在受冲突影响的乌干达北部，与战争相关的绑架和监禁史与女性性工作者中高负担的艾滋病毒相关联。
War-Related Abduction and History of Incarceration Linked to High Burden of HIV Among Female Sex Workers in Conflict-Affected Northern Uganda.
作者信息
Goldenberg Shira M, Muzaaya Godfrey, Akello Monica, Nguyen Paul, Birungi Josephine, Shannon Kate
机构信息
*Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; †Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada; ‡The AIDS Support Organisation Gulu, Gulu, Uganda; §The AIDS Support Organization Uganda, Kampala, Uganda; and ‖Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
出版信息
J Acquir Immune Defic Syndr. 2016 Sep 1;73(1):109-16. doi: 10.1097/QAI.0000000000001030.
OBJECTIVE
Sex workers (SWs) in sub-Saharan Africa face a disproportionate HIV burden and growing concerns of severe human rights violations. Given the dearth of evidence on the burden and correlates of HIV among SWs in sub-Saharan Africa, particularly within conflict-affected settings, we examined the relationship between structural determinants (eg, war-related abduction, incarceration) and HIV infection among conflict-affected SWs in Northern Uganda.
DESIGN
Cross-sectional community-based research study among female SWs in conflict-affected Gulu, Northern Uganda.
METHODS
Interview questionnaires and voluntary HIV testing were conducted with participants recruited through SW/peer-led outreach and time-location sampling from 2011 to 2012. HIV prevalence was calculated, and bivariable and multivariable logistic regression was used to identify independent associations with HIV seroprevalence.
RESULTS
Of 400 SWs, 135 (33.75%) were HIV seropositive; of whom one-third were new/previously undiagnosed HIV infections. In multivariable analysis, after adjusting for age of sex work entry and education, lifetime incarceration (adjusted odds ratio: 1.93, 95% confidence interval: 1.17 to -3.20) was independently associated with HIV seroprevalence, and history of wartime abduction (adjusted odds ratio: 1.62, 95% confidence interval: 1.00 to 2.63) was marginally associated (P = 0.051).
CONCLUSIONS
This study documented a high rate of undiagnosed HIV infections and associations between war-related human rights violations, incarceration, and a heavy HIV burden among SWs in conflict-affected Northern Uganda. These findings highlight the serious harms of conflict and criminalization of marginalized women in sub-Saharan African contexts. SW-led interventions that address conflict experiences and policy shifts to promote a rights-based approach to HIV prevention and care remain critically needed.
目的
撒哈拉以南非洲的性工作者面临着不成比例的艾滋病毒负担，且对严重侵犯人权行为的担忧日益增加。鉴于撒哈拉以南非洲性工作者中关于艾滋病毒负担及其相关因素的证据匮乏，尤其是在受冲突影响的地区，我们研究了乌干达北部受冲突影响的性工作者中结构决定因素（如与战争相关的绑架、监禁）与艾滋病毒感染之间的关系。
设计
对乌干达北部受冲突影响的古卢地区的女性性工作者进行基于社区的横断面研究。
方法
2011年至2012年，通过性工作者/同伴主导的外展活动和时间-地点抽样招募参与者，进行访谈问卷和自愿艾滋病毒检测。计算艾滋病毒感染率，并使用双变量和多变量逻辑回归来确定与艾滋病毒血清阳性率的独立关联。
结果
在400名性工作者中，135人（33.75%）艾滋病毒血清呈阳性；其中三分之一是新感染/以前未被诊断出的艾滋病毒感染者。在多变量分析中，在调整了从事性工作的年龄和教育程度后，终身监禁（调整后的优势比：1.93，95%置信区间：1.17至-3.20）与艾滋病毒血清阳性率独立相关，战时绑架史（调整后的优势比：1.62，95%置信区间：1.00至2.63）与之有边缘关联（P = 0.051）。
结论
本研究记录了乌干达北部受冲突影响地区性工作者中未被诊断出的艾滋病毒感染率很高，以及与战争相关的侵犯人权行为、监禁和沉重的艾滋病毒负担之间的关联。这些发现凸显了冲突以及将边缘化妇女定罪在撒哈拉以南非洲背景下造成的严重危害。迫切需要由性工作者主导的干预措施来解决冲突经历，并进行政策转变，以促进基于权利的艾滋病毒预防和护理方法。
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