Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain.
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
Arch Sex Behav. 2024 Oct;53(9):3625-3637. doi: 10.1007/s10508-024-02939-w. Epub 2024 Aug 15.
Paid sex is associated with HIV and other sexually transmitted infections, which are highly prevalent in Sub-Saharan Africa (SSA). However, few data exist on this sexual practice among the general population in SSA, including the Democratic Republic of the Congo, where data on paid sex mainly comes from sex workers. In the DRC, most HIV Voluntary Counseling and Testing (VCT) centers do not discuss paid sex as a risk factor. Thus, we aimed to analyze the prevalence of paid sex, its associated factors and association with HIV among women and men attending HIV VCT at a reference hospital in Kinshasa. From 2016 to 2018, the Observational Kinshasa AIDS Initiative cohort analyzed the impact of HIV VCT on changes in HIV knowledge, attitudes, and sexual behaviors at follow-up. Participants aged 15-69 years were HIV tested and interviewed at baseline and at 6- and 12-month follow-ups. At baseline, participants were asked about their history of "ever" having had exchanged sex for money. At both follow-ups, the frequency of this practice was referred to as "the previous 6 months." Descriptive, bivariate, and multivariate logistic regression analyses were carried out to evaluate the prevalence of paid sex, its associated factors, and the association between paid sex and HIV. Statistical analyses were performed with Stata 15.1. Among 797 participants at baseline, 10% of those sexually experienced reported having ever had paid sex (18% men and 4% women, p < 0.001). At 6 and 12-month follow-ups, 5% and 2%, respectively. Paid sex was significantly and independently associated with being male (aOR = 2.7; 95% CI = 1.4-5.2), working or studying (aOR = 2.8; 95% CI = 1.5-5.0), daily newspaper reading (aOR = 4.4; 95% CI = 1.7-11.2); daily/weekly alcohol consumption (aOR = 3.3; 95% CI = 1.8-6.1), first sexual intercourse before age 15 years (aOR = 2.3; 95% CI = 1.1-5.0), multiple sexual partners (aOR = 4.1; 95% CI = 2.2-7.7), and extragenital sexual practices (aOR = 2.4; 95% CI = 1.3-4.4). A high religiosity (daily/weekly church attendance and praying) was inversely associated with paid sex (aOR = 0.1; 95% CI = 0.0-0.4). The high prevalence of paid sex among people attending HIV VCT in Kinshasa, associated with other sexual and consumption risk behaviors, highlights the need to include paid sex among the risk factors mentioned in HIV prevention counseling.
有偿性交易与艾滋病毒和其他性传播感染有关，这些疾病在撒哈拉以南非洲（SSA）高度流行。然而，关于该地区普通人群中的这种性行为，包括刚果民主共和国，很少有数据。在刚果民主共和国，大多数艾滋病毒自愿咨询和检测（VCT）中心没有将有偿性交易作为一个风险因素进行讨论。因此，我们旨在分析在金沙萨的一家参考医院接受艾滋病毒 VCT 的女性和男性中，有偿性交易的流行率、其相关因素以及与艾滋病毒的关联。2016 年至 2018 年，观察性金沙萨艾滋病倡议队列分析了艾滋病毒 VCT 对随访中艾滋病毒知识、态度和性行为变化的影响。15 至 69 岁的参与者在基线和 6 个月和 12 个月的随访时接受艾滋病毒检测和访谈。在基线时，参与者被问及他们是否有过“曾经”用钱换取性的经历。在两次随访中，这种行为的频率都被称为“前 6 个月”。使用描述性、双变量和多变量逻辑回归分析评估有偿性交易的流行率、其相关因素以及有偿性交易与艾滋病毒之间的关联。使用 Stata 15.1 进行统计分析。在 797 名基线参与者中，10%有性经验的人报告曾经有过有偿性交易（18%为男性，4%为女性，p<0.001）。在 6 个月和 12 个月的随访中，分别为 5%和 2%。有偿性交易与男性（优势比[OR] = 2.7；95%置信区间[CI] = 1.4-5.2）、工作或学习（OR = 2.8；95%CI = 1.5-5.0）、每日阅读报纸（OR = 4.4；95%CI = 1.7-11.2）显著且独立相关；每日/每周饮酒（OR = 3.3；95%CI = 1.8-6.1）、15 岁前首次性行为（OR = 2.3；95%CI = 1.1-5.0）、多个性伴侣（OR = 4.1；95%CI = 2.2-7.7）和外生殖器性行为（OR = 2.4；95%CI = 1.3-4.4）。高宗教信仰（每日/每周参加教堂和祈祷）与有偿性交易呈负相关（OR = 0.1；95%CI = 0.0-0.4）。在金沙萨接受艾滋病毒 VCT 的人群中，有偿性交易的高流行率与其他性和消费风险行为相关，这突出表明需要将有偿性交易纳入艾滋病毒预防咨询中提到的风险因素。
