Kakchapati Sampurna, Paudel Tarun, Maharjan Manju, Lim Apiradee
Post-doctoral Research Scientist, Department of Computer Science and Mathematics, Faculty of Science and Technology Prince of Songkla University, Pattani, Thailand.
Director, National Centre for AIDS and STD Control, Kathmandu Nepal.
Nepal J Epidemiol. 2016 Dec 31;6(4):620-630. doi: 10.3126/nje.v6i4.17256. eCollection 2016 Dec.
Female Sex Workers (FSWs) are main drivers of the HIV epidemic in Nepal. The work environment of sex work in Nepal is differentiated into establishment based (e.g. massage parlors, dance restaurants, hotels and lodges) and street based (e.g. streets, parks and markets). The study compares HIV, syphilis and risk behaviours among establishment-based FSWs and street-based FSWs in Kathmandu Valley of Nepal.
Cross-sectional bio-behavioral surveys in 2006, 2008, 2011 and 2015 aimed to sample 2093 FSWs using two stage cluster sampling in the Kathmandu valley. Statistical analysis used chi-squared tests and logistic regression models to assess differences of HIV, syphilis and risk behaviors among street-based FSWs and establishment-based FSWs.
The study included 39.7% street-based FSWs and 60.3% establishment-based FSWs. The street-based FSWs had lower education levels, older age groups, separated, longer duration of sex work and inconsistent condom used with clients than establishment-based FSWs (p<0.05). Establishment-based FSWs were lower exposure to HIV intervention programs and pervasive alcohol consumption and use of drugs (p<0.05). The multivariate analysis showed that street-based FSWs were more likely of HIV test (aOR=1.25, 95%CI=1.04, 1.49), HIV (aOR=4.72, 95%CI=2.19, 10.15) and syphilis (aOR=7.96, 95%CI=3.49, 18.15) than establishment-based FSWs.
Street-based FSWs possessed higher risk behaviour and have higher HIV and syphilis prevalence. HIV prevention interventions targeting FSWs should consider risks and vulnerability of street-based FSWs. .
女性性工作者是尼泊尔艾滋病流行的主要推动因素。尼泊尔性工作的工作环境分为场所性（如按摩院、舞蹈餐厅、酒店和旅馆）和街头性（如街道、公园和市场）。本研究比较了尼泊尔加德满都谷地场所性女性性工作者和街头性女性性工作者中的艾滋病毒、梅毒感染情况及风险行为。
2006年、2008年、2011年和2015年进行的横断面生物行为调查旨在通过两阶段整群抽样在加德满都谷地抽取2093名女性性工作者作为样本。统计分析采用卡方检验和逻辑回归模型来评估街头性女性性工作者和场所性女性性工作者在艾滋病毒、梅毒感染情况及风险行为方面的差异。
该研究纳入了39.7%的街头性女性性工作者和60.3%的场所性女性性工作者。与场所性女性性工作者相比，街头性女性性工作者受教育程度较低、年龄较大、分居、性工作时间较长且与客户使用避孕套的情况不一致（p<0.05）。场所性女性性工作者接受艾滋病毒干预项目的机会较少，且普遍存在酗酒和吸毒现象（p<0.05）。多变量分析显示，与场所性女性性工作者相比，街头性女性性工作者进行艾滋病毒检测的可能性更高（调整后比值比[aOR]=1.25，95%置信区间[CI]=1.04，1.49），感染艾滋病毒的可能性更高（aOR=4.72，95%CI=2.19，10.15），感染梅毒的可能性更高（aOR=7.96，95%CI=3.49，18.15）。
街头性女性性工作者具有更高的风险行为，艾滋病毒和梅毒感染率也更高。针对女性性工作者开展的艾滋病毒预防干预措施应考虑街头性女性性工作者面临的风险和脆弱性。
