Becker M L, Mishra S, Gurav K, Doshi M, Buzdugan R, Pise G, Halli S, Moses S, Avery L, Washington R G, Blanchard J F
Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.
Int J STD AIDS. 2012 Jan;23(1):36-40. doi: 10.1258/ijsa.2011.011017.
Female sex workers (FSWs) have among the highest rates of HIV infection in India. However, little is known about their HIV-specific mortality rates. In total, 1561 FSWs participated in a cohort study in Karnataka. Outcome data (mortality) were available on 1559 women after 15 months of follow-up. To gather details on deaths, verbal autopsy (VA) questionnaires were administered to key informants. Two physicians reviewed the VA reports and assigned underlying causes of death. Forty-seven deaths were reported during the follow-up (overall mortality rate was 2.44 per 100 person-years), with VA data available on 45 women. Thirty-five (75.6%) of these women were known to be HIV-positive, but only 42.5% were on antiretroviral therapy (ART). Forty deaths were assessed to be HIV-related, for an HIV-attributable mortality rate of 2.11 deaths per 100 person-years. Absence of a current regular partner (incidence rate ratio: 2.79; 95% confidence interval [CI]: 1.39-5.60) and older age (1.06; 1.01-1.11) were associated with increased HIV-attributable mortality. Reported duration in sex work was not related to HIV-attributable mortality. We found a high HIV-related mortality rate among this cohort of FSWs; nearly 10 times that of national mortality rates among women of a similar age group. Older age, but not reported duration in sex work, was associated with increased mortality, and suggests HIV acquisition prior to self-reported initiation into sex work. Despite significant efforts, there remain considerable gaps in HIV prevention near or before entry into sex work, as well as access and uptake of HIV treatment among FSWs.
在印度，女性性工作者（FSW）的艾滋病毒感染率位居前列。然而，关于她们的艾滋病毒特异性死亡率却知之甚少。共有1561名女性性工作者参与了卡纳塔克邦的一项队列研究。经过15个月的随访，1559名女性的结局数据（死亡率）可得。为收集死亡详情，向关键 informant 发放了口头尸检（VA）问卷。两名医生审查了VA报告并确定了根本死因。随访期间报告了47例死亡（总死亡率为每100人年2.44例），45名女性有VA数据。其中35名（75.6%）女性已知感染艾滋病毒阳性，但只有42.5%接受抗逆转录病毒治疗（ART）。40例死亡被评估为与艾滋病毒相关，艾滋病毒归因死亡率为每100人年2.11例死亡。没有当前固定伴侣（发病率比：2.79；95%置信区间[CI]：1.39 - 5.60）和年龄较大（1.06；1.01 - 1.11）与艾滋病毒归因死亡率增加相关。报告的性工作时长与艾滋病毒归因死亡率无关。我们发现该女性性工作者队列中的艾滋病毒相关死亡率很高；几乎是同年龄组女性全国死亡率的10倍。年龄较大，但不是报告的性工作时长，与死亡率增加相关，这表明在自我报告开始从事性工作之前就已感染艾滋病毒。尽管做出了重大努力，但在进入性工作之前或临近进入性工作时的艾滋病毒预防以及女性性工作者中艾滋病毒治疗的可及性和接受度方面仍存在相当大的差距。
