Shrestha Roman, Karki Pramila, Copenhaver Michael
Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.
Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
Prim Prev Insights. 2016;6:11-17. doi: 10.4137/PPRI.S39664. Epub 2016 Jun 9.
Heterosexual sex involving female sex workers (FSWs) is widely documented for its role in facilitating the spread of sexually transmitted infections (STIs)/HIV. Critical to such studies, and increasingly considered essential to HIV prevention efforts, is the gender constructs and power dynamics within relationships. However, little efforts have been made, which focus on male clients of FSWs, particularly on the relationship between gender ideologies and men's sexual contact with FSWs, within the Nepali context. The present study aims to fill this critical gap by assessing the prevalence of use of FSWs and its association with STIs/HIV-related risk behaviors and gender ideologies among Nepali men. We used data from the nationally representative Nepal Demographic Health Survey (NDHS) 2011. For the purpose of analyses, we included a sample of 4,121 men, aged 15-49 years. During data analyses, we used multivariate logistic regression models, adjusted for the following variables: age, region, residence, religion, educational level, wealth index, employment status, and cigarette smoking status. Of the total sample, approximately 5% reported the use of FSWs in their lifetime. In regression models, men who had sex with FSWs were more likely to report a history of STIs [adjusted odds ratio (aOR): 3.03; 95% confidence interval (CI): 1.69-5.43; < 0.001], not using condom all the time (aOR: 1.31; 95% CI: 1.05-2.12; = 0.010), more than one sexual partner (aOR: 3.75; 95% CI: 2.18-5.23; < 0.001), and have had early sexual debut (aOR: 2.60; 95% CI: 1.85-3.67; < 0.001). Respondents reporting the endorsement of violence against wives (aOR: 1.65; 95% CI: 1.01-2.84; = 0.04) and male sexual entitlement (aOR: 1.63; 95% CI: 1.21-2.32; = 0.001) were significantly more likely to report sexual contact with FSWs. Our findings highlight the need to develop and implement specifically tailored interventions toward male clients of FSWs, with a particular emphasis on promoting equitable gender roles and beliefs.
涉及女性性工作者（FSW）的异性性行为在促进性传播感染（STIs）/艾滋病毒传播方面所起的作用有大量文献记载。对于此类研究至关重要且日益被视为艾滋病毒预防工作必不可少的因素是两性关系中的性别建构和权力动态。然而，在尼泊尔背景下，针对FSW男性客户的研究较少，尤其是关于性别观念与男性与FSW性接触之间的关系。本研究旨在通过评估尼泊尔男性中使用FSW的流行情况及其与STIs/艾滋病毒相关风险行为和性别观念的关联来填补这一关键空白。我们使用了具有全国代表性的2011年尼泊尔人口与健康调查（NDHS）的数据。为了进行分析，我们纳入了4121名年龄在15 - 49岁之间的男性样本。在数据分析过程中，我们使用了多变量逻辑回归模型，并对以下变量进行了调整：年龄、地区、居住状况、宗教、教育水平、财富指数、就业状况和吸烟状况。在总样本中，约5%的人报告在其一生中使用过FSW。在回归模型中，与FSW发生性行为的男性更有可能报告有性传播感染病史[调整后的优势比（aOR）：3.03；95%置信区间（CI）：1.69 - 5.43；P < 0.001]，并非始终使用避孕套（aOR：1.31；95% CI：1.05 - 2.12；P = 0.010），有不止一个性伴侣（aOR：3.75；95% CI：2.18 - 5.23；P < 0.001），以及有过早的首次性行为（aOR：2.60；95% CI：1.85 - 3.67；P < 0.001）。报告赞同对妻子实施暴力（aOR：1.65；95% CI：1.01 - 2.84；P = 0.04）和男性性权利观念（aOR：1.63；95% CI：1.21 - 2.32；P = 0.001）的受访者更有可能报告与FSW有性接触。我们的研究结果凸显了针对FSW男性客户制定和实施专门针对性干预措施的必要性，尤其要强调促进平等的性别角色和观念。
