Family Health International (FHI 360), Durham, NC, United States of America.
Elizabeth Glaser Pediatrics AIDS Foundation, Nairobi, Kenya.
PLoS One. 2019 Jul 24;14(7):e0219813. doi: 10.1371/journal.pone.0219813. eCollection 2019.
Despite considerable efforts to prevent HIV and other sexually transmitted infections (STI) among female sex workers (FSW), other sexual and reproductive health (SRH) needs, such preventing unintended pregnancies, among FSW have received far less attention. Programs targeting FSW with comprehensive, accessible services are needed to address their broader SRH needs. This study tested the effectiveness of an intervention to increase dual contraceptive method use to prevent STIs, HIV and unintended pregnancy among FSW attending services in drop-in centers (DIC) in two cities in Kenya. The intervention included enhanced peer education, and routine screening for family planning (FP) needs plus expanded non-condom FP method availability in the DIC.
We conducted a two-group, pre-/posttest, quasi-experimental study with 719 FSW (360 intervention group, 359 comparison group). Participants were interviewed at baseline and 6 months later to examine changes in condom and non-condom FP method use.
The intervention had a significant positive effect on non-condom, FP method use (OR = 1.38, 95%CI (1.04, 1.83)), but no effect on dual method use. Consistent condom use was reported to be high; however, many women also reported negotiating condom use with both paying and non-paying partners as difficult or very difficult. The strongest predictor of consistent condom use was partner type (paying versus non-paying/emotional); FSW reported both paying and non-paying partners also influence non-condom contraceptive use. Substantial numbers of FSW also reported experiencing sexual violence by both paying and non-paying partners.
Self-reported difficulties with consistent condom use and the sometimes dangerous conditions under which they work leave FSW vulnerable to unintended pregnancy STIs/HIV. Adding non-barrier FP methods to condoms is crucial to curb unintended pregnancies and their potential adverse health, social and economic consequences. Findings also highlight the need for additional strategies beyond condoms to reduce HIV and STI risk among FSW.
Clinicaltrials.gov NCT01957813.
尽管已经做出了相当大的努力来预防女性性工作者（FSW）中的艾滋病毒和其他性传播感染（STI），但 FSW 的其他性和生殖健康（SRH）需求，如预防意外怀孕，却得到了远远较少的关注。需要针对 FSW 提供综合、可及的服务的项目来满足她们更广泛的 SRH 需求。本研究检验了一项干预措施的有效性，该措施旨在通过增加双重避孕方法的使用，来预防 FSW 在肯尼亚两个城市的上门服务中心（DIC）中感染性传播感染、艾滋病毒和意外怀孕。该干预措施包括增强同伴教育，以及对计划生育（FP）需求的常规筛查，加上在 DIC 中扩大非避孕套 FP 方法的供应。
我们进行了一项两组成组、预/后测试、准实验研究，共有 719 名 FSW（360 名干预组，359 名对照组）参与。参与者在基线和 6 个月后接受访谈，以检查避孕套和非避孕套 FP 方法使用的变化。
该干预措施对非避孕套、FP 方法的使用有显著的积极影响（OR = 1.38，95%CI（1.04，1.83）），但对双重方法的使用没有影响。报告的一致性避孕套使用率很高；然而，许多女性还报告说，与付费和非付费伴侣协商使用避孕套既困难又非常困难。一致性避孕套使用的最强预测因素是伴侣类型（付费与非付费/情感）；FSW 报告说，付费和非付费伴侣都影响非避孕套避孕方法的使用。大量 FSW 还报告说，他们遭受过付费和非付费伴侣的性暴力。
自我报告的一致性避孕套使用困难以及她们工作的有时危险条件使 FSW 容易意外怀孕、感染性传播感染/艾滋病毒。向避孕套添加非屏障 FP 方法对于遏制意外怀孕及其潜在的不良健康、社会和经济后果至关重要。研究结果还强调，需要除了避孕套之外的其他策略来降低 FSW 中的 HIV 和 STI 风险。
Clinicaltrials.gov NCT01957813。
