Owen Branwen Nia, Baggaley Rebecca F, Elmes Jocelyn, Harvey Amy, Shubber Zara, Butler Ailsa R, Silhol Romain, Anton Peter, Shacklett Barbara, van der Straten Ariane, Boily Marie-Claude
Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, St Mary's Campus, Praed Street, London, W2 1NY, UK.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
AIDS Behav. 2020 Mar;24(3):697-713. doi: 10.1007/s10461-019-02477-w.
HIV is more efficiently acquired during receptive anal intercourse (AI) compared to vaginal intercourse (VI) and may contribute substantially to female sex workers' (FSW) high HIV burden. We aim to determine how common and frequent AI is among FSW globally. We searched PubMed, Embase and PsycINFO for studies reporting the proportion of FSW practising AI (prevalence) and/or the number of AI acts (frequency) worldwide from 01/1980 to 10/2018. We assessed the influence of participant and study characteristics on AI prevalence (e.g. continent, study year and interview method) through sub-group analysis. Of 15,830 identified studies, 131 were included. Nearly all (N = 128) reported AI prevalence and few frequency (N = 13), over various recall periods. Most studies used face-to-face interviews (N = 111). Pooled prevalences varied little by recall period (lifetime: 15.7% 95%CI 12.2-19.3%, N = 30, I = 99%; past month: 16.2% 95%CI 10.8-21.6%, N = 18, I = 99%). The pooled proportion of FSW reporting < 100% condom use tended to be non-significantly higher during AI compared to during VI (e.g. any unprotected VI: 19.1% 95%CI 1.7-36.4, N = 5 and any unprotected AI: 46.4% 95%CI 9.1-83.6, N = 5 in the past week). Across all study participants, between 2.4 and 15.9% (N = 6) of all intercourse acts (AI and VI) were anal. Neither AI prevalence nor frequency varied substantially by any participant or study characteristics. Although varied, AI among FSW is generally common, inconsistently protected with condoms and practiced sufficiently frequently to contribute substantially to HIV acquisition in this risk group. Interventions to address barriers to condom use are needed.
与阴道性交（VI）相比，在接受性肛交（AI）过程中感染艾滋病毒的几率更高，这可能是导致女性性工作者（FSW）艾滋病毒感染负担沉重的一个重要因素。我们旨在确定全球范围内女性性工作者中肛交的普遍程度和频率。我们检索了PubMed、Embase和PsycINFO数据库，查找1980年1月至2018年10月期间报告全球女性性工作者进行肛交比例（患病率）和/或肛交行为数量（频率）的研究。我们通过亚组分析评估了参与者和研究特征对肛交患病率的影响（如大洲、研究年份和访谈方法）。在15830项已识别的研究中，纳入了131项。几乎所有研究（N = 128）都报告了肛交患病率，很少有研究报告频率（N = 13），且回忆期各不相同。大多数研究采用面对面访谈（N = 111）。合并患病率在不同回忆期内变化不大（终生：15.7%，95%置信区间12.2 - 19.3%，N = 30，I² = 99%；过去一个月：16.2%，95%置信区间10.8 - 21.6%，N = 18，I² = 99%）。报告使用避孕套比例低于100%的女性性工作者在肛交期间的比例往往略高于阴道性交期间（例如，过去一周内任何未采取保护措施的阴道性交：19.1%，95%置信区间1.7 - 36.4，N = 5；任何未采取保护措施的肛交：46.4%，95%置信区间9.1 - 83.6，N = 5）。在所有研究参与者中，所有性交行为（肛交和阴道性交）中有2.4%至15.9%（N = 6）是肛交。肛交患病率和频率在任何参与者或研究特征方面均无显著差异。尽管存在差异，但女性性工作者中的肛交行为总体较为普遍，使用避孕套的情况不一致，且频率足以在这一风险群体中对艾滋病毒感染产生重大影响。因此，需要采取干预措施来消除使用避孕套的障碍。
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