Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA.
Global Health Research Center of Central Asia, Almaty, Kazakhstan.
Int J STD AIDS. 2023 Sep;34(10):666-676. doi: 10.1177/09564624231170902. Epub 2023 Apr 21.
BACKGROUND: Little is known about the prevalence of intimate partner violence (IPV) or client violence, and associated HIV risk among women who engage in sex work (WESW) and use drugs in Kazakhstan, despite a growing HIV epidemic. METHODS: Women who reported engaging in sex work and using illicit drugs were recruited from Almaty and Temirtau, Kazakhstan between 2015 and 2017. A cross-sectional analysis was conducted to determine prevalence and correlates of physical and sexual violence perpetrated by intimate partners and clients. Associations between each type of violence with sexual and drug-related HIV risk behaviors were assessed with negative-binomial and logistic regression models, respectively. RESULTS: Of the 400 women, 45% and 28% reported recent IPV and client violence, respectively. IPV and client violence was associated with a greater number of sex work clients [IPV: adjusted incidence rate ratio (aIRR): 1.86, 1.28-2.71; aIRR: 2.28, 1.56-3.35]; [client violence: aIRR: 2.20, 1.44-3.42; aIRR: 2.54, 1.72-3.83], and client violence was associated with greater frequency of condomless sex with clients [aIRR: 2.33, 1.41-4.03; aIRR: 2.16, 1.35-3.56]. Violence was not associated with injection drug use, despite exchanging sex for drugs being associated with higher odds of violence. CONCLUSION: HIV prevention programs for WESW in Kazakhstan should consider multi-sectoral approaches that address economic hardship and relationship-based components, in addition to violence reduction.
背景:尽管哈萨克斯坦的艾滋病疫情不断扩大,但对于从事性工作和吸毒的女性中亲密伴侣暴力(IPV)或客户暴力的流行程度以及与艾滋病毒相关的风险知之甚少。
方法:2015 年至 2017 年期间,在哈萨克斯坦的阿拉木图和铁米尔套招募了报告从事性工作和使用非法药物的女性。进行了横断面分析,以确定亲密伴侣和客户实施的身体和性暴力的流行率和相关因素。使用负二项回归和逻辑回归模型分别评估了每种类型的暴力与性相关和与毒品相关的艾滋病毒风险行为之间的关联。
结果:在 400 名女性中,分别有 45%和 28%的人报告最近发生了 IPV 和客户暴力。IPV 和客户暴力与更多的性工作客户有关[IPV:调整后的发病率比(aIRR):1.86,1.28-2.71;aIRR:2.28,1.56-3.35];[客户暴力:aIRR:2.20,1.44-3.42;aIRR:2.54,1.72-3.83],客户暴力与与客户无保护性行为的频率更高有关[aIRR:2.33,1.41-4.03;aIRR:2.16,1.35-3.56]。尽管用性换取毒品与更高的暴力风险有关,但暴力与注射吸毒无关。
结论:哈萨克斯坦针对性工作女性的艾滋病毒预防计划应考虑采取多部门方法,除减少暴力外,还应解决经济困难和基于关系的因素。
J Interpers Violence. 2023-10