Department of Epidemiology, University of Washington, Seattle, WA.
Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
J Acquir Immune Defic Syndr. 2020 Sep 1;85(1):11-17. doi: 10.1097/QAI.0000000000002402.
The incidence of pregnancy in female sex workers (FSWs) living with HIV is not well characterized.
Current and former FSWs living with HIV and enrolled in a prospective cohort study in Mombasa, Kenya, were followed monthly to ascertain sexual behavior and underwent quarterly pregnancy testing. Pregnancies were considered planned, mistimed, or unwanted according to fertility desires and pregnancy intentions. Cox proportional hazards models were used to estimate hazard ratios (HRs) of the association between characteristics and incident pregnancy.
Two hundred seventy-nine FSWs were eligible (October 2012-April 2017). Most women had a nonpaying, regular partner (83.2%, 232/279), were not using modern nonbarrier contraception (69.5%, 194/279), and did not desire additional children (70.6%, 197/279). Of 34 first incident pregnancies [5.8/100 person-years (p-y); 95% confidence interval (CI): 4.1 to 8.0], 91.2% (n = 31) were unintended. The incidences of planned (5.7/100 p-y, n = 3), mistimed (10.4/100 p-y, n = 9), and unwanted pregnancies (4.9/100 p-y, n = 22) were similar (P = 0.15). In univariable analysis, oral contraceptive pill use (versus no contraception), having a nonpaying, regular partner, transactional sex, vaginal washing, condomless sex, and higher sex frequency were associated with an increased pregnancy risk. Older age was associated with a lower pregnancy risk. In multivariable analysis, having a nonpaying, regular partner (adjusted HR 4.0, 95% CI: 1.2 to 14.1) and age ≥40 years (aHR 0.2, 95% CI: 0.0 to 0.9) remained significantly associated with a higher and lower pregnancy risk, respectively.
In this cohort of HIV-positive FSWs, most pregnancies were unintended. Identifying FSWs' fertility desires and pregnancy intentions could facilitate efforts to increase contraceptive use and implement safer conception strategies.
女性性工作者（FSW）中妊娠的发生率尚不清楚。
本研究纳入了肯尼亚蒙巴萨正在参与一项前瞻性队列研究的现性和既往性 FSW，并对其进行每月随访以确定性行为，并每季度进行妊娠检测。妊娠被认为是计划内、计划外或非意愿妊娠，取决于生育意愿和妊娠意图。使用 Cox 比例风险模型估计特征与妊娠发生之间的关联的风险比（HR）。
共有 279 名 FSW 符合条件（2012 年 10 月至 2017 年 4 月）。大多数女性有非付费的、固定伴侣（83.2%，232/279），不使用现代非屏障避孕方法（69.5%，194/279），并且不希望再有孩子（70.6%，197/279）。34 例首次发生的妊娠中[5.8/100 人年（p-y）；95%置信区间（CI）：4.1 至 8.0]，91.2%（n=31）为非意愿妊娠。计划内妊娠（5.7/100 p-y，n=3）、计划外妊娠（10.4/100 p-y，n=9）和非意愿妊娠（4.9/100 p-y，n=22）的发生率相似（P=0.15）。在单变量分析中，口服避孕药的使用（与无避孕措施相比）、有非付费的固定伴侣、交易性行为、阴道冲洗、无保护性行为和较高的性频率与妊娠风险增加相关。年龄较大与妊娠风险降低相关。在多变量分析中，有非付费的固定伴侣（调整后的 HR 4.0，95%CI：1.2 至 14.1）和年龄≥40 岁（aHR 0.2，95%CI：0.0 至 0.9）与妊娠风险增加和降低分别显著相关。
在本队列中，大多数妊娠是意外妊娠。确定 FSW 的生育意愿和妊娠意图可以促进增加避孕措施的使用，并实施更安全的受孕策略。
