condom use with clients was reported by 56 (12%) SWs in Antananarivo and 137 (29%) in Tamatave (P < 0.0001); 320 (70%) SWs in Antananarivo and 11 (2%) in Tamatave reported sex with a non-paying partner in the past month (P < 0.0001). In Antananarivo, 422 (92%) of the SWs thought they were at no or low risk of having an STI compared to 100 (21%) in Tamatave (P = 0.02). At follow-up, 277 (61%) SWs reported no birth control for their last sex act in Antananarivo, compared to 26 (5%) in Tamatave (P < 0.0001). Socio-demographic and behavioural risk factors for incident gonorrhoea, chlamydia and trichomoniasis varied by city.
Strategies to address the needs of women who trade sex should include educational and economic opportunities; should tackle male partners of SWs; promote dual protection against unintended pregnancy and STIs, while taking into account local socio-demographic and behavioural characteristics.
对于马达加斯加众多通过性交易获取收入的女性，人们了解甚少。
为塔那那利佛的493名非主动寻求治疗的女性性工作者以及塔马塔夫的493名女性性工作者提供了临床和实验室检查。性工作者由其所在社区的同伴招募；在招募时对她们进行访谈、咨询并治疗性传播感染（STIs），并在2个月后进行重新评估。
塔那那利佛的186名（38%）性工作者和塔马塔夫的113名（23%）性工作者未完成小学教育（P < 0.0001）。塔那那利佛和塔马塔夫的淋病发病率分别为每人每月0.09和0.08；衣原体感染发病率分别为0.05和0.03；滴虫病发病率分别为0.24和0.15；梅毒发病率分别为0.07和0.05。在随访中，塔那那利佛的56名（12%）性工作者和塔马塔夫的137名（29%）性工作者报告在与客户发生性行为时始终使用避孕套（P < 0.0001）；塔那那利佛的320名（70%）性工作者和塔马塔夫的11名（2%）性工作者报告在过去一个月与非付费性伴侣发生过性行为（P < 0.0001）。在塔那那利佛，422名（92%）性工作者认为自己感染性传播感染的风险很低或没有风险，而在塔马塔夫这一比例为100名（21%）（P = 0.02）。在随访中，塔那那利佛的277名（61%）性工作者报告在最近一次性行为中未采取避孕措施，而在塔马塔夫这一比例为26名（5%）（P < 0.0001）。淋病、衣原体感染和滴虫病的社会人口统计学及行为风险因素因城市而异。
满足女性性工作者需求的策略应包括教育和经济机会；应针对女性性工作者的男性伴侣；推广针对意外怀孕和性传播感染的双重保护，同时考虑当地的社会人口统计学和行为特征。
