Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Sex Transm Infect. 2010 Feb;86 Suppl 1(Suppl_1):i17-24. doi: 10.1136/sti.2009.038513.
OBJECTIVES: To examine the impact of a large-scale HIV prevention programme for female sex workers (FSW) in Karnataka state, south India, on the prevalence of HIV/sexually transmitted infections (STI), condom use and programme coverage. METHODS: Baseline and follow-up integrated biological and behavioural surveys were conducted on random samples of FSW in five districts in Karnataka between 2004 and 2009. RESULTS: 4712 FSW participated in the study (baseline 2312; follow-up 2400), with follow-up surveys conducted 28-37 months after baseline. By follow-up, over 85% of FSW reported contact by a peer educator and having visited a project STI clinic. Compared with baseline, there were reductions in the prevalence of HIV (19.6% vs 16.4%, adjusted odds ratio (AOR) 0.81, 95% CI 0.67 to 0.99, p=0.04); high-titre syphilis (5.9% vs 3.4%, AOR 0.53, 95% CI 0.37 to 0.77, p=0.001); and chlamydia and/or gonorrhoea (8.9% vs 7.0%, AOR 0.72, 95% CI 0.54 to 0.94, p=0.02). Reported condom use at last sex increased significantly for repeat clients (66.1% vs 84.1%, AOR 1.98, 95% CI 1.58 to 2.48, p<0.001) and marginally for occasional clients (82.9% vs 88.0%, AOR 1.22, 95% CI 0.89 to 1.66, p=0.2), but remained stable for regular partners (32%). Compared with street and home-based FSW, brothel-based FSW were at highest risk of HIV and STI, despite high levels of reported condom use. CONCLUSIONS: This large-scale HIV prevention programme for FSW achieved reductions in HIV and STI prevalence, high rates of condom use with clients and high rates of programme coverage. Improved strategies to increase condom use with regular partners and reduce the vulnerability of brothel-based FSW to HIV are required.
目的：调查在印度南部卡纳塔克邦为女性性工作者（FSW）实施的大规模艾滋病毒预防规划对艾滋病毒/性传播感染（STI）流行率、 condom 使用和规划覆盖范围的影响。
方法：在 2004 年至 2009 年间，在卡纳塔克邦的五个区对随机抽取的 FSW 进行了基线和随访的综合生物学和行为调查。
结果：共有 4712 名 FSW 参加了研究（基线 2312 人；随访 2400 人），在基线后 28-37 个月进行了随访调查。与基线相比，超过 85%的 FSW 报告接触过同伴教育者并曾访问过项目性传播感染诊所。与基线相比，艾滋病毒（19.6%对 16.4%，调整后的优势比（AOR）0.81，95%置信区间（CI）0.67 至 0.99，p=0.04）、高滴度梅毒（5.9%对 3.4%，AOR 0.53，95%CI 0.37 至 0.77，p=0.001）、衣原体和/或淋病（8.9%对 7.0%，AOR 0.72，95%CI 0.54 至 0.94，p=0.02）的流行率有所下降。重复客户的 condom 使用报告显著增加（66.1%对 84.1%，AOR 1.98，95%CI 1.58 至 2.48，p<0.001），偶尔客户的 condom 使用报告略有增加（82.9%对 88.0%，AOR 1.22，95%CI 0.89 至 1.66，p=0.2），但稳定客户的 condom 使用报告保持不变（32%）。尽管 condom 使用报告率较高，但与街头和家庭为基础的 FSW 相比，妓院为基础的 FSW 感染艾滋病毒和性传播感染的风险最高。
结论：为 FSW 实施的这项大规模艾滋病毒预防规划降低了艾滋病毒和性传播感染的流行率， condom 与客户的使用率较高，规划覆盖范围较广。需要改进策略，以增加与稳定伴侣 condom 的使用，并降低妓院为基础的 FSW 感染艾滋病毒的脆弱性。
Bull World Health Organ. 2021-4-1
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