Argento Elena, Duff Putu, Bingham Brittany, Chapman Jules, Nguyen Paul, Strathdee Steffanie A, Shannon Kate
Gender & Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
AIDS Behav. 2016 Jun;20(6):1275-83. doi: 10.1007/s10461-015-1230-8.
Community empowerment can be a powerful determinant of HIV risk among sex workers (SWs). This study modeled the impact of social cohesion on client condom refusal among SWs in Vancouver. Longitudinal data were drawn from a prospective cohort of SWs (2010-2013). Lippman and colleagues' Social Cohesion Scale measured SWs' connectedness (i.e., perception of mutual aid, trust, support). Multivariable logistic regression examined the independent effect of social cohesion on client condom refusal. Of 654 SWs, 22 % reported baseline client condom refusal and 34 % over 3 years. The baseline median social cohesion score was 24 (IQR 20-29, range 4-45). In the final confounding model, for every one-point increase in the social cohesion score, average odds of condom refusal decreased by 3 % (AOR 0.97; 95 % CI 0.95-0.99). Community empowerment can have a direct protective effect on HIV risk. These findings highlight the need for a legal framework that enables collectivization and SW-led efforts in the HIV response.
社区赋权可能是性工作者中艾滋病毒风险的一个有力决定因素。本研究模拟了社会凝聚力对温哥华性工作者中客户拒绝使用避孕套的影响。纵向数据来自一个性工作者前瞻性队列（2010 - 2013年）。李普曼及其同事的社会凝聚力量表测量了性工作者的联系程度（即互助、信任、支持的感知）。多变量逻辑回归分析了社会凝聚力对客户拒绝使用避孕套的独立影响。在654名性工作者中，22%报告基线时客户拒绝使用避孕套，34%在3年期间有此情况。基线时社会凝聚力得分中位数为24（四分位间距20 - 29，范围4 - 45）。在最终的混杂模型中，社会凝聚力得分每增加1分，避孕套拒绝的平均几率降低3%（调整后比值比0.97；95%置信区间0.95 - 0.99）。社区赋权对艾滋病毒风险可产生直接保护作用。这些发现凸显了建立一个法律框架的必要性，该框架应能促进集体化以及由性工作者主导的艾滋病毒应对努力。
