Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Enda Santé, Dakar, Senegal.
J Acquir Immune Defic Syndr. 2019 May 1;81(1):63-71. doi: 10.1097/QAI.0000000000001991.
Female sex workers (FSWs) are disproportionately affected by HIV even in the most generalized HIV epidemics. Although structural HIV risks have been understood to affect condom negotiation among FSWs globally, there remain limited data on the relationship between structural determinants of HIV risk, including violence and socioeconomic status, and condom use among FSWs across sub-Saharan Africa. Here, we describe the prevalence of structural determinants and their associations with condom use among FSWs in Senegal.
In 2015, 758 FSWs >18 years of age were recruited using respondent driven sampling in Senegal. Data on individual, community, network, and structural-level risks were collected through an interviewer-administered questionnaire. Poisson regression with robust variance estimation was used to model the associations of consistent condom use (CCU) and selected structural determinants.
The respondent driven sampling-adjusted prevalence of CCU in the last 10 sexual acts was 76.8% [95% confidence interval (CI): 70.8 to 82.8]. Structural determinants that were significantly associated with lower CCU were as follows: physical violence [adjusted prevalence ratio (aPR): 0.71; 95% CI: 0.52 to 0.98]; working primarily in a hotel or guest house (aPR: 0.85; 95% CI: 0.73 to 0.99); and difficultly accessing condoms (aPR: 0.72; 95% CI: 0.52 to 0.96). High income from sex work (aPR: 1.23; 95% CI: 1.04 to 1.46) was significantly associated with higher CCU.
Taken together, these data highlight the role of structural risk determinants on condom use among FSWs in Senegal. Moreover, these results highlight the need for structural interventions, including safe working spaces and violence mitigation programs, to support condom negotiation and access. Combined with condom distribution programs, structural interventions could ultimately increase condom use among FSWs in Senegal.
即使在最普遍的 HIV 流行中，女性性工作者（FSWs）也不成比例地受到 HIV 的影响。尽管已经了解到结构性 HIV 风险会影响全球 FSW 之间的 condom 谈判，但在撒哈拉以南非洲，有关结构性 HIV 风险决定因素（包括暴力和社会经济地位）与 FSW 使用 condom 之间关系的数据仍然有限。在这里，我们描述了塞内加尔 FSW 中结构性决定因素的流行情况及其与 condom 使用的关系。
2015 年，使用塞内加尔的受访者驱动抽样方法招募了 758 名年龄在 18 岁以上的 FSW。通过访谈者管理的问卷收集了个人、社区、网络和结构性风险的数据。使用具有稳健方差估计的泊松回归模型来模拟 condom 使用的一致性（CCU）和选定的结构性决定因素之间的关联。
最后 10 次性行为中 CCU 的受访者驱动抽样调整患病率为 76.8%[95%置信区间（CI）：70.8%至 82.8%]。与较低 CCU 显著相关的结构性决定因素如下：身体暴力[调整后的患病率比（aPR）：0.71；95%CI：0.52 至 0.98]；主要在酒店或宾馆工作（aPR：0.85；95%CI：0.73 至 0.99）；难以获得 condom（aPR：0.72；95%CI：0.52 至 0.96）。高性工作收入（aPR：1.23；95%CI：1.04 至 1.46）与较高的 CCU 显著相关。
综上所述，这些数据突出了结构性风险决定因素对塞内加尔 FSW 使用 condom 的作用。此外，这些结果强调了需要采取结构性干预措施，包括安全工作空间和减少暴力方案，以支持 condom 谈判和获取。与 condom 分发方案相结合，结构性干预措施最终可能会增加塞内加尔 FSW 使用 condom 的人数。
