印度卡纳塔克邦女性性工作者中避孕套破裂的决定因素。
Determinants of condom breakage among female sex workers in Karnataka, India.
机构信息
CHARME-India Project, Bangalore; India KHPT office, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore 560 044, India.
出版信息
BMC Public Health. 2011 Dec 29;11 Suppl 6(Suppl 6):S14. doi: 10.1186/1471-2458-11-S6-S14.
BACKGROUND
Condoms are effective in preventing the transmission of HIV and other sexually transmitted infections, when properly used. However, recent data from surveys of female sex workers (FSWs) in Karnataka in south India, suggest that condom breakage rates may be quite high. It is important therefore to quantify condom breakage rates, and examine what factors might precipitate condom breakage, so that programmers can identify those at risk, and develop appropriate interventions.
METHODS
We explored determinants of reported condom breakage in the previous month among 1,928 female sex workers in four districts of Karnataka using data from cross-sectional surveys undertaken from July 2008 to February 2009. Using stepwise multivariate logistic regression, we examined the possible determinants of condom breakage, controlling for several independent variables including the district and client load.
RESULTS
Overall, 11.4% of FSWs reported at least one condom break in the previous month. FSWs were much more likely to report breakage if under 20 years of age (AOR 3.43, p = 0.005); if divorced/ separated/widowed (AOR 1.52, p = 0.012); if they were regular alcohol users (AOR 1.63, p = 0.005); if they mostly entertained clients in lodges/rented rooms (AOR 2.99, p = 0.029) or brothels (AOR 4.77, p = 0.003), compared to street based sex workers; if they had ever had anal sex (AOR 2.03, p = 0.006); if the sex worker herself (as opposed to the client) applied the condom at last use (AOR 1.90, p < 0.001); if they were inconsistent condom users (AOR 2.77, p < 0.001); and if they had never seen a condom demonstration (AOR 2.37, p < 0.001).
CONCLUSIONS
The reported incidence of condom breakage was high in this study, and this is a major concern for HIV/STI prevention programs, for which condom use is a key prevention tool. Younger and more marginalized female sex workers were most vulnerable to condom breakage. Special effort is therefore required to seek out such women and to provide information and skills on correct condom use. More research is also needed on what specific situational parameters might be important in predisposing women to condom breakage.
背景
避孕套在正确使用时可有效预防 HIV 和其他性传播感染的传播。然而，最近来自印度南部卡纳塔克邦的女性性工作者（FSW）调查的数据表明，避孕套破裂率可能相当高。因此，定量评估避孕套破裂率并研究可能导致避孕套破裂的因素非常重要，以便计划人员能够确定处于危险中的人群，并制定相应的干预措施。
方法
我们使用 2008 年 7 月至 2009 年 2 月期间进行的横断面调查数据，探索了卡纳塔克邦四个地区的 1928 名女性性工作者在过去一个月中报告的避孕套破裂的决定因素。使用逐步多变量逻辑回归，我们在控制了包括地区和客户量在内的几个独立变量的情况下，检查了避孕套破裂的可能决定因素。
结果
总体而言，11.4%的 FSW 在过去一个月中报告至少一次避孕套破裂。如果年龄在 20 岁以下（AOR 3.43，p = 0.005）；如果离婚/分居/丧偶（AOR 1.52，p = 0.012）；如果她们是经常饮酒者（AOR 1.63，p = 0.005）；如果她们主要在旅馆/出租房（AOR 2.99，p = 0.029）或妓院（AOR 4.77，p = 0.003）为客户提供服务，而不是在街头工作的性工作者；如果她们曾经有过肛交（AOR 2.03，p = 0.006）；如果是性工作者自己（而不是客户）在最后一次使用时戴上避孕套（AOR 1.90，p < 0.001）；如果她们是不一致的避孕套使用者（AOR 2.77，p < 0.001）；并且如果她们从未见过避孕套演示（AOR 2.37，p < 0.001），则更有可能报告避孕套破裂。
结论
本研究中报告的避孕套破裂发生率很高，这是 HIV/性传播感染预防计划的主要关注点，因为避孕套的使用是预防的关键工具。年轻和边缘化程度更高的女性性工作者更容易发生避孕套破裂。因此，需要特别努力寻找这些妇女，并提供有关正确使用避孕套的信息和技能。还需要更多的研究来了解哪些具体的情境参数可能会导致妇女更容易发生避孕套破裂。
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