Toh Wen Qiang, Treibich Carole, Szawlowski Sandie, Cust Henry, Mbaye Elhadj A, Gueye Khady, Ndour Cheikh T, Lépine Aurélia
Erasmus School of Economics, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, PA 3062, The Netherlands.
University Grenoble Alpes, CNRS, INRAE, Grenoble INP, GAEL, Grenoble 38000, France.
Health Policy Plan. 2025 Aug 18;40(7):685-695. doi: 10.1093/heapol/czaf023.
Literature suggests that individuals may trade off health for income in face of an economic shock. Being in a close contact profession, the livelihoods of sex workers were severely affected by the COVID-19 pandemic. Few studies exist on whether prevalence of better-renumerated condomless sex increased among this population in low and middle-income countries and discuss its implications on HIV/STI transmission, specifically during pandemic situations. We reported cross-sectional condom use prevalence estimates of 600 female sex workers in Dakar, Senegal from data collected before (2015, 2017) and during the pandemic (June-July 2020). Condom use prevalence was elicited via list experiments for more truthful estimates. Double list experiment estimates of mean condom use prevalence declined from 78.2% (95% CI: 70.9-85.5%) in 2017 to 65.1% (95% CI: 57.6-72.7%) in 2020. This statistically significant decrease of 13.1 percentage points (P = .014) represents a 16.8% fall in condom use and a 60.2% increase in condomless sex prevalence. The fall in condom use prevalence was largely concentrated amongst the asset-poor, providing some suggestive evidence that economic reasons drove the fall in condom use, reinforcing findings in existing literature regarding the positive relationship between economic shocks and risky sexual behaviours. At the point of the survey, the observed decline in client numbers exceeded the reduction in condom use prevalence, suggesting potential mitigation of HIV/STI transmission risks during the COVID-19 pandemic; nevertheless, the lack of direct comparability between these two metrics warrants cautious interpretation. However, more accurate epidemiological modelling considering the non-sex worker population and longer-term studies on whether condom use prevalence returned to pre-COVID levels after client numbers recovered are required for a comprehensive assessment of the pandemic's short-term and longer-term impact on HIV/STI transmission.
文献表明，面对经济冲击时，个人可能会以健康换取收入。性工作者从事密切接触行业，其生计受到新冠疫情的严重影响。关于中低收入国家的这一人群中报酬更高的无保护性行为的流行率是否上升，以及讨论其对艾滋病毒/性传播感染传播的影响，特别是在疫情期间，相关研究较少。我们根据在塞内加尔达喀尔收集的2015年、2017年（疫情前）以及疫情期间（2020年6月至7月）的数据，报告了600名女性性工作者的横断面避孕套使用流行率估计值。通过列表实验得出避孕套使用流行率，以获得更真实的估计值。双列表实验估计的平均避孕套使用流行率从2017年的78.2%（95%置信区间：70.9 - 85.5%）降至2020年的65.1%（95%置信区间：57.6 - 72.7%）。这一具有统计学意义的13.1个百分点的下降（P = 0.014）意味着避孕套使用下降了16.8%，无保护性行为流行率上升了60.2%。避孕套使用流行率的下降主要集中在资产匮乏者中，这提供了一些暗示性证据，表明经济原因导致了避孕套使用的下降，强化了现有文献中关于经济冲击与危险性行为之间正相关关系的研究结果。在调查时，观察到的客户数量下降超过了避孕套使用流行率的下降，这表明在新冠疫情期间艾滋病毒/性传播感染传播风险可能得到了缓解；然而，这两个指标缺乏直接可比性，需要谨慎解读。但是，为了全面评估疫情对艾滋病毒/性传播感染传播的短期和长期影响，需要进行更准确的考虑非性工作者人群的流行病学建模，以及关于客户数量恢复后避孕套使用流行率是否恢复到新冠疫情前水平的长期研究。
