Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Global Health. 2014 Jun 10;10:46. doi: 10.1186/1744-8603-10-46.
Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa.
On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for studies describing clinical and non-clinical facility-based SRH prevention and care services for FSWs in low- and middle-income countries in Africa. We also identified articles in key non-indexed journals and on websites of international organizations. A single reviewer screened titles and abstracts, and extracted data from articles using standardised tools.
We located 149 articles, which described 54 projects. Most were localised and small-scale; focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services.
Sex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs' health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa.
一些生物学、行为学和结构风险因素使女性性工作者（FSW）面临更高的艾滋病毒、性传播感染（STI）和其他不良性健康和生殖健康（SRH）后果的风险。在许多情况下，FSW 项目已经证明了改变这种风险的有效方法，改善了这些女性的健康和福祉。然而，非洲 FSW 项目的最佳交付模式尚不清楚。本系统评价描述了干预包、服务交付模式以及政府在这些服务中的参与程度在非洲。
于 2012 年 11 月 22 日，我们在 Web of Science 和 MEDLINE 上进行了搜索，没有日期限制，以寻找描述在非洲中低收入国家为 FSW 提供临床和非临床基于设施的 SRH 预防和保健服务的研究。我们还在主要的非索引期刊和国际组织的网站上确定了文章。一名评审员筛选标题和摘要，并使用标准化工具从文章中提取数据。
我们找到了 149 篇文章，其中描述了 54 个项目。大多数是本地化和小规模的；侧重于研究活动（而不是大规模服务提供）；在国家或地区层面协调很少；并且几乎没有政府支持（而不是一系列国际捐助者通常为服务提供资金）。几乎所有地点只解决了艾滋病毒预防和性传播感染问题。大多数服务分发男用避孕套，但只有 10%提供女用避孕套。艾滋病毒服务主要包括艾滋病毒咨询和检测；很少提供艾滋病毒护理和治疗，如 CD4 检测或抗逆转录病毒治疗（ART）。虽然性传播感染服务更全面，但仅在 11 例中提供定期推定治疗。服务往往忽略了更广泛的 SRH 需求，如计划生育、宫颈癌筛查和基于性别的暴力服务。
非洲的性工作方案的覆盖范围有限，服务范围狭窄，与更广泛的艾滋病毒和 SRH 服务协调不佳。为了改善 FSW 的健康状况并减少艾滋病毒的传播，迫切需要解决获得抗逆转录病毒治疗的问题。然而，艾滋病毒预防仍应是服务的主要内容。需要提供整合更广泛的 SRH 服务并解决结构性风险因素的服务提供模式。政府主导的高质量和大规模的 FSW 服务将显著降低非洲 FSW 的 SRH 脆弱性。
