Gutiérrez Juan Pablo, Molina-Yépez Diana, Samuels Fiona, Bertozzi Stefano Michele
División de Economia y Políticas de la Salud, Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
Salud Publica Mex. 2006 Mar-Apr;48(2):104-12. doi: 10.1590/s0036-36342006000200004.
Whilst existing data suggests that the HIV epidemic in Ecuador is concentrated amongst men who have sex with men (MSM), there is very little available information on the situation of key populations, i.e. those most at risk of HIV infection and/or transmitting the infection. In particular, there is very little known about sex workers (SWs), their rate of condom use and other behaviors and characteristics with respect to the risk of acquiring sexually transmitted infections (STIs). This study presents findings from a survey carried out with SWs in eight cities in Ecuador.
Using a cross-sectional design, a questionnaire focusing on behaviours, attitudes and socio-economic and demographic characteristics was administered to SWs in eight cities in Ecuador. These eight cities together account for the majority of the population in the country, and they were also identified as the locations with high reported levels of HIV.
Information from a total of 2867 SWs was obtained, the majority were captured in their workplaces. Most of SWs interviewed carry out their activities in closed settings dedicated to sex work (i.e. not in the street). The average age of respondents was 28 (95%CI 27-29), and around half of them live with a male partner (married or not). The rate of condom use with the last client was 88% (82% consistently with the last three), whilst with regular partners it was 6%. A high index of life-skills, high socio-economic status and having an official document that allows them to work, were positively associated with condom use with clients (PR [CI95%] 1.40 [1.40-1.40], 1.37 [1.36-1.37], y 7.26 [6.87-7.46], respectively).
Whilst condom use with clients amongst Ecuadorian SWs is high, this diminishes if one analyzes consistent condom use and is notably low with respect to regular partners. Condom use appears to be related to variables that can be linked to interventions, e.g. life-skills and official permission to carry out sex work. It is, therefore, important to tailor interventions for this population so they maximize the likelihood to increase consistent condom use.
现有数据表明，厄瓜多尔的艾滋病病毒疫情集中在男男性行为者（MSM）中，但关于关键人群（即感染艾滋病病毒风险最高和/或传播该病毒风险最高的人群）的情况，现有信息非常少。特别是，对于性工作者（SWs）、他们使用避孕套的比例以及其他与感染性传播感染（STIs）风险相关的行为和特征，了解甚少。本研究展示了对厄瓜多尔八个城市的性工作者进行调查的结果。
采用横断面设计，向厄瓜多尔八个城市的性工作者发放了一份聚焦于行为、态度以及社会经济和人口特征的问卷。这八个城市的人口占该国总人口的大部分，并且它们也被确定为报告艾滋病病毒感染水平较高的地区。
共获得了2867名性工作者的信息，大多数是在她们的工作场所采集到的。接受访谈的大多数性工作者在专门用于性工作的封闭场所开展活动（即不在街头）。受访者的平均年龄为28岁（95%置信区间27 - 29岁），其中约一半与男性伴侣同居（已婚或未婚）。与最后一位客户使用避孕套的比例为88%（与最后三位客户始终使用避孕套的比例为82%），而与固定伴侣使用避孕套的比例为6%。生活技能指数高、社会经济地位高以及拥有允许其工作的官方文件，与与客户使用避孕套呈正相关（PR[CI95%]分别为1.40[1.40 - 1.40]、1.37[1.36 - 1.37]和7.26[6.87 - 7.46]）。
虽然厄瓜多尔性工作者与客户使用避孕套的比例较高，但如果分析始终使用避孕套的情况，这一比例会降低，并且与固定伴侣使用避孕套的比例明显较低。避孕套的使用似乎与一些可与干预措施相关联的变量有关，例如生活技能和从事性工作的官方许可。因此，为这一人群量身定制干预措施非常重要，以便最大程度地提高始终使用避孕套的可能性。
