Lyons Carrie E, Grosso Ashley, Drame Fatou M, Ketende Sosthenes, Diouf Daouda, Ba Ibrahima, Shannon Kate, Ezouatchi Rebecca, Bamba Amara, Kouame Abo, Baral Stefan
*Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD; †Department of Geography, School of Social Sciences, Gaston Berger University, St. Louis, Senegal; ‡Enda Santé, Dakar, Senegal; §Gender and Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada; ‖Canada University of British Columbia, Vancouver, British Columbia, Canada; ¶Enda Santé, Abidjan, Côte d'Ivoire; and #Programme National de Lutte Contre le SIDA, Ministere de la Lutte Contre Le SIDA, Abidjan, Côte d'Ivoire.
J Acquir Immune Defic Syndr. 2017 May 1;75(1):9-17. doi: 10.1097/QAI.0000000000001310.
Violence is a human rights violation, and an important measure in understanding HIV among female sex workers (FSW). However, limited data exist regarding correlates of violence among FSW in Côte d'Ivoire. Characterizing prevalence and determinants of violence and the relationship with structural risks for HIV can inform development and implementation of comprehensive HIV prevention and treatment programs.
FSW > 18 years were recruited through respondent driven sampling (RDS) in Abidjan, Côte d'Ivoire. In total, 466 participants completed a socio-behavioral questionnaire and HIV testing. Prevalence estimates of violence were calculated using crude and RDS-adjusted estimates. Relationships between structural risk factors and violence were analyzed using χ tests and multivariable logistic regression.
The prevalence of physical violence was 53.6% (250/466), and sexual violence was 43.2% (201/465) among FSW in this study. Police refusal of protection was associated with physical (adjusted Odds Ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.7 to 4.4) and sexual violence (aOR: 3.0; 95% CI: 1.9 to 4.8). Blackmail was associated with physical (aOR: 2.5; 95% CI: 1.5 to 4.2) and sexual violence (aOR: 2.4; 95% CI: 1.5 to 4.0). Physical violence was associated with fear (aOR: 2.2; 95% CI: 1.3 to 3.1) and avoidance of seeking health services (aOR: 2.3; 95% CI: 1.5 to 3.8).
Violence is prevalent among FSW in Abidjan and associated with features of the work environment and access to care. These relationships highlight layers of rights violations affecting FSW, underscoring the need for structural interventions and policy reforms to improve work environments, and to address police harassment, stigma, and rights violations to reduce violence and improve access to HIV interventions.
暴力是对人权的侵犯，也是了解女性性工作者（FSW）中艾滋病毒情况的一项重要措施。然而，关于科特迪瓦女性性工作者暴力行为相关因素的数据有限。明确暴力行为的流行程度、决定因素以及与艾滋病毒结构性风险的关系，可为制定和实施全面的艾滋病毒预防与治疗方案提供依据。
通过应答者驱动抽样（RDS）在科特迪瓦阿比让招募18岁以上的女性性工作者。共有466名参与者完成了社会行为问卷调查和艾滋病毒检测。使用粗略估计值和经RDS调整的估计值计算暴力行为的流行率估计值。使用χ检验和多变量逻辑回归分析结构性风险因素与暴力行为之间的关系。
在本研究中，女性性工作者中身体暴力的流行率为53.6%（250/466），性暴力的流行率为43.2%（201/465）。警方拒绝提供保护与身体暴力（调整后的优势比[aOR]：2.8；95%置信区间[CI]：1.7至4.4）和性暴力（aOR：3.0；95%CI：1.9至4.8）相关。敲诈勒索与身体暴力（aOR：2.5；95%CI：1.5至4.2）和性暴力（aOR：2.4；95%CI：1.5至4.0）相关。身体暴力与恐惧（aOR：2.2；95%CI：1.3至3.1）和避免寻求医疗服务（aOR：2.3；95%CI：1.5至3.8）相关。
暴力行为在阿比让的女性性工作者中普遍存在，且与工作环境特征和获得护理的机会相关。这些关系凸显了影响女性性工作者的多层权利侵犯问题，强调需要进行结构性干预和政策改革，以改善工作环境，并解决警方骚扰、耻辱感和权利侵犯问题，从而减少暴力行为并改善获得艾滋病毒干预措施的机会。
