Division of Social and Behavioural Research, Indian Council of Medical Research-National AIDS Research Institute (ICMR-NARI), Pune, India.
Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India.
Front Public Health. 2022 Dec 8;10:1030914. doi: 10.3389/fpubh.2022.1030914. eCollection 2022.
BACKGROUND: The public health interventions among Female Sex Workers (FSWs) have mainly addressed HIV/ STI prevention. The focus of the HIV prevention program on FSWs' Reproductive and Sexual Health (RSH) has been limited, thus, rendering them at a higher risk of unintended pregnancies, delayed pregnancy detection, and utilizing unsafe abortion methods. METHODS: A multistakeholder analysis was performed to study access and use of RSH services among FSWs in urban and rural India. Between January 2016 and June 2019, a qualitative grounded theory approach was used to explore the FSWs' perspectives and experiences about services pertaining to HIV prevention, Antenatal Care (ANC), child delivery, abortion, and pregnancy prevention. Using purposive and convenience sampling, 29 In-Depth Interviews (IDIs), 2 Focus Group Discussions (FGDs) and 22 Key Informant Interviews (KIIs) were conducted with consenting FSWs and indirect stakeholders, respectively. Verbatim translated data was entered in NVivo12 Software and analyzed inductively. RESULTS: The following themes emerged: (1) Condomless sex, unintended pregnancy, vertical transmission, (2) Signs/ indication used for pregnancy detection causing delay (3) Pregnancy prevention methods used, (4) Pregnancy prevention or AIDS prevention, (5) Legal formalities as a barrier to access RSH, (6) Differential facility preference. CONCLUSION: Pregnancy prevention is a greater motivation for condom use than HIV prevention among FSWs. Therefore, there is an emerging need to reallocate public health resources and redesign policies to meet the RSH needs of FSWs, especially for the prevention of unintended pregnancies. FSW-focused Information Education Communication (IEC) strategies for RSH service utilization are essential to reduce the burden of unintended pregnancies. The National HIV Targeted Intervention (TI) program needs to include pregnancy testing services and information to non-barrier contraceptive methods. An ambient policy environment calls for examining the need for male involvement in pregnancy, family planning and abortion decisions.
背景：针对女性性工作者（FSW）的公共卫生干预措施主要针对艾滋病毒/性传播感染（STI）预防。艾滋病毒预防计划对 FSW 生殖和性健康（RSH）的关注有限，因此，使她们面临更高的意外怀孕、延迟怀孕检测和使用不安全堕胎方法的风险。
方法：进行了多方利益相关者分析，以研究印度城乡 FSW 获得和使用 RSH 服务的情况。在 2016 年 1 月至 2019 年 6 月期间，采用定性扎根理论方法探讨了 FSW 对与艾滋病毒预防、产前保健（ANC）、分娩、堕胎和妊娠预防相关服务的看法和经验。采用目的抽样和便利抽样，分别对 29 名知情同意的 FSW 和间接利益相关者进行了深入访谈（IDIs）、2 次焦点小组讨论（FGD）和 22 次关键知情人访谈（KII）。逐字翻译的数据输入 NVivo12 软件进行归纳分析。
结果：出现了以下主题：（1）无保护性行为、意外怀孕、垂直传播，（2）导致延迟的怀孕检测迹象/指征，（3）使用的妊娠预防方法，（4）妊娠预防或艾滋病预防，（5）获得 RSH 的法律手续障碍，（6）差异设施偏好。
结论：与 HIV 预防相比，妊娠预防是 FSW 更愿意使用避孕套的动机。因此，需要重新分配公共卫生资源并重新设计政策，以满足 FSW 的 RSH 需求，特别是预防意外怀孕。针对 FSW 的信息、教育和宣传（IEC）策略对于促进 RSH 服务的利用至关重要，有助于减轻意外怀孕的负担。国家艾滋病毒针对性干预（TI）计划需要包括妊娠检测服务和非障碍避孕方法信息。宽松的政策环境需要审查男性在怀孕、计划生育和堕胎决策中的参与需求。
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