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“我下定决心要完成这些疗程”:一项针对乌干达从事性工作的女性的基于证据的艾滋病毒减少风险干预措施的可接受性的定性研究。

"I decided in my heart I have to complete the sessions": A qualitative study on the acceptability of an evidence-based HIV risk reduction intervention among women engaged in sex work in Uganda.

机构信息

Brown School, Washington University in St. Louis, St. Louis, MO, United States of America.

International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America.

出版信息

PLoS One. 2023 Jan 12;18(1):e0280138. doi: 10.1371/journal.pone.0280138. eCollection 2023.


DOI:10.1371/journal.pone.0280138
PMID:36634037
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9836279/
Abstract

BACKGROUND: The HIV burden remains a critical public health concern and women engaged in sex work [WESW] are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high rates of HIV prevalence among WESW. Yet, they have not been targeted by theory-informed HIV prevention intervention approaches. METHODS: We conducted semi-structured in-depth interviews with 20 WESW upon intervention completion to explore their experiences with an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda (2018-2023. Specifically, we explored their initial motivations and concerns for participating in the intervention, barriers and facilitators to attendance, and their feedback on specific intervention characteristics. RESULTS: The main expectations revolved around access to health-related information, including information on STIs, HIV, and PrEP as well as on how one can protect themselves while engaging in sex work. Initial concerns were around potential breach of confidentiality and fear of arrest. The main facilitators for session attendance were the motivation to learn health-related information, the attitude of facilitators, and the incentives received for participation, whereas main challenges were related to family commitments and work schedules. WESW appreciated the group format of the intervention and found the location and times of the intervention delivery acceptable. DISCUSSION AND CONCLUSIONS: Overall, our findings suggest that the HIV risk reduction intervention was appropriate and acceptable to WESW. Yet, WESW experience unique concerns and barriers that need to be accounted for when designing interventions targeting this population, especially in resource-limited settings where sex work is illegal and highly stigmatized. CLINICAL TRIAL REGISTRATION: NCT03583541.

摘要

背景:艾滋病毒负担仍然是一个重大的公共卫生关注点,与普通成年人群相比,从事性工作的女性(WESW)面临着更高的风险。与其他撒哈拉以南非洲国家一样,乌干达报告称,WESW 中的艾滋病毒感染率很高。然而,针对她们的理论指导的艾滋病毒预防干预措施并未得到实施。

方法:我们在干预措施完成后对 20 名 WESW 进行了半结构式深入访谈,以探讨她们对基于证据的艾滋病毒减少风险干预措施的经验,该干预措施是在乌干达进行的一项组合干预措施(2018-2023 年)的一部分。具体来说,我们探讨了她们最初参与干预的动机和担忧、参加的障碍和促进因素,以及对特定干预特征的反馈。

结果:主要期望围绕着获取与健康相关的信息,包括性传播感染、艾滋病毒和 PrEP 的信息,以及如何在从事性工作时保护自己。最初的担忧是潜在的保密性违反和被捕的恐惧。出席会议的主要促进因素是学习健康相关信息的动机、促进者的态度以及参与获得的奖励,而主要挑战与家庭承诺和工作时间表有关。WESW 欣赏干预措施的小组形式,并认为干预措施的地点和时间可以接受。

讨论和结论:总的来说,我们的研究结果表明,艾滋病毒减少风险干预措施对 WESW 是适当和可接受的。然而,WESW 经历了独特的担忧和障碍,在设计针对这一人群的干预措施时需要考虑到这些因素,特别是在性工作非法且高度污名化的资源有限的环境中。

临床试验注册:NCT03583541。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a501/9836279/93360cc3c5ff/pone.0280138.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a501/9836279/93360cc3c5ff/pone.0280138.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a501/9836279/93360cc3c5ff/pone.0280138.g001.jpg

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引用本文的文献

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本文引用的文献

[1]
"I expected little, although I learned a lot": perceived benefits of participating in HIV risk reduction sessions among women engaged in sex work in Uganda.

BMC Womens Health. 2022-5-13

[2]
"I felt very small and embarrassed by the health care provider when I requested to be tested for syphilis": barriers and facilitators of regular syphilis and HIV testing among female sex workers in Uganda.

BMC Public Health. 2021-11-2

[3]
HIV self-testing and oral pre-exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda.

J Int AIDS Soc. 2021-9

[4]
The role of sex work laws and stigmas in increasing HIV risks among sex workers.

Nat Commun. 2020-2-18

[5]
Preference and uptake of different community-based HIV testing service delivery models among female sex workers along Malaba-Kampala highway, Uganda, 2017.

BMC Health Serv Res. 2019-11-5

[6]
Implementing Evidence-Based HIV Prevention for Female Sex Workers in Mexico: Provider Assessments of Feasibility and Acceptability.

Glob Soc Welf. 2019-6

[7]
"The Drug Will Help Protect My Tomorrow": Perceptions of Integrating PrEP into HIV Prevention Behaviors Among Female Sex Workers in Lilongwe, Malawi.

AIDS Educ Prev. 2019-10

[8]
A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial.

BMC Womens Health. 2019-8-17

[9]
Health providers' experiences, perceptions and readiness to provide HIV services to men who have sex with men and female sex workers in Uganda - a qualitative study.

BMC Infect Dis. 2019-3-5

[10]
Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review.

BMC Public Health. 2019-1-5

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