尽管肯尼亚蒙巴萨的性工作年轻女性面临着高性健康、结构性和生殖健康脆弱性的负担，但她们获得项目服务的机会仍然很低。

Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya.

机构信息

MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada.

Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.

出版信息

BMC Public Health. 2020 May 29;20(1):806. doi: 10.1186/s12889-020-08872-6.

DOI:10.1186/s12889-020-08872-6

PMID:32471410

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7257181/

Abstract

BACKGROUND

Across Sub-Saharan Africa, young women who sell sex (YSW) face institutional barriers in accessing sexual health and HIV prevention programs designed for female sex workers. In 2018, Kenya developed a national framework to guide service provision for YSW aged 14-24 years. To help inform the implementation of the framework, we estimated the burden of vulnerabilities related to the Sustainable Development Goals (SDGs related to health and gender equality) and program contact among YSW.

METHODS

We used data from Transitions, a 2015 bio-behavioural cross-sectional survey of 408 YSW aged 14-24 years in Mombasa, Kenya. We estimated the prevalence of sexual (inconsistent condom use), structural (financial, violence), and reproductive health vulnerabilities; and characterized engagement with local HIV programs tailored to sex workers. We then compared the prevalence of vulnerabilities by age group (14-18 years, N = 117; 19-24 years, N = 291) and by program contact (ever contacted by local program for sex workers).

RESULTS

47.3% reported inconsistent condom use with any partner in the previous week (no difference by age-group, p = 1.00). Structural vulnerabilities were common and did not vary by age: 83.6% did not have a regular source of income; 29.9 and 29.2% had experienced physical and sexual violence, respectively. 26.5% reported at least one pregnancy before age 18, and 18.5% used a non-reliable form of contraception with little variability by age. 25.7% were aware of at least one program, and only 13.7% of YSW had ever been contacted by a program (8.5% of those aged 14-18 years; and 15.8% of those aged 19-24 years, p = 0.06). Sexual, structural, and reproductive health vulnerabilities did not vary by program contact.

CONCLUSIONS

SDG-related vulnerabilities begin early in the lives of YSW who are not currently reached by programs designed for female sex workers.

摘要

背景

在撒哈拉以南非洲地区，性工作的年轻女性（YSW）在获得专为女性性工作者设计的性健康和艾滋病毒预防方案方面面临制度障碍。2018 年，肯尼亚制定了一项国家框架，指导为 14-24 岁的 YSW 提供服务。为了帮助为该框架的实施提供信息，我们估计了与可持续发展目标（与健康和性别平等相关的目标）相关的脆弱性负担以及 YSW 与方案的接触情况。

方法

我们使用了 2015 年在肯尼亚蒙巴萨进行的一项关于 408 名 14-24 岁 YSW 的跨性别、生物行为学横断面调查的数据。我们估计了性（ condom 使用不一致）、结构（财务、暴力）和生殖健康脆弱性的流行率；并描述了与专为性工作者设计的当地艾滋病毒方案的接触情况。然后，我们比较了按年龄组（14-18 岁，N=117；19-24 岁，N=291）和方案接触情况（是否曾被当地性工作者方案接触）划分的脆弱性流行率。

结果

47.3%的人报告在过去一周内与任何伴侣 condom 使用不一致（年龄组之间无差异，p=1.00）。结构脆弱性很常见，且与年龄无关：83.6%没有稳定的收入来源；分别有 29.9%和 29.2%的人经历过身体和性暴力。26.5%的人在 18 岁之前至少怀孕一次，18.5%的人使用不可靠的避孕方法，且年龄之间的差异不大。25.7%的人至少了解一个方案，只有 13.7%的 YSW 曾被方案接触过（14-18 岁的占 8.5%；19-24 岁的占 15.8%，p=0.06）。性、结构和生殖健康脆弱性与方案接触情况无关。