Deering K N, Montaner J S, Chettiar J, Jia J, Ogilvie G, Buchner C, Feng C, Strathdee S A, Shannon K
a Division of AIDS, Department of Medicine, Faculty of Medicine , University of British Columbia , Vancouver , Canada.
AIDS Care. 2015;27(4):499-506. doi: 10.1080/09540121.2014.978730. Epub 2014 Nov 27.
Despite evidence globally of the heavy HIV burden among sex workers (SWs) as well as other poor health outcomes, including violence, SWs are often excluded from accessing voluntary, confidential and non-coercive health services, including HIV prevention, treatment, care and support. This study therefore assessed the prevalence and association with regular HIV testing among street- and off-street SWs in Vancouver, Canada. Cross-sectional baseline data were used from a longitudinal cohort known as "An Evaluation of Sex Worker's Health Access" (AESHA; January 2010-July 2012). This cohort included youth and adult SWs (aged 14+ years). We used multivariable logistic regression to assess the relationship between explanatory variables and having a recent HIV test (in the last year). Of the 435 seronegative SWs included, 67.1% reported having a recent HIV test. In multivariable logistic regression analysis, having a recent HIV test remained significantly independently associated with elevated odds of inconsistent condom use with clients [adjusted (multivariable) odds ratios, AOR: 2.59, 95% confidence intervals [95% CIs]: 1.17-5.78], injecting drugs (AOR: 2.33, 95% CIs: 1.17-4.18) and contact with a mobile HIV prevention programme (AOR: 1.76, 95% CIs: 1.09-2.84) within the last six months. Reduced odds of having a recent HIV test was also significantly associated with being a migrant/new immigrant to Canada (AOR: 0.33, 95% CIs: 0.19-0.56) and having a language barrier to health care access (AOR: 0.26, 95% CIs: 0.09-0.73). Our results highlight successes of reaching SWs at high risk of HIV through drug and sexual pathways. To maximize the effectiveness of including HIV testing as part of comprehensive HIV prevention and care to SWs, increased mobile outreach and safer-environment interventions that facilitate access to voluntary, confidential and non-coercive HIV testing remain a critical priority, in addition to culturally safe services with language support.
尽管全球有证据表明性工作者中艾滋病病毒负担沉重，且存在包括暴力在内的其他不良健康后果，但性工作者往往被排除在获得自愿、保密和非强制性健康服务之外，包括艾滋病病毒预防、治疗、护理和支持。因此，本研究评估了加拿大温哥华街头和非街头性工作者中艾滋病病毒定期检测的患病率及相关因素。横断面基线数据来自一个名为“性工作者健康获取评估”（AESHA；2010年1月至2012年7月）的纵向队列。该队列包括青年和成年性工作者（年龄14岁及以上）。我们使用多变量逻辑回归来评估解释变量与最近（过去一年）进行艾滋病病毒检测之间的关系。在纳入的435名血清阴性性工作者中，67.1%报告最近进行了艾滋病病毒检测。在多变量逻辑回归分析中，最近进行艾滋病病毒检测仍然与与客户使用避孕套不一致的几率升高显著独立相关[调整后（多变量）优势比，AOR：2.59，95%置信区间[95% CIs]：1.17 - 5.78]、注射毒品（AOR：2.33，95% CIs：1.17 - 4.18）以及在过去六个月内与流动艾滋病病毒预防项目接触（AOR：1.
