尼日利亚关键人群的性行为、性习惯和艾滋病毒风险概况。
Sexual practices, sexual behavior and HIV risk profile of key populations in Nigeria.
机构信息
Heartland Alliance International, Abuja, Nigeria.
New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria.
出版信息
BMC Public Health. 2019 Sep 2;19(1):1210. doi: 10.1186/s12889-019-7553-z.
BACKGROUND
There is little evidence on the need for differentiated HIV prevention services for men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID in Nigeria. The aim of the study was to determine and compare the HIV sexual risk profiles of FSW, MSM and PWID resident in Nigeria; and identify factors associated with condom use among the groups. This will help identify if differentiated HIV prevention services are needed for MSM, FSW and PWID in Nigeria.
METHODS
This is a cross-sectional study. Data on sexual practices (anal, vaginal and oral sex), history of alcohol and psychoactive substance use, and high risk sexual behaviors for HIV infection (inconsistent use of condom) was collected from study FSW, MSM and PWID resident in Enugu, Nassarawa, Benue, and Akwa-Ibom States of Nigeria between April and June, 2015. Association between sexual practices, alcohol and psychoactive substance use, and HIV sexual risk behaviors; and differences in sexual risk behaviors of MSM, FSW and PWID were determined using Pearson chi-square for categorical variables, and t-test for continuous variables. Determinants of condom use in the last 30 days were identified using logistic regression analysis.
RESULTS
The study population consisted of 188 (38.5%) FSW, 145 (29.7%) MSM and 155 (31.8%) PWID. MSM (AOR: 0.17; 95%CI: 0.05-0.67; p = 0.01) and PWID (AOR: 0.07; 95%CI: 0.02-0.21; p < 0.001) were significantly less likely than FSW to have used condom in the last 30 days. A lower proportion of FSW and PWID used condom during anal sex in the last 12 months when compared with MSM (p < 0.001 respectively). The proportion of MSM (23.5%) and FSW (23.4%) who had ever used psychoactive drugs was high. Of those who had ever used psychoactive drugs, 25.0% of FSW and 29.4% of MSM had injected drugs in the last 30 days of the survey. Also, 39.3% of PWID shared needles and syringes. The use of psychoactive substances (AOR: 5.01; 95%CI: 2.59-9.68; p < 0.001) and the ability to negotiate condom use (AOR: 2.04; 95%CI: 1.06-3.93; p = 0.03) were factors associated with condom use in the last 30 days of the survey.
CONCLUSION
HIV prevention programs designed for MSM, FSW and PWID need to address inconsistent condom use during sex by addressing condom negotation skills. This sexual risk behavior is common to the three groups.
背景
在尼日利亚，针对男男性行为者（MSM）、女性性工作者（FSW）和注射吸毒者（PWID）的差异化 HIV 预防服务需求证据有限。本研究旨在确定和比较尼日利亚驻留的 FSW、MSM 和 PWID 的 HIV 性风险特征；并确定与各组 condom 使用相关的因素。这将有助于确定尼日利亚是否需要针对 MSM、FSW 和 PWID 提供差异化的 HIV 预防服务。
方法
这是一项横断面研究。数据收集自 2015 年 4 月至 6 月期间，在尼日利亚埃努古、纳萨拉瓦、贝努埃和阿克瓦-伊博姆州居住的研究 FSW、MSM 和 PWID 关于性实践（肛门、阴道和口交）、酒精和精神活性物质使用史以及与 HIV 感染相关的高风险性行为（ condom 使用不一致）。使用 Pearson 卡方检验用于分类变量，t 检验用于连续变量，确定性行为、酒精和精神活性物质使用与 condom 使用之间的关联，以及 MSM、FSW 和 PWID 的性风险行为差异。使用逻辑回归分析确定 condom 在过去 30 天内使用的决定因素。
结果
研究人群包括 188 名（38.5%）FSW、145 名（29.7%）MSM 和 155 名（31.8%）PWID。MSM（AOR：0.17；95%CI：0.05-0.67；p=0.01）和 PWID（AOR：0.07；95%CI：0.02-0.21；p<0.001）与 FSW 相比，在过去 30 天内使用 condom 的可能性明显较低。与 MSM 相比，FSW 和 PWID 在过去 12 个月中进行肛门性行为时使用 condom 的比例较低（分别为 p<0.001）。MSM（23.5%）和 FSW（23.4%）使用精神活性药物的比例较高。在曾经使用过精神活性药物的人群中，25.0%的 FSW 和 29.4%的 MSM 在调查的最后 30 天内注射过毒品。此外，39.3%的 PWID 共用过针头和注射器。使用精神活性物质（AOR：5.01；95%CI：2.59-9.68；p<0.001）和 condom 使用谈判能力（AOR：2.04；95%CI：1.06-3.93；p=0.03）是 condom 在调查最后 30 天内使用的相关因素。
结论
为 MSM、FSW 和 PWID 设计的 HIV 预防计划需要解决 condom 使用不一致的问题，即 condom 使用谈判技能。这种性风险行为在这三个群体中都很常见。
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