Wickersham Jeffrey A, Gibson Britton A, Bazazi Alexander R, Pillai Veena, Pedersen Courtney J, Meyer Jaimie P, El-Bassel Nabila, Mayer Kenneth H, Kamarulzaman Adeeba, Altice Frederick L
From the *Section of Infectious Diseases, AIDS Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; †Faculty of Medicine, Department of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia; ‡Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT; §Social Intervention Group, School of Social Work, Columbia University, New York, NY; and ¶The Fenway Institute, Fenway Health, Boston, MA; and ∥Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard T.C. Chan School of Public Health, Boston, MA.
Sex Transm Dis. 2017 Nov;44(11):663-670. doi: 10.1097/OLQ.0000000000000662.
Sex workers face a disproportionate burden of human immunodeficiency virus (HIV) and sexually transmitted infections (STI) worldwide. For cisgender women sex workers (CWSW), global HIV prevalence is over 10%, whereas transgender women sex workers (TWSW) face an HIV burden of 19% to 27%.
We used respondent-driven sampling to recruit 492 sex workers, including CWSW (n = 299) and TWSW (n = 193) in Greater Kuala Lumpur, Malaysia. Participants completed an in-depth survey and were screened for HIV, syphilis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Sample characteristics stratified by gender identity and interview site are presented. Bivariate analyses comparing CWSW and TWSW were conducted using independent samples t tests for continuous variables and χ tests for categorical variables.
Pooled HIV prevalence was high (11.7%; 95% confidence interval [CI], 8.8-14.5), and was similar for CWSW (11.1%) and TWSW (12.4%). Rates of syphilis 25.5% (95% CI, 21.6-29.5), C. trachomatis (14.8%; 95% CI, 11.6-18.0) and N. gonorrhoeae (5.8%; 95% CI, 3.7-7.9) were also concerning. Both groups reported lifetime HIV testing (62.4%), but CWSW were less likely to have ever been HIV tested (54.5%) than TWSW (74.6%). Median time since last HIV test was 24 months. Previous screening for STI was low. Inconsistent condom use and drug use during sex work were not uncommon.
High HIV and STI prevalence, coupled with infrequent HIV and STI screening, inconsistent condom use, and occupational drug use, underscore the need for expanded HIV and STI prevention, screening, and treatment efforts among CWSW and TWSW in Malaysia.
在全球范围内，性工作者面临着不成比例的人类免疫缺陷病毒（HIV）和性传播感染（STI）负担。对于顺性别女性性工作者（CWSW）而言，全球HIV患病率超过10%，而跨性别女性性工作者（TWSW）面临的HIV负担为19%至27%。
我们采用应答驱动抽样方法，在马来西亚吉隆坡招募了492名性工作者，其中包括顺性别女性性工作者（n = 299）和跨性别女性性工作者（n = 193）。参与者完成了一项深入调查，并接受了HIV、梅毒、沙眼衣原体和淋病奈瑟菌的筛查。呈现了按性别认同和访谈地点分层的样本特征。使用独立样本t检验对连续变量进行双变量分析，比较顺性别女性性工作者和跨性别女性性工作者，对分类变量进行χ检验。
合并的HIV患病率很高（11.7%；95%置信区间[CI]，8.8 - 14.5），顺性别女性性工作者（11.1%）和跨性别女性性工作者（12.4%）的患病率相似。梅毒患病率为25.5%（95% CI，21.6 - 29.5），沙眼衣原体患病率为14.8%（95% CI，11.6 - 18.0），淋病奈瑟菌患病率为5.8%（95% CI，3.7 - 7.9），这些情况也令人担忧。两组均报告有终生HIV检测经历（62.4%），但顺性别女性性工作者（曾接受HIV检测的比例为54.5%）比跨性别女性性工作者（74.6%）接受HIV检测的可能性更低。自上次HIV检测以来的中位时间为24个月。既往STI筛查率较低。性工作期间不坚持使用避孕套和吸毒的情况并不罕见。
高HIV和STI患病率，加上HIV和STI筛查不频繁、避孕套使用不一致以及职业性吸毒，凸显了在马来西亚的顺性别女性性工作者和跨性别女性性工作者中扩大HIV和STI预防、筛查及治疗工作的必要性。
