尼日利亚男男性交易者的污名化、医疗保健获取情况及感染艾滋病毒的风险
Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria.
作者信息
Crowell Trevor A, Keshinro Babajide, Baral Stefan D, Schwartz Sheree R, Stahlman Shauna, Nowak Rebecca G, Adebajo Sylvia, Blattner William A, Charurat Manhattan E, Ake Julie A
机构信息
U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
出版信息
J Int AIDS Soc. 2017 Apr 20;20(1):21489. doi: 10.7448/IAS.20.01.21489.
INTRODUCTION
Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour-related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria.
METHODS
Respondent-driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self-report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex-selling on the risk of HIV.
RESULTS
From 12 initial seed participants, 1552 men were recruited from March 2013-March 2016. Of these, 735 (47.4%) reported sex-selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84-1.05]).
CONCLUSION
These data highlight increased sexual behaviour-related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.
引言
在男男性行为者（MSM）中，以性交易为生的男性（MSS）可能面临与性行为相关的更多耻辱感，这会影响他们获得医疗保健的机会以及感染性传播感染（STIs）的风险。本研究的目的是描述尼日利亚MSS的耻辱感、获得医疗保健的情况以及艾滋病毒的流行率。
方法
采用应答者驱动抽样方法，将阿布贾和拉各斯的男男性行为者招募到正在进行的TRUST/RV368研究中，该研究提供艾滋病毒检测和治疗。由经过培训的访谈员收集详细的行为数据。通过自我报告与男性发生性行为以换取物品或金钱来确定MSS。使用具有稳健误差方差的泊松回归来探讨性交易对艾滋病毒风险的影响。
结果
从2013年3月至2016年3月，从12名初始种子参与者中招募了1552名男性。其中，735名（47.4%）报告有性交易行为。与其他男男性行为者相比，以性交易为生的男性更年轻（中位数分别为22岁和24岁，p<0.001），更有可能认同自己为同性恋（42.4%对31.5%，p<0.001）。以性交易为生的男性更有可能报告感知到的和经历过的耻辱感，如避免就医（27.6%对21.5%，p=0.005）和言语骚扰（39.2%对26.8%，p<0.001）。艾滋病毒总流行率为53.4%。在控制其他因素后，以性交易为生的男性中的艾滋病毒流行率与其他男男性行为者中观察到的流行率相似（相对风险0.94[95%置信区间0.84 - 1.05]）。
结论
这些数据表明，与其他男男性行为者相比，以性交易为生的男性面临与性行为相关的更多耻辱感，这限制了他们获得医疗保健服务的机会。以性交易为生的男性的独特特征和风险表明，在尼日利亚需要采取具体干预措施，以优化与艾滋病毒预防和治疗服务的联系。
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