Tata Institute of Social Sciences, Mumbai, India.
PLoS One. 2013 Sep 2;8(9):e73470. doi: 10.1371/journal.pone.0073470. eCollection 2013.
BACKGROUND: It seems generally accepted that targeted interventions in India have been successful in raising condom use between female sex workers (FSWs) and their clients. Data from clients of FSWs have been under-utilised to analyse the risk environments and vulnerability of both partners. METHODS: The 2009 Integrated Biological and Behavioural Assessment survey sampled clients of FSWs at hotspots in Andhra Pradesh, Maharashtra and Tamil Nadu (n=5040). The risk profile of clients in terms of sexual networking and condom use are compared across usual pick-up place. We used propensity score matching (PSM) to estimate the average treatment effect on treated (ATT) of intervention messages on clients' consistent condom use with FSW. RESULTS: Clients of the more hidden sex workers who solicit from home or via phone or agents had more extensive sexual networks, reporting casual female partners as well as anal intercourse with male partners and FSW. Clients of brothel-based sex workers, who were the least educated, reported the fewest number/categories of partners, least anal sex, and lowest condom use (41%). Consistent condom use varied widely by state: 65% in Andhra Pradesh, 36% in Maharashtra and 29% in Tamil Nadu. Exposure to intervention messages on sexually transmitted infections was lowest among men frequenting brothels (58%), and highest among men soliciting less visible sex workers (70%). Exposure had significant impact on consistent condom use, including among clients of home-based sex workers (ATT 21%; p=0.001) and among men soliciting other more hidden FSW (ATT 17%; p=0.001). In Tamil Nadu no impact could be demonstrated. CONCLUSION: Commercial sex happens between two partners and both need to be, and can be, reached by intervention messages. Commercial sex is still largely unprotected and as the sex industry gets more diffuse a greater focus on reaching clients of sex workers seems important given their extensive sexual networks.
背景:人们普遍认为,印度的针对性干预措施已成功提高了性工作者(FSW)及其客户的 condom 使用率。但是,针对 FSW 客户的数据一直未被充分利用,无法对双方的风险环境和脆弱性进行分析。
方法:2009 年综合生物和行为评估调查在安得拉邦、马哈拉施特拉邦和泰米尔纳德邦的热点地区对 FSW 的客户进行了抽样调查(n=5040)。根据性网络和 condom 使用情况,比较了客户的风险状况。我们使用倾向评分匹配(PSM)来估计干预信息对客户与 FSW 持续 condom 使用的平均处理效应(ATT)。
结果:从家里或通过电话或代理人招揽客户的更隐蔽的性工作者的客户,其性网络更为广泛,报告有随意的女性伴侣,以及与男性伴侣和 FSW 的肛交。教育程度最低的妓院性工作者的客户报告的性伴侣数量/类别最少,肛交最少, condom 使用率最低(41%)。 condom 的持续使用情况因州而异:安得拉邦为 65%,马哈拉施特拉邦为 36%,泰米尔纳德邦为 29%。在光顾妓院的男性中,性传播感染干预信息的暴露率最低(58%),而在招揽不太明显的性工作者的男性中最高(70%)。暴露情况对 condom 的持续使用有显著影响,包括家庭性工作者的客户(ATT 21%;p=0.001)和招揽其他更隐蔽的 FSW 的男性(ATT 17%;p=0.001)。在泰米尔纳德邦,无法证明有任何影响。
结论:商业性交易发生在两个伴侣之间,都需要并且可以通过干预信息来影响。商业性交易仍然很大程度上没有得到保护,随着性产业的扩散,更多地关注接触性工作者的客户似乎很重要,因为他们的性网络广泛。
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