Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ, 08901, USA.
Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA.
AIDS Behav. 2024 Mar;28(3):898-906. doi: 10.1007/s10461-023-04196-9. Epub 2023 Oct 16.
Many adolescents under 18 years old who sell sex are at elevated risk for sexually transmitted infection (STI) acquisition, which may persist into adulthood. There has been limited study of the burden of the risks and vulnerabilities among women who started selling sex as adolescents across Sub-Saharan Africa. In this study, a Adult female sex workers (FSW) recruited through respondent-driven sampling in five cities in Cameroon from December 2015 to October 2016 completed a questionnaire and human immunodeficiency virus (HIV) and syphilis testing. Multivariable logistic regression analysis controlling for age was used to identify factors associated with reporting selling sex before age 18. Selling sex before age 18 was reported by 11.5% (256/2,220) of FSW. Initiation of selling sex as an adolescent was positively associated with experiencing dysuria (adjusted odds ratio [aOR]:1.50, 95% confidence interval [CI]:1.08-2.10) or genital warts (aOR:1.78, 95% CI:1.08-2.94) and negatively associated with prior recent testing for HIV (aOR:0.71, 95% CI:0.53-0.96) or STIs (aOR:0.65, 95% CI:0.44-0.96). Consistent condom use with clients was negatively associated with early initiation of selling sex (aOR:0.58, 95% CI:0.42-0.80), while experience of recent sexual violence was positively associated with early initiation (aOR:1.74, 95% CI:1.15-2.63). There were no independent significant differences in HIV (24.5%) or syphilis (8.3%) prevalence. Given the limited use of HIV and STI testing services by women who sold sex as adolescents, the prevalence of forced sex, condomless sex, and STI symptoms were high. Programs serving FSW should more vigorously aim to serve adolescents and adults who began selling sex early.
许多未满 18 岁就开始卖淫的青少年面临性传播感染（STI）的风险增加，这些风险可能会持续到成年。在撒哈拉以南非洲，很少有研究关注那些青少年时期就开始卖淫的女性所面临的风险和脆弱性。在这项研究中，2015 年 12 月至 2016 年 10 月期间，通过在喀麦隆五个城市的 respondent-driven sampling 招募了成年女性性工作者（FSW），并完成了一份问卷和艾滋病毒（HIV）和梅毒检测。多变量逻辑回归分析控制了年龄因素，以确定与报告 18 岁前卖淫相关的因素。报告 18 岁前卖淫的 FSW 占 11.5%（256/2220）。青少年时期开始卖淫与出现尿痛（调整后的优势比 [aOR]：1.50，95%置信区间 [CI]：1.08-2.10）或生殖器疣（aOR：1.78，95% CI：1.08-2.94）呈正相关，与近期 HIV（aOR：0.71，95% CI：0.53-0.96）或性传播感染（aOR：0.65，95% CI：0.44-0.96）检测呈负相关。与客户一致使用安全套与早期开始卖淫呈负相关（aOR：0.58，95% CI：0.42-0.80），而最近遭受性暴力的经历与早期开始卖淫呈正相关（aOR：1.74，95% CI：1.15-2.63）。HIV（24.5%）或梅毒（8.3%）的患病率没有独立的显著差异。鉴于青少年时期就开始卖淫的女性很少使用艾滋病毒和性传播感染检测服务，被迫发生性行为、无保护性行为和性传播感染症状的比例很高。为性工作者服务的项目应该更积极地为那些很早就开始卖淫的青少年和成年人提供服务。
