肯尼亚基苏木的一项定性研究：女性和男性性工作者中，PrEP 和物质使用、暴力与艾滋病毒的综合流行
PrEP and the syndemic of substance use, violence, and HIV among female and male sex workers: a qualitative study in Kisumu, Kenya.
机构信息
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
Department of Anthropology, Ohio State University, Columbus, OH, USA.
出版信息
J Int AIDS Soc. 2019 Apr;22(4):e25266. doi: 10.1002/jia2.25266.
INTRODUCTION
Female and male sex workers experience heightened vulnerability to HIV and other health harms that are compounded by substance use, physical and sexual violence, and limited access to health services. In Kisumu, Kenya, where sex work is widespread and substance use is a growing public health concern, offering pre-exposure prophylaxis (PrEP) for HIV prevention could help curtail the HIV epidemic. Our study examines "syndemics," or mutually reinforcing epidemics of substance use, violence and HIV, in relation to PrEP acceptability and feasibility among female and male sex workers in Kenya, one of the first African countries to approve PrEP for HIV prevention.
METHODS
From 2016 to 2017, sex workers in Kisumu reporting recent alcohol or drug use and experiences of violence participated in qualitative interviews on HIV risk and perspectives on health service needs, including PrEP programming. Content analysis identified themes relating to PrEP knowledge, acceptability, access challenges and delivery preferences.
RESULTS
Among 45 female and 28 male sex workers, median age was 28 and 25 respectively. All participants reported past-month alcohol use and 91% of women and 82% of men reported past-month drug use. Violence was pervasive, with most women and men reporting past-year physical (96% women, 86% men) and sexual (93% women, 79% men) violence. Concerning PrEP, interviews revealed: (1) low PrEP knowledge, especially among women; (2) high PrEP acceptability and perceived need, particularly within syndemic contexts of substance use and violence; and (3) preferences for accessible, non-stigmatizing PrEP delivery initiatives designed with input from sex workers.
CONCLUSIONS
Through a syndemic lens, substance use and violence interact to increase HIV vulnerability and perceived need for PrEP among female and male sex workers in Kisumu. Although interest in PrEP was high, most sex workers in our sample, particularly women, were not benefiting from it. Syndemic substance use and violence experienced by sex workers posed important barriers to PrEP access for sex workers. Increasing PrEP access for sex workers will require addressing substance use and violence through integrated programming.
简介
女性和男性性工作者更容易受到 HIV 和其他健康危害的影响，而物质使用、身体和性暴力以及获得卫生服务的机会有限，使这种脆弱性更加复杂。在肯尼亚基苏木，性工作普遍存在，物质使用问题也日益成为公共卫生关注的焦点，提供 HIV 预防用的暴露前预防（PrEP）可能有助于遏制 HIV 疫情。我们的研究考察了性工作者中与 PrEP 可接受性和可行性相关的“综合征”，即物质使用、暴力和 HIV 相互增强的流行，这是肯尼亚——第一个批准 PrEP 用于 HIV 预防的非洲国家之一。
方法
在 2016 年至 2017 年期间，基苏木报告最近有酒精或药物使用经历以及经历过暴力的性工作者参加了关于 HIV 风险和对卫生服务需求的定性访谈，包括 PrEP 规划。内容分析确定了与 PrEP 知识、可接受性、获取挑战和提供偏好相关的主题。
结果
在 45 名女性和 28 名男性性工作者中，年龄中位数分别为 28 岁和 25 岁。所有参与者均报告过去一个月有饮酒行为，91%的女性和 82%的男性报告过去一个月有药物使用行为。暴力行为普遍存在，大多数女性和男性报告过去一年有身体暴力（96%的女性，86%的男性）和性暴力（93%的女性，79%的男性）。关于 PrEP，访谈揭示了：（1）PrEP 知识水平低，尤其是女性；（2）高 PrEP 可接受性和感知需求，特别是在物质使用和暴力的综合征背景下；（3）偏好可及、无污名化的 PrEP 提供举措，并希望由性工作者参与设计。
结论
从综合征的角度来看，物质使用和暴力相互作用，增加了基苏木女性和男性性工作者的 HIV 脆弱性和对 PrEP 的感知需求。尽管对 PrEP 的兴趣很高，但我们研究样本中的大多数性工作者，尤其是女性，并未从中受益。性工作者经历的综合征物质使用和暴力对性工作者获得 PrEP 造成了重要障碍。增加性工作者获得 PrEP 的机会需要通过综合方案解决物质使用和暴力问题。
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