减轻情节：基于模型的分析，探讨中国街头性工作者风险环境与不频繁使用避孕套之间的关联。
Mitigating circumstances: A model-based analysis of associations between risk environment and infrequent condom use among Chinese street-based sex workers.
机构信息
Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington DC, United States of America.
Griffith Criminology Institute, Griffith University, Mt. Gravatt, Queensland, Australia.
出版信息
PLoS One. 2018 May 15;13(5):e0195982. doi: 10.1371/journal.pone.0195982. eCollection 2018.
BACKGROUND
Little is known about how freelance street-based sex workers navigate condom use while soliciting. Traditional behavioural model may fail to account for the complex risk environment that most street-based sex workers work within. We examine first the association of self-efficacy and the infrequent condom use, then we investigated the roles of clients and venues frequented on this association.
METHOD
Using a purposive chain-referral sampling method, we surveyed 248 street-based sex workers in Shanghai. The survey focused on sex workers HIV risk factors, sex work patterns, HIV knowledge, and related HIV self-efficacy. Clients types and behaviours, and characteristics of the venues frequented by these commercial sex workers were also collected. We conducted a series of multiple logistic regression models to explore how the association between a sex worker's self-efficacy with infrequent condom use change as client and venue characteristics were added to the models.
RESULTS
We find that within the basic model, low self-efficacy was marginally associated with infrequent condom use (54.9% vs. 45.1%, AOR = 1.70, 95% CI = 0.95-3.03). As client- and venue- characteristics were added, the associations between self-efficacy and condom use were strengthened (AOR = 2.10 95% CI = 1.12-3.91 and 2.54 95% CI = 1.24-5.19 respectively). Those who reported middle-tiered income were more likely to report infrequent condom use compared to their peers of high income (AOR = 3.92 95% CI = 1.32-11.70) whereas such difference was not found between low income and high income sex workers. Visiting multiple venues and having migrant workers as clients were also associated with infrequent condom use.
CONCLUSION
Our findings suggest sex worker's self-efficacy matters in their HIV risk behaviours only when environment characteristics were adjusted. Risk environment for street-based sex workers are complex. Programming addressing behavioural changes among female sex workers should adopt holistic, multilevel models with the consideration of risk environments.
背景
对于自由职业的街头性工作者在拉客时如何使用避孕套，我们知之甚少。传统的行为模式可能无法解释大多数街头性工作者所处的复杂风险环境。我们首先考察了自我效能感与避孕套使用频率较低之间的关联，然后研究了光顾的客户类型和场所对这种关联的作用。
方法
我们采用有目的的连锁式 referral 抽样方法，调查了上海 248 名街头性工作者。调查重点是性工作者的 HIV 风险因素、性工作模式、HIV 知识以及相关的 HIV 自我效能感。还收集了这些商业性工作者光顾的客户类型和行为以及场所特征。我们进行了一系列多项逻辑回归模型，以探讨随着模型中加入客户和场所特征，性工作者自我效能感与避孕套使用频率较低之间的关联如何变化。
结果
我们发现，在基本模型中，低自我效能感与避孕套使用频率较低（54.9% 与 45.1%，AOR = 1.70，95%CI = 0.95-3.03）之间存在微弱关联。随着客户和场所特征的加入，自我效能感与避孕套使用之间的关联得到了加强（AOR = 2.10，95%CI = 1.12-3.91 和 2.54，95%CI = 1.24-5.19）。与高收入同行相比，报告中等收入的人更有可能报告避孕套使用频率较低（AOR = 3.92，95%CI = 1.32-11.70），而低收入和高收入性工作者之间没有发现这种差异。光顾多个场所和接待农民工客户也与避孕套使用频率较低有关。
结论
我们的研究结果表明，只有在调整环境特征的情况下，性工作者的自我效能感才会影响他们的 HIV 风险行为。街头性工作者的风险环境非常复杂。针对女性性工作者行为改变的规划应该采用整体的、多层次的模型，并考虑风险环境。
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