From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Sociology, The University of Texas at Austin, Austin, TX.
Sex Transm Dis. 2021 Sep 1;48(9):648-653. doi: 10.1097/OLQ.0000000000001400.
Female sex workers (FSWs) have elevated rates of sexually transmitted infections (STIs) including HIV, yet few studies in the United States have characterized the STI burden in this population.
Data were derived from the EMERALD study, a structural community-based intervention with FSWs in Baltimore, MD. Participants (n = 385) were recruited through targeted sampling on a mobile van. Prevalent positive chlamydia or gonorrhea infections were determined by biological samples. Multivariable logistic regressions modeled correlates of confirmed positive STI (gonorrhea or chlamydia).
Confirmed STI positive prevalence was 28%, 15% chlamydia and 18% gonorrhea. Approximately two-thirds of the sample (64%) was younger than 40 years, one-third (36%) were Black, and 10% entered sex work in the past year. The sample was characterized by high levels of structural vulnerabilities (e.g., housing instability and food insecurity) and illicit substance use. Female sex workers were more likely to have a positive STI if they had financial dependent(s) (P = 0.04), experienced food insecurity at least weekly (P = 0.01), entered sex work in the past year (P = 0.002), and had 6 or more clients in the past week (P = 0.01). Female sex workers were less likely to have a positive STI test result if they were 40 years or older compared with FSW 18 to 29 years old (P = 0.02), and marginally (P = 0.08) less likely with high (vs. low) social cohesion.
More than a quarter of FSWs had confirmed chlamydia or gonorrhea. In addition to STI risks at the individual level, STIs are driven by structural vulnerabilities. Results point to a number of salient factors to be targeted in STI prevention among FSWs.
性工作者（FSWs）的性传播感染（STIs）包括 HIV 的发病率较高，尽管美国很少有研究描述这一人群的 STI 负担。
数据来自 EMERALD 研究，这是一项在马里兰州巴尔的摩市针对 FSWs 的基于结构的社区干预措施。通过流动货车上的有针对性抽样招募参与者（n = 385）。通过生物样本确定现患性衣原体或淋病感染。多变量逻辑回归模型确定了确诊性 STI（淋病或衣原体）的相关因素。
确诊性 STI 阳性率为 28%，15%为衣原体感染，18%为淋病感染。约三分之二的样本（64%）年龄小于 40 岁，三分之一（36%）为黑人，10%的人在过去一年中进入性工作。该样本具有高水平的结构性脆弱性（例如，住房不稳定和粮食不安全）和非法药物使用。如果女性性工作者有经济依赖者（P = 0.04）、至少每周经历一次粮食不安全（P = 0.01）、过去一年中进入性工作（P = 0.002）或过去一周有 6 个或更多客户（P = 0.01），则更有可能出现阳性 STI。与 18 至 29 岁的 FSW 相比，40 岁或以上的 FSW 出现阳性 STI 检测结果的可能性较小（P = 0.02），并且与低社会凝聚力相比（P = 0.08）可能性略低。
超过四分之一的 FSW 被确诊患有衣原体或淋病。除了个体层面的 STI 风险外，STI 还受到结构性脆弱性的驱动。结果指出了针对 FSW 中 STI 预防的一些突出因素。
