Mee Paul, Neuman Melissa, Kumwenda Moses, Lora Wezzie S, Sikwese Simon, Sambo Mwiza, Fielding Katherine, Indravudh Pitchaya P, Hatzold Karin, Johnson Cheryl, Corbett Elizabeth L, Desmond Nicola
Lincoln International Institute for Rural Health, College of Health and Science, University of Lincoln, Lincoln, UK.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
BMC Infect Dis. 2024 Mar 11;22(Suppl 1):978. doi: 10.1186/s12879-024-09178-3.
In Malawi, female sex workers (FSW) have high HIV incidence and regular testing is suggested. HIV self-testing (HIVST) is a safe and acceptable alternative to standard testing services. This study assessed; whether social harms were more likely to be reported after HIVST distribution to FSW by peer distributors than after facility-based HIV testing and whether FSW regretted HIVST use or experienced associated relationship problems.
Peer HIVST distributors, who were FSW, were recruited in Blantyre district, Malawi between February and July 2017. Among HIVST recipients a prospective cohort was recruited. Interviews were conducted at baseline and at end-line, 3 months later. Participants completed daily sexual activity diaries. End-line data were analysed using logistic regression to assess whether regret or relationship problems were associated with HIVST use. Sexual activity data were analysed using Generalised Estimating Equations to assess whether HIVST use was temporally associated with an increase in social harms.
Of 265 FSW recruited and offered HIVST, 131 completed both interviews. Of these, 31/131(23.7%) reported initial regret after HIVST use, this reduced to 23/131(17.6%) at the 3-month follow-up. Relationship problems were reported by 12/131(9.2%). Regret about HIVST use was less commonly reported in those aged 26-35 years compared to those aged 16-25 years (OR immediate regret-0.40 95% CI 0.16-1.01) (OR current regret-0.22 95% CI 0.07 - 0.71) and was not associated with the HIVST result. There was limited evidence that reports of verbal abuse perpetrated by clients in the week following HIVST use were greater than when there was no testing in the preceding week. There was no evidence for increases in any other social harms. There was some evidence of coercion to test, most commonly initiated by the peer distributor.
Little evidence was found that the peer distribution model was associated with increased levels of social harms, however programmes aimed at reaching FSW need to carefully consider possible unintended consequences of their service delivery approaches, including the potential for peer distributors to coerce individuals to test or disclose their test results and alternative distribution models may need to be considered.
在马拉维，女性性工作者（FSW）的艾滋病毒感染率很高，建议定期进行检测。艾滋病毒自我检测（HIVST）是标准检测服务的一种安全且可接受的替代方法。本研究评估了：与基于医疗机构的艾滋病毒检测相比，由同伴分发者向女性性工作者分发HIVST后，是否更有可能报告社会危害，以及女性性工作者是否后悔使用HIVST或经历相关的关系问题。
2017年2月至7月期间，在马拉维布兰太尔区招募了身为女性性工作者的同伴HIVST分发者。在HIVST接受者中招募了一个前瞻性队列。在基线和3个月后的终线进行访谈。参与者完成每日性活动日记。使用逻辑回归分析终线数据，以评估后悔或关系问题是否与使用HIVST有关。使用广义估计方程分析性活动数据，以评估使用HIVST是否在时间上与社会危害增加有关。
在招募并提供HIVST的265名女性性工作者中，131人完成了两次访谈。其中，31/131（23.7%）报告在使用HIVST后最初感到后悔，在3个月随访时这一比例降至23/131（17.6%）。12/131（9.2%）报告了关系问题。与16 - 25岁的人相比，26 - 35岁的人较少报告对使用HIVST感到后悔（即时后悔的比值比 - 0.40，95%置信区间0.16 - 1.01）（当前后悔的比值比 - 0.22，95%置信区间0.07 - 0.71），且与HIVST结果无关。仅有有限的证据表明，在使用HIVST后的一周内，客户实施言语虐待的报告比前一周未进行检测时更多。没有证据表明其他任何社会危害有所增加。有一些证据表明存在强制检测的情况，最常见的是由同伴分发者发起。
几乎没有证据表明同伴分发模式与社会危害水平的增加有关，然而，旨在覆盖女性性工作者的项目需要仔细考虑其服务提供方式可能产生的意外后果，包括同伴分发者可能强制个人进行检测或披露检测结果的可能性，可能需要考虑其他分发模式。
