Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America.
Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica.
PLoS One. 2018 Nov 26;13(11):e0206962. doi: 10.1371/journal.pone.0206962. eCollection 2018.
HIV prevention strategies often include outreach to female sex workers at social venues identified as places where people meet new sexual partners. Patrons and staff at these venues may include female sex workers, their clients, as well as others who have high rates of new sexual partnerships. Few studies have compared HIV/STI among venue-based and general populations, across types of venues, or by sub-group of the venue population. Program planners often assume that the prevalence of infection is highest among female sex workers and considerably lower among other people at these venues, but there are few empiric studies assessing the prevalence of infection by sex worker status and type of venue.
In 2011, we used the PLACE method to identify public venues where people meet new sexual partners across Jamaica. The study team visited all venues with reported sex work as well as a 10% random sample of other venues and subsequently interviewed and tested a probability sample of 991 venue patrons and workers for HIV and other STI.
Community informants identified 1207 venues. All venues where sex work was reported (735 venues) and a random sample of the remainder (134 of 472) were selected for onsite visits. Of these, 585 were found and operational. At a stratified random sample of venues, survey teams interviewed and tested 717 women and 274 men. 394 women reported recent sex work and 211 of these women reported soliciting clients on the street. Women exchanging sex for money were more likely to be infected with HIV (5.4% vs 1.0%; OR = 5.6, 95% CI = 1.8,17.3) or syphilis (11.7% vs. 5.8%, OR = 2.2, 95% CI = 1.7,4,0) than other women, but not significantly more likely to be infected with gonorrhea (8.4% vs 7.8%; OR = 1.1,95% CI = 0.6,1.9), chlamydia (16.2% vs 21.6%;OR = 0.7,95% CI = 0.5,1.0) or trichomoniasis (23.0% vs 17.0%, OR = 1.5,95% CI = 0.9,2.2). Women at venues were more likely to report sex work and multiple partners than women interviewed in a 2008 national population-based household survey commissioned by the Ministry of Health.
In Jamaica, although the highest HIV prevalence was among street-based sex workers, the risk of HIV and STI extends to men and women at high risk venues, even those who do not self-identify as sex workers. Findings confirm the appropriateness of outreach to all men and women at these venues.
艾滋病毒预防策略通常包括在被确定为人们结识新性伴侣的社交场所对女性性工作者进行外展。这些场所的顾客和工作人员可能包括女性性工作者、她们的客户以及其他新性伴侣比例较高的人。很少有研究比较过基于场所和一般人群、不同类型场所或基于场所人群亚组的艾滋病毒/性传播感染情况。规划人员通常假设感染率在性工作者中最高，而在这些场所的其他人中则低得多，但很少有经验研究评估性工作者身份和场所类型与感染率的相关性。
2011 年，我们使用 PLACE 方法在牙买加确定了人们结识新性伴侣的公共场所。研究小组访问了所有报告有性工作的场所，以及其他场所的 10%随机样本，随后对 991 名场所顾客和工作人员进行了艾滋病毒和其他性传播感染的概率抽样访谈和检测。
社区线人确定了 1207 个场所。所有报告有性工作的场所（735 个）和其余场所的随机样本（472 个中的 134 个）都进行了现场访问。其中，585 个被发现并投入运营。在分层随机抽样的场所中，调查小组对 717 名女性和 274 名男性进行了访谈和检测。394 名女性报告最近从事性工作，其中 211 名女性在街上招揽客户。为钱发生性行为的女性更有可能感染艾滋病毒（5.4%比 1.0%；OR = 5.6，95%CI = 1.8，17.3）或梅毒（11.7%比 5.8%；OR = 2.2，95%CI = 1.7，4.0），而不是其他女性，但感染淋病（8.4%比 7.8%；OR = 1.1，95%CI = 0.6，1.9）、衣原体（16.2%比 21.6%；OR = 0.7，95%CI = 0.5，1.0）或滴虫病（23.0%比 17.0%；OR = 1.5，95%CI = 0.9，2.2）的可能性没有显著增加。与卫生部委托进行的 2008 年全国基于人群的家庭调查中接受访谈的女性相比，场所内的女性更有可能报告性工作和多个性伴侣。
在牙买加，尽管街头性工作者的艾滋病毒感染率最高，但艾滋病毒和性传播感染的风险也延伸到高危场所的男性和女性，甚至包括那些不自我认定为性工作者的人。研究结果证实了向这些场所的所有男性和女性提供外展服务的合理性。
