Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.
J Acquir Immune Defic Syndr. 2019 Mar 1;80(3):e64-e73. doi: 10.1097/QAI.0000000000001920.
Female sex workers (FSW) are disproportionately affected by HIV in Cameroon, with an estimated 23.6% HIV prevalence. Given the unavailability of HIV incidence data, to better understand associations with acquiring HIV we assessed the prevalence and associations with new HIV diagnoses among FSW in Cameroon.
In 2016, FSW were recruited through respondent-driven sampling from 5 cities for a biobehavioral survey. Participants self-reporting living with HIV or with an indeterminate test status were excluded from analysis. New diagnoses were defined as testing HIV-positive when participants self-reported HIV-negative or unknown status. A multivariable modified Poisson regression model was developed to assess determinants of new HIV diagnosis (referent group: HIV-negative) using key covariates; adjusted prevalence ratios (aPR) are reported if statistically significant (P < 0.05).
Overall 2255 FSW were recruited. Excluding participants who self-reported living with HIV (n = 297) and indeterminate test results (n = 7), 260/1951 (13.3%) FSW were newly diagnosed with HIV. Variables significantly associated with new HIV diagnosis were: no secondary/higher education [aPR: 1.56, 95% confidence interval (CI): 1.12 to 2.15], 5+ dependents compared with none (aPR: 2.11, 95% CI: 1.01 to 4.40), 5+ years involved in sex work compared with <1 year (aPR: 2.84, 95% CI: 1.26 to 6.42), history of incarceration (aPR: 2.13, 95% CI: 1.13 to 3.99), and low social capital (aPR: 1.53, 95% CI: 1.12 to 2.10). Higher monthly income (>250,000 FCFA vs. <50,000 FCFA) was associated with lower prevalence of new HIV diagnosis (aPR: 0.22, 95% CI: 0.05 to 0.86).
There are significant sociostructural factors that seem to potentiate risk of HIV infection and delay diagnosis among FSW in Cameroon. Initiatives to build social capital and integrate services such as pre-exposure prophylaxis and HIV self-testing into HIV programs may reduce new infections and decrease time to diagnosis and treatment.
在喀麦隆，女性性工作者（FSW）受到艾滋病毒的影响不成比例，艾滋病毒感染率估计为 23.6%。由于无法获得艾滋病毒发病率数据，为了更好地了解与艾滋病毒感染相关的因素，我们评估了喀麦隆 FSW 中新诊断的 HIV 感染的流行率及其相关性。
2016 年，通过来自 5 个城市的反应者驱动抽样，从 FSW 中招募参与者进行生物行为调查。排除自我报告患有 HIV 或不确定检测结果的参与者（共 297 名）。新诊断定义为当参与者自我报告 HIV 阴性或未知状态时，检测 HIV 阳性。使用关键协变量开发了多变量修正泊松回归模型来评估新 HIV 诊断的决定因素（参考组：HIV 阴性）；如果有统计学意义（P < 0.05），则报告调整后的患病率比（aPR）。
共招募了 2255 名 FSW。排除自我报告患有 HIV（n = 297）和不确定检测结果（n = 7）的参与者后，1951 名 FSW 中有 260 名被新诊断为 HIV 阳性。与新诊断 HIV 显著相关的变量为：无中等/高等教育（aPR：1.56，95%置信区间（CI）：1.12 至 2.15），与无依赖者相比，有 5 个或更多依赖者（aPR：2.11，95%CI：1.01 至 4.40），性工作年限为 5 年或以上与<1 年相比（aPR：2.84，95%CI：1.26 至 6.42），有入狱史（aPR：2.13，95%CI：1.13 至 3.99），以及社会资本低（aPR：1.53，95%CI：1.12 至 2.10）。与收入每月高于 250,000 FCFA（FCFA 是一种货币单位）相比，收入每月<50,000 FCFA 与新 HIV 诊断的患病率较低相关（aPR：0.22，95%CI：0.05 至 0.86）。
喀麦隆的 FSW 中，存在明显的社会结构因素，似乎增加了 HIV 感染的风险，并延迟了 HIV 的诊断。建立社会资本的举措，并将暴露前预防和 HIV 自我检测等服务纳入 HIV 方案中，可能会减少新的感染，并缩短诊断和治疗时间。
