Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94105, USA.
Sex Transm Dis. 2013 Jun;40(6):462-8. doi: 10.1097/OLQ.0b013e318286db8a.
Accurate measurement of unprotected sex is essential in HIV prevention research. Since 2001, the 100% Condom Use Program targeting female sex workers (FSWs) has been a central element of the Cambodian National HIV/AIDS Strategy. We sought to assess the validity of self-reported condom use using the rapid prostate-specific antigen (PSA) test among Cambodian FSWs.
From 2009 to 2010, we enrolled 183 FSWs in Phnom Penh in a prospective study of HIV risk behavior. Prostate-specific antigen test results from the OneStep ABAcard were compared with self-reported condom use in the past 48 hours at quarterly follow-up visits.
Among women positive for seminal fluid at the first follow-up visit, 42% reported only protected sex or no sex in the detection period. Discordant results were more likely among brothel and street-based FSW versus entertainment (56% vs. 17%), recent (last 3 months) amphetamine-type stimulant (ATS) users (53% vs. 20%), and those with 5 or more partners in the past month (58% vs. 13%). In multivariable regression models, positive PSA results were associated with recent ATS use (adjusted risk ratio [ARR], 1.5; 95% confidence interval [CI], 1.1-2.2), having a nonpaying last sex partner (ARR, 1.7; CI, 1.2-2.5), and sex work venue (ARR, 3.0; CI, 1.4-6.5). Correspondingly, women with a nonpaying last sex partner were more likely to report unprotected sex (ARR, 1.5; CI, 1.1-2.2), but no associations were found with sex work venue or ATS use.
Results confirm the questionable validity of self-reported condom use among FSW. The PSA biomarker assay is an important monitoring tool in HIV/sexually transmitted infection research including prevention trials.
在 HIV 预防研究中，准确测量无保护性行为至关重要。自 2001 年以来，针对性工作者的 100% condom use program 一直是柬埔寨国家 HIV/AIDS 战略的核心要素。我们试图评估快速前列腺特异性抗原（PSA）检测在柬埔寨性工作者中自我报告的避孕套使用的有效性。
2009 年至 2010 年，我们在金边招募了 183 名性工作者，对他们进行了 HIV 风险行为的前瞻性研究。OneStep ABAcard 的 PSA 检测结果与每季度随访时过去 48 小时内自我报告的避孕套使用情况进行了比较。
在第一次随访时检测到精液的女性中，42%报告在检测期间仅进行了保护性行为或无性行为。在性工作者中，与娱乐场所相比，妓院和街头性工作者（56%比 17%）、最近（过去 3 个月）使用安非他命类兴奋剂（ATS）者（53%比 20%）和过去一个月有 5 个或更多性伴侣者（58%比 13%）的检测结果更不一致。在多变量回归模型中，PSA 阳性结果与最近使用 ATS（调整后的风险比 [ARR]，1.5；95%置信区间 [CI]，1.1-2.2）、非付费性伴侣（ARR，1.7；CI，1.2-2.5）和性工作场所（ARR，3.0；CI，1.4-6.5）有关。相应地，与付费性伴侣最后一次性交的女性更有可能报告无保护性行为（ARR，1.5；CI，1.1-2.2），但与性工作场所或 ATS 使用无关。
结果证实了性工作者自我报告的避孕套使用的有效性值得怀疑。PSA 生物标志物检测是 HIV/性传播感染研究（包括预防试验）中的重要监测工具。
