Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E4142, Baltimore, MD 21212, USA.
Sex Transm Infect. 2012 Jun;88(4):278-83. doi: 10.1136/sextrans-2011-050171. Epub 2012 Jan 27.
BACKGROUND/OBJECTIVES: The HIV prevalence in Eastern Europe and Central Asia continues to increase. While injection drug use (IDU) is leading factor, heterosexual transmission is on the rise. Little is known about female sex workers (FSWs) in the region despite the central role of commercial sex in heterosexual sexually transmitted infection (STI)/HIV transmission globally. The authors evaluated the prevalence of STI/HIV among Moscow-based FSWs and potential risk factors including IDU, sexual risks and violence victimisation.
Moscow-based FSWs (n=147) completed a clinic-based survey and STI/HIV testing over an 8-month period in 2005.
HIV prevalence was 4.8%, and 31.3% were infected with at least one STI including HIV. Sexual behaviours significantly associated with STI/HIV included anal sex (adjusted odds ratio (AOR) 3.48), high client volume (three or more clients daily, AOR 2.71), recent subbotnik (sex demanded by police; AOR 2.50) and regularly being presented with more clients than initially agreed to (AOR 2.45). Past year experiences of physical violence from clients and threats of violence from pimps were associated with STI/HIV (AOR 3.14 and AOR 3.65, respectively). IDU was not significantly associated with STI/HIV. Anal sex and high client volume partially mediated the associations of abuse with STI/HIV.
Findings illustrate substantial potential for heterosexual STI/HIV transmission in a setting better known for IDU-related risk. Many of the STI/HIV risks observed are not modifiable by FSWs alone. STI/HIV prevention efforts for this vulnerable population will benefit from reducing coercion and abuse perpetrated by pimps and clients.
背景/目的：东欧和中亚的艾滋病毒流行率持续上升。虽然注射吸毒是主要因素，但异性传播呈上升趋势。尽管商业性交易在全球范围内是异性间性传播感染（STI）/艾滋病毒传播的核心因素，但该地区对女性性工作者（FSW）的了解甚少。作者评估了莫斯科 FSW 中 STI/HIV 的流行率，以及包括注射吸毒、性风险和暴力受害在内的潜在危险因素。
在 2005 年的 8 个月期间，147 名莫斯科 FSW 完成了一项基于诊所的调查和 STI/HIV 检测。
HIV 流行率为 4.8%，31.3%的人感染了至少一种 STI，包括 HIV。与 STI/HIV 显著相关的性行为包括肛交（调整后的优势比（AOR）为 3.48）、高客户量（每天三个或更多客户，AOR 为 2.71）、最近的 subbotnik（警察要求的性服务；AOR 为 2.50）和经常被介绍给比最初同意的更多的客户（AOR 为 2.45）。过去一年中，客户的身体暴力和皮条客的暴力威胁与 STI/HIV 相关（AOR 分别为 3.14 和 3.65）。注射吸毒与 STI/HIV 无显著相关性。虐待与 STI/HIV 的关联部分由肛交和高客户量介导。
研究结果表明，在一个以与注射吸毒相关的风险为主的环境中，异性 STI/HIV 传播的可能性很大。观察到的许多 STI/HIV 风险因素不能仅由 FSW 单独改变。减少皮条客和客户实施的胁迫和虐待将使这一弱势群体的 STI/HIV 预防工作受益。
