埃塞俄比亚阿达马市女性性工作者中与工作相关的暴力行为以及与不付费性伴不一致使用避孕套的情况。
Work-related violence and inconsistent condom use with non-paying partners among female sex workers in Adama City, Ethiopia.
作者信息
Mooney Alyssa, Kidanu Aklilu, Bradley Heather M, Kumoji Evelyn Kuor, Kennedy Caitlin E, Kerrigan Deanna
机构信息
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.
出版信息
BMC Public Health. 2013 Aug 23;13:771. doi: 10.1186/1471-2458-13-771.
BACKGROUND
Although reported condom use between female sex workers and their clients is high in Ethiopia, condom use with regular, non-paying partners remains low, posing a substantial risk of HIV infection to sex workers, their partners and the general population. Previous studies have identified the synergistic effects of substance abuse, violence and HIV risk, but few have examined these inter-relationships among female sex workers and their regular, non-paying partners. This study explored the associations between work-related violence, alcohol abuse and inconsistent condom use among establishment-based female sex workers and their regular, non-paying partners in Adama City, Ethiopia.
METHODS
A cross-sectional survey was conducted with 350 establishment-based female sex workers, aged 15-35, at 63 bars, hotels and nightclubs. Multivariate logistic regression analysis was conducted to test the association between work-related violence and condom use with regular, non-paying partners, controlling for age, overall income, education and sex workers' total number of sexual partners in the past week. Alcohol abuse was explored as an effect modifier.
RESULTS
Respondents reported a high prevalence of work-related violence (59%) and alcohol abuse (51%). Work-related violence was statistically significantly associated with unprotected sex with regular, non-paying partners among those who abused alcohol (OR: 6.34, 95% CI: 2.43-16.56) and among those who did not (OR: 2.98, 95% CI: 1.36-6.54). Alcohol abuse was not associated with inconsistent condom use within these partnerships, though it may strengthen the effect of work-related violence on unprotected sex.
CONCLUSIONS
Findings suggest violence against establishment-based female sex workers is associated with HIV risk within regular, non-paying partnerships. Qualitative work is needed to better understand the links between a violent work environment and condom use with regular, non-paying partners and how interventions can be implemented in this context to prevent violence against sex workers and reduce HIV transmission.
背景
尽管据报告在埃塞俄比亚，女性性工作者与其客户之间避孕套的使用率很高，但与固定的非付费伴侣使用避孕套的比例仍然很低，这给性工作者、她们的伴侣及普通人群带来了很大的艾滋病毒感染风险。以往的研究已经确定了药物滥用、暴力和艾滋病毒感染风险之间的协同效应，但很少有研究探讨女性性工作者与其固定的非付费伴侣之间的这些相互关系。本研究探讨了埃塞俄比亚阿达马市在场所工作的女性性工作者及其固定的非付费伴侣中，与工作相关的暴力、酒精滥用和不坚持使用避孕套之间的关联。
方法
对63家酒吧、酒店和夜总会中年龄在15 - 35岁的350名在场所工作的女性性工作者进行了横断面调查。进行多因素逻辑回归分析，以检验与工作相关的暴力与与固定的非付费伴侣使用避孕套之间的关联，并控制年龄、总收入、教育程度以及性工作者在过去一周内性伴侣的总数。将酒精滥用作为一个效应修饰因素进行探讨。
结果
受访者报告与工作相关的暴力发生率很高（59%），酒精滥用发生率也很高（51%）。在酗酒者中，与工作相关的暴力与与固定的非付费伴侣发生无保护性行为在统计学上显著相关（比值比：6.34，95%置信区间：2.43 - 16.56），在不酗酒者中也是如此（比值比：2.98，95%置信区间：1.36 - 6.54）。在这些伴侣关系中，酒精滥用与不坚持使用避孕套没有关联，不过它可能会加强与工作相关的暴力对无保护性行为的影响。
结论
研究结果表明，对在场所工作的女性性工作者的暴力行为与固定的非付费伴侣关系中的艾滋病毒感染风险相关。需要开展定性研究，以更好地理解暴力的工作环境与与固定的非付费伴侣使用避孕套之间的联系，以及如何在此背景下实施干预措施以防止对性工作者的暴力行为并减少艾滋病毒传播。
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