Pitpitan Eileen V, Strathdee Steffanie A, Semple Shirley J, Chavarin Claudia V, Magis-Rodriguez Carlos, Patterson Thomas L
Eileen V. Pitpitan, Steffanie A. Strathdee, Shirley J. Semple, and Claudia V. Chavarin are with the Division of Global Public Health, Department of Medicine, University of California San Diego. Carlos Magis-Rodriguez is with the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico. Thomas L. Patterson is with the Department of Psychiatry, University of California San Diego.
Am J Public Health. 2015 Sep;105(9):1866-71. doi: 10.2105/AJPH.2014.302366. Epub 2015 Feb 25.
We sought to test the efficacy of a sexual risk intervention for male clients of female sex workers (FSWs) and examine whether efficacy was moderated by syndemic risk.
From 2010 to 2014, we conducted a 2-arm randomized controlled trial (60-minute, theory-based, safer sex intervention versus a didactic time-equivalent attention control) that included 400 male clients of FSWs on the US-Mexico border with follow-up at 4, 8, and 12 months. We measured 5 syndemic risk factors, including substance use and depression. Primary outcomes were sexually transmitted infections incidence and total unprotected sex with FSWs.
Although participants in both groups became safer, there was no significant difference in behavior change between groups. However, baseline syndemic risk moderated intervention efficacy. At baseline, there was a positive association between syndemic risk and unprotected sex. Then at 12 months, longitudinal analyses showed the association depended on intervention participation (B = -0.71; 95% confidence interval [CI] = -1.22, -0.20; P = .007). Among control participants there still existed this modest association (B = 0.36; 95% CI = -0.49, 1.22; P = .09); among intervention participants there was a significant negative association (B = -0.35; 95% CI = -0.63, -0.06; P = .02).
A brief intervention might attenuate syndemic risks among clients of FSWs. Other populations experiencing syndemic problems may also benefit from such programs.
我们试图测试一项针对女性性工作者（FSW）男性客户的性风险干预措施的效果，并研究效果是否受到共病风险的调节。
2010年至2014年，我们进行了一项双臂随机对照试验（60分钟、基于理论的安全性行为干预与时长相等的讲授式注意力控制组对比），纳入了400名美墨边境的FSW男性客户，并在4个月、8个月和12个月时进行随访。我们测量了5种共病风险因素，包括药物使用和抑郁。主要结局指标为性传播感染发病率以及与FSW发生的无保护性行为总数。
尽管两组参与者的行为都更安全了，但两组之间的行为改变没有显著差异。然而，基线共病风险调节了干预效果。在基线时，共病风险与无保护性行为之间存在正相关。到12个月时，纵向分析显示这种关联取决于是否参与干预（B = -0.71；95%置信区间[CI] = -1.22，-0.20；P = .007）。在对照组参与者中，这种适度的关联仍然存在（B = 0.36；95% CI = -0.49，1.22；P = .09）；在干预组参与者中，存在显著的负相关（B = -0.35；95% CI = -0.63，-0.06；P = .02）。
简短的干预可能会减轻FSW客户中的共病风险。其他存在共病问题的人群也可能从这类项目中受益。
