在性健康和生殖健康与艾滋病毒服务的交叉点：乌干达坎帕拉的性工作者中使用中等有效的计划生育方法。
At the intersection of sexual and reproductive health and HIV services: use of moderately effective family planning among female sex workers in Kampala, Uganda.
机构信息
Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA.
School of Public Health, Makerere University, Kampala, Uganda.
出版信息
BMC Pregnancy Childbirth. 2022 Aug 17;22(1):646. doi: 10.1186/s12884-022-04977-5.
BACKGROUND
Female sex workers are vulnerable to HIV, sexually transmitted diseases, and unintended pregnancies; however, the literature on female sex workers (FSW) focuses primarily on HIV and is limited regarding these other health issues.
METHODS
We conducted a respondent-driven sampling (RDS) survey during April-December 2012 to characterize the reproductive health of and access to contraceptives FSW in Kampala, Uganda. Eligibility criteria included age ≥ 15 years, residence in greater Kampala, and having sold sex to men in ≤ 6 months. Data were analyzed using RDS-Analyst. Survey logistic regression was used in SAS.
RESULTS
We enrolled 1,497 FSW with a median age of 27 years. Almost all FSW had been pregnant at least once. An estimated 33.8% of FSW were currently not using any form of family planning (FP) to prevent pregnancy; 52.7% used at least moderately effective FP. Among those using FP methods, injectable contraception was the most common form of FP used (55.4%), followed by condoms (19.7%), oral contraception (18.1%), and implants (3.7%). HIV prevalence was 31.4%, syphilis prevalence was 6.2%, and 89.8% had at least one symptom of a sexually transmitted disease in the last six months. Using at least a moderately effective method of FP was associated with accessing sexually transmitted disease treatment in a stigma-free environment in the last six months (aOR: 1.6, 95% CI: 1.1-2.4), giving birth to 2-3 children (aOR: 2.5, 95% CI: 1.4-4.8) or 4-5 children (aOR: 2.9, 95% CI: 1.4-5.9). It is plausible that those living with HIV are also less likely than those without it to be using a moderately effective method of FP (aOR: 0.7, 95% CI: 0.5-1.0).
CONCLUSIONS
The provision of integrated HIV and sexual and reproductive health services in a non-stigmatizing environment has the potential to facilitate increased health service uptake by FSW and decrease missed opportunities for service provision.
背景
女性性工作者易感染艾滋病毒、性传播疾病和意外怀孕；然而，有关女性性工作者（FSW）的文献主要集中在艾滋病毒方面，而对其他健康问题的关注有限。
方法
我们于 2012 年 4 月至 12 月期间在乌干达坎帕拉进行了一项基于回应者驱动抽样（RDS）的调查，以描述性工作者的生殖健康状况以及获得避孕措施的情况。纳入标准包括年龄≥15 岁、居住在大坎帕拉地区、且在过去 6 个月内向男性提供性服务。使用 RDS-Analyst 进行数据分析，使用 SAS 进行调查逻辑回归分析。
结果
我们共招募了 1497 名年龄中位数为 27 岁的女性性工作者。几乎所有的性工作者都至少怀孕过一次。据估计，目前有 33.8%的性工作者没有使用任何形式的计划生育（FP）方法来预防怀孕；52.7%的人使用了至少中等有效的 FP 方法。在使用 FP 方法的人中，注射避孕药是最常用的 FP 形式（55.4%），其次是避孕套（19.7%）、口服避孕药（18.1%）和植入物（3.7%）。HIV 感染率为 31.4%，梅毒感染率为 6.2%，89.8%的人在过去六个月中有至少一种性传播疾病的症状。在过去六个月中，至少使用了一种中等有效的 FP 方法与获得无污名环境下的性传播疾病治疗相关（调整后的比值比：1.6，95%可信区间：1.1-2.4），生育 2-3 个孩子（调整后的比值比：2.5，95%可信区间：1.4-4.8）或 4-5 个孩子（调整后的比值比：2.9，95%可信区间：1.4-5.9）。那些感染 HIV 的人可能比没有感染 HIV 的人更不可能使用中等有效的 FP 方法（调整后的比值比：0.7，95%可信区间：0.5-1.0）。
结论
在无污名环境下提供艾滋病毒和性健康与生殖健康综合服务有可能促进性工作者更多地利用卫生服务，并减少服务提供的错失机会。
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