住房在印度安得拉邦女性性工作者的 HIV 风险决定中的作用:考虑到女性的生活背景。

The role of housing in determining HIV risk among female sex workers in Andhra Pradesh, India: considering women's life contexts.

机构信息

George Washington University School of Public Health, Department of Prevention and Community Health, 2175 K Street, NW, Suite 700, Washington, DC 20037, USA.

出版信息

Soc Sci Med. 2011 Mar;72(5):710-6. doi: 10.1016/j.socscimed.2010.12.009. Epub 2011 Jan 18.

Abstract

Recent research on HIV prevention, regardless of the population, has increasingly recognized the relevance of contextual factors in determining HIV risk. Investigating such factors among female sex workers (FSW) is especially relevant in the South Indian state of Andhra Pradesh, where HIV rates are among the highest across Indian states and where HIV has largely affected FSW. Stable housing is a particular contextual challenge experienced by female sex workers in this region (as well as elsewhere); however, local studies have not examined the impact of this issue on HIV risk. In this paper, we examine residential instability, defined as a high frequency of reported evictions, among FSW and relation to experiences of violence (as a factor increasing risk for HIV) and sexual risk factors for HIV. Women were recruited through respondent-driven sampling for a survey on HIV risk. Using logistic regression models, we assessed: (1) residential instability and association with HIV sexual risk variables (including unprotected sex, reported STIs, and recent physical and sexual victimization) and (2) whether the association between residential instability and reported STI (as an indicator of HIV risk) was attenuated by individual risk behaviors and violence. In adjusted logistic regression models, FSW who reported residential instability were more likely to report: sexual violence, physical violence, accepting more money for unprotected sex, and a recent STI symptom. Violence associated with residential instability contributed to reported STIs; however, residential instability remained significantly associated with STIs beyond the influence of both violence and unprotected sex with clients. Findings highlight the interrelation among residential instability, violence, and HIV risk. Residential instability appears to be associated with women's HIV risk, above and beyond its association with individual risky sexual behaviors.

摘要

最近的艾滋病毒预防研究,无论针对的人群如何,都越来越认识到,在确定艾滋病毒风险方面,背景因素具有相关性。在印度安得拉邦这样的地方,针对性工作者(FSW)进行此类因素的调查尤其具有现实意义,因为在该邦,艾滋病毒感染率在印度各邦中处于最高之列,艾滋病毒主要影响的就是性工作者。稳定的住房是该地区(以及其他地区)性工作者面临的一个特殊背景挑战;然而,当地的研究尚未考察这一问题对艾滋病毒风险的影响。本文探讨了性工作者的居住不稳定状况,即频繁报告被驱逐的情况,以及与暴力经历(增加艾滋病毒风险的因素)和性传播艾滋病毒的风险因素之间的关系。通过回应者驱动抽样方法招募了女性,对她们进行了艾滋病毒风险调查。我们利用逻辑回归模型评估了:(1)居住不稳定状况与艾滋病毒性风险变量(包括无保护性行为、报告的性传播感染和近期身体及性暴力受害)之间的关联;(2)居住不稳定状况与报告的性传播感染(艾滋病毒风险的一个指标)之间的关联是否因个人风险行为和暴力行为而减弱。在调整后的逻辑回归模型中,报告居住不稳定状况的性工作者更有可能报告:性暴力、身体暴力、为无保护性行为接受更多的钱、以及近期性传播感染症状。与居住不稳定状况相关的暴力行为导致了报告的性传播感染;然而,居住不稳定状况与性传播感染之间仍然存在显著关联,其影响力超出了暴力行为和与客户发生无保护性行为的影响。这些发现凸显了居住不稳定状况、暴力行为和艾滋病毒风险之间的相互关系。居住不稳定状况似乎与女性的艾滋病毒风险有关,其关联程度超出了与个人危险性行为的关联程度。

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