肯尼亚蒙巴萨市为期五年的同伴介导干预措施对女性性工作者性行为及性传播感染的影响
Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya.
作者信息
Luchters Stanley, Chersich Matthew F, Rinyiru Agnes, Barasa Mary-Stella, King'ola Nzioki, Mandaliya Kishorchandra, Bosire Wilkister, Wambugu Sam, Mwarogo Peter, Temmerman Marleen
机构信息
International Centre for Reproductive Health, Mombasa, Kenya.
出版信息
BMC Public Health. 2008 Apr 29;8:143. doi: 10.1186/1471-2458-8-143.
BACKGROUND
Since 2000, peer-mediated interventions among female sex workers (FSW) in Mombasa Kenya have promoted behavioural change through improving knowledge, attitudes and awareness of HIV serostatus, and aimed to prevent HIV and other sexually transmitted infection (STI) by facilitating early STI treatment. Impact of these interventions was evaluated among those who attended peer education and at the FSW population level.
METHODS
A pre-intervention survey in 2000, recruited 503 FSW using snowball sampling. Thereafter, peer educators provided STI/HIV education, condoms, and facilitated HIV testing, treatment and care services. In 2005, data were collected using identical survey methods, allowing comparison with historical controls, and between FSW who had or had not received peer interventions.
RESULTS
Over five years, sex work became predominately a full-time activity, with increased mean sexual partners (2.8 versus 4.9/week; P < 0.001). Consistent condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; P < 0.001) as well as the likelihood of refusing clients who were unwilling to use condoms (OR = 4.9, 95%CI = 3.7-6.6). In 2005, FSW who received peer interventions (28.7%, 145/506), had more consistent condom use with clients compared with unexposed FSW (86.2% versus 64.0%; AOR = 3.6, 95%CI = 2.1-6.1). These differences were larger among FSW with greater peer-intervention exposure. HIV prevalence was 25% (17/69) in FSW attending > or = 4 peer-education sessions, compared with 34% (25/73) in those attending 1-3 sessions (P = 0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498) in 2005 (P = 0.36).
CONCLUSION
Peer-mediated interventions were associated with an increase in protected sex. Though peer-mediated interventions remain important, higher coverage is needed and more efficacious interventions to reduce overall vulnerability and risk.
背景
自2000年以来，肯尼亚蒙巴萨针对女性性工作者开展的同伴介导干预措施，通过提高她们对艾滋病毒血清学状态的知识、态度和认识来促进行为改变，旨在通过促进性传播感染的早期治疗来预防艾滋病毒和其他性传播感染。在参加同伴教育的人群以及女性性工作者总体层面评估了这些干预措施的影响。
方法
2000年进行了一项干预前调查，采用滚雪球抽样法招募了503名女性性工作者。此后，同伴教育者提供性传播感染/艾滋病毒教育、避孕套，并协助开展艾滋病毒检测、治疗和护理服务。2005年，使用相同的调查方法收集数据，以便与历史对照进行比较，并对比接受或未接受同伴干预的女性性工作者。
结果
在五年时间里，性工作主要变成了一项全职活动，平均性伴侣数量增加（从每周2.8个增至4.9个；P<0.001）。与客户始终坚持使用避孕套的比例从28.8%（145/503）增至70.4%（356/506；P<0.001），拒绝不使用避孕套客户的可能性也增加（比值比=4.9，95%置信区间=3.7-6.6）。2005年，接受同伴干预的女性性工作者（28.7%，145/506）与未接受干预的女性性工作者相比，与客户始终坚持使用避孕套的比例更高（86.2%对64.0%；调整后比值比=3.6，95%置信区间=2.1-6.1）。在接受同伴干预程度更高的女性性工作者中，这些差异更大。参加≥4次同伴教育课程的女性性工作者中艾滋病毒感染率为25%（17/69），而参加1-3次课程的女性性工作者中这一比例为34%（25/73）（P=0.21）。2000年总体艾滋病毒感染率为30.6%（151/493），2005年为33.3%（166/498）（P=0.36）。
结论
同伴介导干预措施与安全性行为的增加有关。尽管同伴介导干预措施仍然很重要，但需要更高的覆盖率以及更有效的干预措施来降低总体脆弱性和风险。
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