aGender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS bDepartment of Medicine, University of British Columbia, Vancouver, British Columbia, Canada cGlobal Health Sciences, University of California San Diego School of Medicine, San Diego, USA.
Curr Opin HIV AIDS. 2014 Mar;9(2):174-82. doi: 10.1097/COH.0000000000000042.
This article reviews the current state of the epidemiological literature on female sex work and HIV from the past 18 months. We offer a conceptual framework for structural HIV determinants and sex work that unpacks intersecting structural, interpersonal, and individual biological and behavioural factors.
Our review suggests that despite the heavy HIV burden among female sex workers (FSWs) globally, data on the structural determinants shaping HIV transmission dynamics have only begun to emerge. Emerging research suggests that factors operating at macrostructural (e.g., migration, stigma, criminalized laws), community organization (e.g., empowerment) and work environment levels (e.g., violence, policing, access to condoms HIV testing, HAART) act dynamically with interpersonal (e.g., dyad factors, sexual networks) and individual biological and behavioural factors to confer risks or protections for HIV transmission in female sex work.
Future research should be guided by a Structural HIV Determinants Framework to better elucidate the complex and iterative effects of structural determinants with interpersonal and individual biological and behavioural factors on HIV transmission pathways among FSWs, and meet critical gaps in optimal access to HIV prevention, treatment, and care for FSWs globally.
本文回顾了过去 18 个月来关于女性性工作者和 HIV 的流行病学文献现状。我们提供了一个关于 HIV 决定因素和性工作的概念框架，该框架剖析了相互交叉的结构、人际和个人生物及行为因素。
我们的综述表明，尽管全球范围内女性性工作者（FSW）的 HIV 负担沉重，但有关塑造 HIV 传播动态的结构性决定因素的数据才刚刚开始出现。新出现的研究表明，在宏观结构（如移民、耻辱感、刑法化法律）、社区组织（如赋权）和工作环境层面（如暴力、警察、获得避孕套、艾滋病毒检测、抗逆转录病毒治疗）运作的因素与人际（如二人因素、性网络）和个人生物及行为因素一起，对 HIV 在女性性工作者中的传播途径产生动态影响，从而带来或保护 HIV 传播的风险。
未来的研究应遵循 HIV 结构决定因素框架，以更好地阐明结构决定因素与人际和个人生物及行为因素对 FSW 中 HIV 传播途径的复杂和迭代影响，并弥补全球范围内 FSW 获得最佳 HIV 预防、治疗和护理的关键差距。
