Slabbert Mariette, Venter Francois, Gay Cynthia, Roelofsen Corine, Lalla-Edward Samanta, Rees Helen
Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
University of North Carolina, Chapel Hill, NC, USA.
BMC Public Health. 2017 Jul 4;17(Suppl 3):442. doi: 10.1186/s12889-017-4346-0.
The sexual and reproductive health (SRH) status of female sex workers is influenced by a wide range of demographic, behavioural and structural factors. These factors vary considerably across and even within settings. Adopting an overly standardised approach to sex worker programmes may compromise its impact on some sub-groups in local areas.
Records of female sex workers attending clinic-, community-, or hotel-based health services in Johannesburg (n = 1422 women) and Pretoria (n = 408 women), South Africa were analysed. We describe the population's characteristics and identified factors associated with sexual and reproductive health outcomes, namely HIV status; previous symptomatic sexually transmitted infection (STI); modern contraceptive use and number of child dependents.
The women in Johannesburg were less likely than those in Pretoria to have HIV (42.2% vs 52.9%), or previous symptomatic STIs (44.3% vs. 8.3%), and were 1.4 fold less likely to have child dependents (20.1% vs. 15.3%). About 43% of women in Johannesburg were Zimbabwean and 40% in Pretoria. Of concern, only about 15% of women in both sites were using modern contraceptives. Johannesburg women were also more likely to access health services at a hotel (85.0% vs. 80.6%) or clinic (5.7% vs. 0.5%), to have completed secondary education (57.1% vs. 36.0%), and moved house more than twice during the past year (19.6 vs. 2.0%). In both cities, risk of HIV rose rapidly with age (23.8%-58.2% vs. 22.0%-64.8%). Of interest, HIV prevalence was considerably higher in those with consistent condom use with one's main partner than inconsistent users.
Sex worker populations are heterogeneous. Local health programmes must prioritise services that reflect the variety and complexity of sex worker needs and behaviours, and should be designed in consultation with sex workers. Segmenting sex worker populations according to age, country of origin and place of service delivery, and training healthcare providers accordingly, could help prevent new HIV infections, improve adherence to antiretroviral treatment and increase uptake of SRH services.
女性性工作者的性与生殖健康（SRH）状况受到多种人口统计学、行为学和结构性因素的影响。这些因素在不同地区甚至同一地区内部都存在很大差异。对性工作者项目采用过于标准化的方法可能会削弱其对当地某些亚群体的影响。
对在南非约翰内斯堡（n = 1422名女性）和比勒陀利亚（n = 408名女性）的诊所、社区或酒店提供的健康服务机构就诊的女性性工作者的记录进行了分析。我们描述了该人群的特征，并确定了与性与生殖健康结果相关的因素，即艾滋病毒感染状况；既往有症状的性传播感染（STI）；现代避孕方法的使用情况以及受抚养子女的数量。
约翰内斯堡的女性感染艾滋病毒的可能性低于比勒陀利亚的女性（42.2%对52.9%），或既往有症状的性传播感染的可能性也较低（44.3%对8.3%），并且有受抚养子女的可能性低1.4倍（20.1%对15.3%）。约翰内斯堡约43%的女性来自津巴布韦，比勒陀利亚为40%。令人担忧的是，两个地点只有约15%的女性在使用现代避孕方法。约翰内斯堡的女性也更有可能在酒店（85.0%对80.6%）或诊所（5.7%对0.5%）获得健康服务，完成中等教育的比例更高（57.1%对36.0%），并且在过去一年中搬家超过两次的比例更高（19.6对2.0%）。在两个城市，艾滋病毒感染风险都随着年龄的增长而迅速上升（23.8% - 58.2%对22.0% - 64.8%）。有趣的是,与主要伴侣始终坚持使用避孕套的人相比，不坚持使用避孕套的人的艾滋病毒感染率要高得多。
性工作者群体是异质的。当地的健康项目必须优先提供反映性工作者需求和行为的多样性和复杂性的服务，并且应该在与性工作者协商的基础上进行设计。根据年龄、原籍国和服务提供地点对性工作者群体进行细分，并相应地培训医疗保健提供者，有助于预防新的艾滋病毒感染，提高对抗逆转录病毒治疗的依从性，并增加对性与生殖健康服务的接受度。
