Institute for Global Health, University College London, London, United Kingdom.
CNRS, INRA, Grenoble INP, GAEL, Univ. Grenoble Alpes, Grenoble, France.
PLoS One. 2023 Aug 16;18(8):e0289882. doi: 10.1371/journal.pone.0289882. eCollection 2023.
Evidence suggests that treating sexually transmitted infections (STIs) amongst female sex workers (FSWs) is a cost-effective strategy to reduce the spread of HIV/AIDS. Senegal is the only African country where sex work is regulated by a public health policy which aims to monitor and routinely treat STIs. The law requires FSWs to be at least 21 years old, register with a health centre and the police, carry an up-to-date registration booklet, attend monthly health check-ups, and test negative for STIs. Despite health and legal benefits of registration, 80% of FSWs in Senegal are not registered. Hence, the potential health benefits of the policy have not materialised. To understand why FSWs do not want to register and to define policy changes that would increase the registration rate of FSWs in Senegal, we designed and implemented a discrete choice experiment (DCE) completed by 241 registered and 273 non-registered FSWs. Participants made choices between a series of hypothetical but realistic registration policy changes. Conditional logit models were used to analyse the DCE data. The results highlighted that confidentiality at the health facility was an important element, registered and non-registered FWs were respectively 26.0 percentage points (pp) and 22.1 pp more likely to prefer a policy that guaranteed confidentiality at the health centre. Similarly, both groups preferred a policy where their health record was only held at the health centre and not with the police. Several interventions to increase FSW registration rate and improve their wellbeing may be implemented without modifying the law. For example, the introduction of psychosocial support in the registration policy package, replacing the registration booklet by a QR code, the use of electronic medical files and the integration of FSWs routine visits with maternal health appointments to increase confidentiality have the potential to encourage registration of FSWs.
有证据表明，治疗性工作者（FSWs）中的性传播感染（STIs）是减少艾滋病毒/艾滋病传播的一种具有成本效益的策略。塞内加尔是唯一通过公共卫生政策监管性工作的非洲国家，该政策旨在监测和定期治疗性传播感染。该法律要求性工作者至少 21 岁，在卫生中心和警察局注册，携带最新的注册簿，每月接受健康检查，并检测出性传播感染呈阴性。尽管登记有健康和法律上的好处，但塞内加尔仍有 80%的性工作者没有登记。因此，该政策的潜在健康益处并未实现。为了了解为什么性工作者不愿意登记，并确定可以提高塞内加尔性工作者登记率的政策变更，我们设计并实施了一项离散选择实验（DCE），该实验由 241 名已登记和 273 名未登记的性工作者完成。参与者在一系列假设但现实的登记政策变更之间做出选择。条件逻辑回归模型用于分析 DCE 数据。结果强调，医疗机构的保密性是一个重要因素，已登记和未登记的性工作者分别有 26.0 个百分点（pp）和 22.1 个百分点更倾向于选择保证医疗机构保密性的政策。同样，两组都更喜欢仅在医疗机构而不是警察局保留其健康记录的政策。可以在不修改法律的情况下实施增加性工作者登记率和改善其福利的若干干预措施。例如，在登记政策包中引入心理社会支持，用二维码代替登记簿，使用电子病历，以及将性工作者的常规就诊与产妇保健预约相结合以增加保密性，这些措施有可能鼓励性工作者登记。
