Department of Epidemiology and Threat Assessment, United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817, USA.
Sex Transm Infect. 2013 Mar;89(2):156-64. doi: 10.1136/sextrans-2012-050557. Epub 2012 Sep 21.
Biological and behavioural surveillance of HIV and sexually transmitted infections (STIs) among populations at highest risk have been used to monitor trends in prevalence and in risk behaviours. Sex work in Panama is regulated through registration with the Social Hygiene Programme, Ministry of Health. We estimated prevalence of HIV and STIs, and factors associated with active syphilis among female sex workers (FSWs).
A cross-sectional study using venue-based, time-space sampling was conducted among FSWs in Panama from 2009 to 2010. FSWs were interviewed about sociodemographic characteristics, sexual risk behaviour, health history and drug use using an anonymous structured questionnaire. Blood was collected for serological testing of HIV and other STIs. Factors associated with active syphilis were studied using logistic regression analysis.
The overall HIV-1 prevalence of 0.7% varied by FSW category; 1.6% in 379 unregistered, and 0.2% in 620 registered FSWs. Overall prevalence (and 95% CI) of STIs were: syphilis antibody, 3.8% (2.7% to 5.2%); herpes simplex virus type 2 antibody (anti-HSV-2), 74.2% (71.4% to 76.9%); hepatitis B surface antigen, 0.6% (0.2% to 1.3%); hepatitis B core antibody, 8.7% (7.0% to 10.6%); and hepatitis C antibody, 0.2% (0.0% to 0.7%). In multivariate analysis, registration (adjusted OR (AOR)=0.35; 95% CI 0.16 to 0.74), having a history of STI (AOR=2.37; 95% CI 1.01 to 5.58), forced sex (AOR=2.47; 95% CI 1.11 to 5.48), and anti-HSV-2 (AOR=10.05; 95% CI 1.36 to 74.38) were associated with active syphilis.
Although HIV prevalence is low among FSWs in Panama, unregistered FSWs bear a higher burden of HIV and STIs than registered FSWs. Programmes aimed at overcoming obstacles to registration, and HIV, STI and harm reduction among unregistered FSWs is warranted to prevent HIV transmission, and to improve their sexual and reproductive health.
对高危人群中的艾滋病毒和性传播感染（STIs）进行生物和行为监测，以监测流行率和风险行为的趋势。巴拿马的性工作受卫生部社会卫生计划注册制度的监管。我们评估了艾滋病毒和性传播感染的流行率，以及与女性性工作者（FSWs）活动性梅毒相关的因素。
2009 年至 2010 年期间，我们在巴拿马采用基于场所的时空抽样方法对 FSWs 进行了横断面研究。FSWs 使用匿名结构化问卷接受社会人口统计学特征、性风险行为、健康史和吸毒情况的访谈。采集血液进行 HIV 和其他 STI 的血清学检测。使用逻辑回归分析研究与活动性梅毒相关的因素。
0.7%的 HIV-1 总流行率因 FSW 类别而异；未注册的 379 名中为 1.6%，注册的 620 名中为 0.2%。性传播感染的总流行率（95%CI）为：梅毒抗体 3.8%（2.7%至 5.2%）；单纯疱疹病毒 2 型抗体（抗-HSV-2）74.2%（71.4%至 76.9%）；乙型肝炎表面抗原 0.6%（0.2%至 1.3%）；乙型肝炎核心抗体 8.7%（7.0%至 10.6%）；丙型肝炎抗体 0.2%（0.0%至 0.7%）。多变量分析显示，登记（调整后的比值比（AOR）=0.35；95%CI 0.16 至 0.74）、性传播感染史（AOR=2.37；95%CI 1.01 至 5.58）、强迫性性行为（AOR=2.47；95%CI 1.11 至 5.48）和抗-HSV-2（AOR=10.05；95%CI 1.36 至 74.38）与活动性梅毒相关。
尽管巴拿马 FSWs 的 HIV 流行率较低，但未登记的 FSWs比登记的 FSWs承受着更高的 HIV 和性传播感染负担。有必要针对未登记的 FSWs 开展旨在克服登记障碍以及艾滋病毒、性传播感染和减少伤害的方案，以预防 HIV 传播，并改善其性健康和生殖健康。
