Sex work venue and condom use among female sex workers in Senggigi,Indonesia

This paper examines the structural influence of sex work venues on condom use among female sex workers in the Senggigi area of Lombok, Indonesia. A cross-sectional design employing ethnographic observation, structured interviews and hierarchical linear modelling was used to examine condom use among female sex workers who solicited clients at three types of sex work venues: (1) freelance locations, (2) brothels and (3) entertainment places (karaoke bars and massage parlours). The sample consisted of 115 women ‘nested’ within 16 sex work venues drawn from the three venue types. Rate (39%) of condom use varied across sex work venues. Perceived management style, HIV/AIDS-related policies and risk-reduction services differed by venue, but this variation did not explain differences in condom use. At the individual level, higher condom use was associated with female sex workers having ever been married. At the client level, condoms were more likely to be used with foreign rather than domestic/local Indonesian clients. Low rates of condom use among Indonesian female sex workers during commercial sex suggests the need for increased HIV-prevention efforts that acknowledge sex worker characteristics and relationships with clients that place them at risk. Future research into the effects of social context on HIV risk should also be considered.     

2010年中山市流动人口艾滋病和梅毒感染率调查

目的获得中山市流动人口人类免疫缺陷病毒（HIV）和梅毒感染率及相关影响因素。方法 2010年采用多级抽样的方法对工厂工人、建筑工人、餐饮宾馆从业人员和劳务市场寻工人员等4类流动人口进行问卷调查和血清学检测。结果共1 600人接受调查,HIV抗体、梅毒ELISA和梅毒TRUST血清学阳性率分别为0.13%（95%CI：0~0.30）、1.13%（95%CI：0.61~1.64）和0.44%（95%CI：0.11~0.76）。最近一年男性发生非保护性商业性行为的比例为8.6%（60/701）,与男性肛交发生的比例为0.89%（8/894）;最近一年非保护性临时性行为发生率为7.5%（106/1 414）。＂最近1年发生非保护性临时性行为＂是梅毒ELISA血清学阳性（OR=4.39,95%CI：1.40~13.74）和梅毒TRUST血清学阳性（OR=5.57,95%CI：1.07~29.10）的危险因素。结论中山市流动人口HIV尚处于低流行阶段,但存在导致HIV进一步流行的危险因素,需不断开展干预和综合防治工作。     

Condom use in China: prevalence, policies, issues and barriers

In this review, we describe condom use and its influencing factors in China, with a particular focus on the five populations that are at high risk for HIV/sexually transmissible infections (STI) infection: female sex workers, men who have sex with men, migrant workers, young people and sero-discordant couples. The risk for HIV/STI infection is high while condom use rates are low among these five populations. The 100% Condom Use Programme was successful in trial regions in increasing condom use and decreasing HIV/STI prevalence; however, long-term and routine condom promotion strategies should be in place to ensure better awareness of condom use, high availability of condoms and high rate of condom use among populations at high risk of HIV/STI infection in China. Realistic and vigorous condom-related policies and action plans should be developed and implemented to address the issues and barriers facing condom promotion in China.     

Talking the talk,walking the walk: Social network norms,communication patterns,and condom use among the male partners of female sex workers in La Romana,Dominican Republic

Male partners of female sex workers are rarely targeted by HIV prevention interventions in the commercial sex industry, despite recognition of their central role and power in condom use negotiation. Social networks offer a naturally existing social structure to increase male participation in preventing HIV. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic. Male partners (N = 318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioral outcome was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months. In general, men reported small, dense networks with high levels of communication about condoms and consistent condom use. Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members. Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of communication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners.     

Who's at Risk? Men's STD Experience and Condom Use in Southwest Nigeria

Many STD/HIV-prevention programs worldwide assume that individuals' risk of acquiring sexually transmitted diseases, including HIV infection, is highest in the context of commercial sex. To address this assumption, research conducted in urban Southwest Nigeria combined qualitative and quantitative methods to examine men's sexual behavior, condom use, and STD experience in different types of sexual relationships (marital, casual, and commercial). Logistic regression analysis of survey data indicates that number of sexual partners and sex with sex workers are positively and significantly related to STD experience. Follow-up in-depth interviews with clients of sex workers indicate, however, that these men are actually more likely to report having contracted an STD from a casual sex partner than from a sex worker. Men are most uncertain about their vulnerability to STDs with casual partners. Men's condom use is highest in commercial sex, inconsistent in casual relationships, and lowest in marriage. STD/HIV-prevention programs need to address the range of sexual relationships and the meanings and behaviors associated with them.     

越南籍跨境暗娼艾滋病性病感染及危险因素调查

目的 了解越南籍跨境暗娼人群艾滋病(acquired immunodeficiency syndrome, AIDS)性病(sexually transmitted diseases,STD)感染情况,高危行为特征及危险因素,为制定有针对性的预防控制措施提供依据。 方法 采用"滚雪球、同伴推动"等方法,由经培训懂双语的外展人员对越南籍跨境暗娼人群进行面对面问卷调查,调查内容包括人口学特征、艾滋病知识、高危行为、安全套使用情况等,并采集静脉血3～5 ml进行艾滋病病毒(human immunodeficiency virus,HIV)、梅毒抗体检测,应用SPSS 19.0 软件分析其中HIV、梅毒感染状况及探讨影响越南籍跨境暗娼人群商业性行为不使用安全套的可能因素。 结果 92例调查对象中,未发现HIV抗体阳性者,梅毒抗体阳性1例,阳性率为1.09%。调查对象均存在有多国商业性伴情况,每日接客数量为3个及以上者高达60.87%,最近1次和最近1个月商业性行为每次都使用安全套的比例分别为80.44%和68.48%;有54.35%的调查对象,在最近1个月内与固定性伴(熟客)发生过性关系, 最近1次和最近1个月每次性行为均无人使用安全套。通过多因素logistic回归分析显示,高档/中档服务场所(OR=15.021, 95%CI:2.820～80.023)是越南跨境暗娼商业性行为使用安全套的保护因素,首次性服务年龄≥30岁(OR=0.165, 95%CI:0.042～0.651)、每日接客数量≥3个(OR=0.129, 95%CI:0.023～0.737)是越南跨境暗娼商业性行为使用安全套的主要危险因素。 结论 越南籍跨境暗娼人群普遍存在多国商业性伴情况,低档服务场所、每日接客数量较多、高年龄组的暗娼安全套使用频率较低。提示在今后干预工作中,应充分考虑不同档次高危娱乐场所和高危性行为特征,开展有针对性的综合干预工作。     

应用结构方程模型分析女性性工作者HIV检测行为影响因素的研究

目的 通过结构方程模型,阐明女性性工作者HIV检测行为影响因素.方法 在重庆、四川、广西和新疆对1613名女性性工作者进行问卷调查,采用结构方程模型分析其HIV检测行为影响因素.结果 通过结构方程模型发现女性性工作者HIV检测行为影响因素包括社会地位、艾滋病知识、危险自评、安全套使用、性服务频率5个因素.结构方程模型拟合结果:GFI=0.9952,AGFI=0.9898,RMR=0.0115.结论 影响因素模型拟合效果良好.社会地位、艾滋病知识、危险自评、安全套使用、性服务频率均影响女性性工作者的HIV检测行为,应根据干预对象的不同社会地位制定不同的干预机制.     

Focusing strategies of condom use against HIV in different behavioural settings: an evaluation based on a simulation model.

Using a sexually transmitted diseases simulation model (STDSIM), we made projections of HIV spread for four profiles of sexual behaviour reflecting patterns encountered across the developing world: 1) much commercial sex, no short relationships; 2) commercial sex, concurrent short relationships; 3) concurrent relationships, no commercial sex; 4) serial short relationships, some commercial sex. We studied the effects of increasing condom use in three target groups: commercial sex workers (CSWs); men engaging in commercial contacts and short relationships; and females in steady relationships. The projections indicated that the CSW and male strategies were more effective in reducing HIV incidence than the strategy focusing on females in steady relationships. In the long run, even the group of men and women with one recent partner were better protected against HIV infection by condom use in high-risk contacts than by condom use in steady relationships. Furthermore, the numbers of HIV cases prevented per condom used were 7 to 500 times higher for condoms used by CSWs or men engaging in short relationships and commercial sex than for ones used by females in steady relationships. The results indicated the merit of focusing on high-risk groups irrespective of the pattern of sexual behaviour, even in epidemics that had already spread throughout populations.     

Community-level HIV intervention in 5 cities: final outcome data from the CDC AIDS Community Demonstration Projects

OBJECTIVES: This study evaluated a theory-based community-level intervention to promote progress toward consistent condom and bleach use among selected populations at increased risk for HIV infection in 5 US cities. METHODS: Role-model stories were distributed, along with condoms and bleach, by community members who encouraged behavior change among injection drug users, their female sex partners, sex workers, non-gay-identified men who have sex with men, high-risk youth, and residents in areas with high sexually transmitted disease rates. Over a 3-year period, cross-sectional interviews (n = 15,205) were conducted in 10 intervention and comparison community pairs. Outcomes were measured on a stage-of-change scale. Observed condom carrying and intervention exposure were also measured. RESULTS: At the community level, movement toward consistent condom use with main (P < .05) and nonmain (P < .05) partners, as well as increased condom carrying (P < .0001), was greater in intervention than in comparison communities. At the individual level, respondents recently exposed to the intervention were more likely to carry condoms and to have higher stage-of-change scores for condom and bleach use. CONCLUSIONS: The intervention led to significant communitywide progress toward consistent HIV risk reduction.     

Sex work,discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala

ABSTRACT

The risk of HIV infection is higher among transgender women and cisgender men who have sex with men (MSM) compared to the general population due in part to social and contextual factors. This study aimed to determine the prevalence and association of alcohol and drug abuse, discrimination and violence among transgender sex workers compared to cisgender male sex workers and cisgender men who had not received money for sex in Guatemala City. In 2010, transgender women and cisgender men who had had sex with men or transgender women were recruited into a cross-sectional behavioural survey. Among transgender women, 86% received money for sex in the past year. Transgender sex workers were more likely to use drugs and binge drink, three times as likely to be discriminated against and eight times as likely to be forced to have sex compared to non-sex worker men. Male sex workers were twice as likely to use illicit drugs or experience physical violence and six times as likely to experience forced sex compared to non-sex worker men. Transgender and male sex workers would benefit from harm reduction for substance use, violence prevention, response and strategies to mitigate discrimination.     

417例女性性服务者感染艾滋病性病情况调查

目的 了解掌握提供或可能提供性服务的女性感染艾滋病性病情况以及在商业性性行为中使用安全套情况，为针对此类人群开展行为干预提供科学依据。方法 调查某市提供或可能提供商业性性服务的女性，选取符合417例，按服务方式分为“娱乐场所性服务”和“路边性服务”两类。分别采集血液和阴道分泌物标本，进行HIV、梅毒、衣原体感染检测和淋球菌、念珠菌涂片及培养鉴定。问卷调查她们在商业性性行为中使用安全套的情况。结果 417例中尚未发现感染HIV，感染1种或多种性病的占18．94％，其中感染梅毒为7．38％，感染淋病的为3．57％。感染衣原体的为10．95％。路边性服务女性性病总感染率为50．00％，远比娱乐场所性服务女性感染率高，路边性服务女性安全套使用率比娱乐场所性服务女性低。结论路边性服务女性感染性传播疾病的危险性比娱乐场所性服务女性的危险性大．应有针对性的进行安全性行为干预。     

Prevalence survey on condom use and infection of urogenital mycoplasmas in female sex workers in China

GOAL: We evaluated the prevalence of condom use and the effects of condom use on urogenital mycoplasma infection in female sex workers in Jinjiang, China. METHODS: Two-hundred ninety-nine female sex workers from Jinjiang city, Jiangsu Province, were interviewed, and three mycoplasmas of Ureaplasma urealyticum (Uu), Mycoplasma hominis (Mh) and Mycoplasma genitalium (Mg) were detected by nested polymerase chain reaction in genital secretions of 72 female sex workers and 42 female patients seen with symptoms of genital infection (control group). RESULTS: The results showed that 87.29% of the sex workers used condom in their last sexual intercourse, and that 2.68% did not use, 38.80% sometimes used and 58.52% used condoms every time in the last month. Those who were older, married and have a stable partnership used condoms less frequently. The infection rates of Uu, Mh and Mg were 77.78%, 34.72% and 16.67%, respectively, in sex worker subjects compared to those of controls at 59.52%, 9.62% and 21.43%, respectively. The infection rates of Uu and Mg were lower among all subjects (NS) who used condoms every time. In this observational study, genital mycoplasma infection was common and occurred more frequently among sex workers, and infection occurred less often when condoms were used. These results tend to support the efficacy of condom use in reducing urogenital mycoplasma infection among Chinese women.     

广西 50 岁及以上嫖客 HIV 感染现况及影响因素研究

目的了解广西50岁及以上嫖客人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染现况,并探讨该人群HIV感染的影响因素。方法2012年10～12月,在广西贵港市和平南县针对50岁及以上嫖客开展横断面调查,调查内容包括一般人口学特征、性行为特征、艾滋病相关知识和血清学HIV及梅毒检测。结果共调查676人,HIV和梅毒感染率分别为2．8％和4．O％。在单因素分析中,嫖娼史、商业性行为时是否使用安全套、每次商业性行为平均价格、是否知道艾滋病自愿咨询检测门诊、是否做过艾滋病检测与HIV感染差异均有统计学意义（均有P〈0．10）。在多因素Logistic回归模型中,商业性行为时从未使用安全套（OR=4．756,95％C／：1．138—19．879）和做过艾滋病检测（OR=5．670,95％C／：1．981—16．223）是HW感染的危险因素。结论在艾滋病重点省份要加强开展面向普通人群的艾防宣传和面向低档女性性服务者（femalesexworkers,FSWs）的干预,以促进50岁及以上嫖客安全性行为,减少H1V传播。     

2007年山东省部分城市女性多性伴者行为监测结果分析

[目的]了解山东省女性多性伴者行为特征及性病艾滋病感染状况,为实施有效的干预措施和防治对策提供信息和依据。[方法]2007年7～9月对娱乐场所的女性多性伴者进行匿名问卷调查和血标本收集。[结果]共调查女性多性伴者1197人,年龄15～45岁,以低年龄组（≤24岁）、未婚、初中及以下文化程度为主,对艾滋病3种传播途径全部回答正确者占76．9％,最近1个月商业性行为每次都使用安全套者639例,占53．6％;与固定性伴最近一个月性行为每次都使用安全套的比例低,仅为17．6％;45．6％的调查对象出现过性病症状,29．8％的人自愿做过艾滋病病毒检测。[结论]山东省女性多性伴人群艾滋病阳性率目前总体仍处于较低水平,但高危行为广泛存在,需要实施综合干预,加大对该类人群的健康教育。     

Sex Trade Behavior among Heterosexually Active Homeless Men

Sex trade behavior is fairly common among homeless adults and may contribute to higher rates of HIV/AIDS in this population. This study provides a detailed examination of the sex trade-related attitudes and behaviors of homeless men by: (1) determining the prevalence of sex trade-related behaviors, including sex with female sex workers (FSWs); (2) identifying risk factors for having sex with FSWs; and (3) comparing men’s relationships with FSWs and non-FSWs in terms of relationship qualities and HIV-related risk behaviors, such as condom use. Structured interviews were conducted with a probability sample of 305 heterosexually active homeless men recruited from meal lines in Los Angeles. Recent sex with a FSW was reported by 26 % of men, and more likely among those who were older, used crack cocaine, had more sex partners, believed that sometimes men just need to have sex no matter what, and were embedded in networks that were denser and where risky sex was more normative. Compared to non-FSW partners, men with FSW partners felt less emotionally close to them, were more likely to believe the partner had never been tested for HIV, and were more likely to have sex with them under the influence of drugs or alcohol; however, they were not more likely to talk about using condoms or to use condoms with FSWs. Whether the relationship was considered “serious” was a stronger correlate of condom use than whether the partner was a FSW. Implications of these findings for HIV prevention efforts among homeless adults are discussed.     

开远市嫖客人群艾滋病相关知识、高危行为和STDs感染状况分析

  目的  了解开远市嫖客人群艾滋病(acquired immunodeficiency syndrome, AIDS)相关知识和高危行为状况, 以及感染人类免疫缺陷病毒(human immunodeficiency virus, HIV)、梅毒、生殖器单纯疱疹病毒(herpes simplex virus type 2, HSV-2)状况, 分析HSV-2感染相关因素, 为制定预防措施提供依据。  方法  采用“外展人员招募”与“滚雪球”方式招募对象, 问卷调查并采集血液和尿液进行相应实验室检查。  结果  98.22%的嫖客知晓艾滋病知识; 9.33%曾使用过毒品; 14.67%在最近一次商业性行为时未使用安全套; 62.22%曾有过非婚性伴, 在过去一年与非婚性伴有性行为的嫖客中, 59.55%未坚持使用安全套。嫖客中HIV/梅毒/HSV-2的总体感染率为18.22%, 其中HIV、梅毒、HSV-2的感染率分别为3.11%、1.33%、16.44%。年龄较大者HSV-2感染率较高[AOR=1.044, 95%CI: 1.016~1.073, P=0.002], 最近一次商业性行为中未使用安全套者HSV-2感染率较高[AOR=3.125, 95%CI: 1.229~7.945, P=0.017]。  结论  开远市嫖客人群艾滋病知识知晓率高, 但仍存在高危行为, 有较高的HIV和其它性传播疾病感染率, 需采取针对性干预措施, 提高该人群感染性传播疾病的风险意识, 促进他们在商业和非婚性行为中坚持使用安全套。     

Control and condoms in commercial sex: client perspectives

Indepth interviews were recorded with 24 clients of female sex workers to explore their perspectives on the control of commercial sex encounters. The men saw the encounter as falling into three phases, only the first of which - the decision to have sex - was under their control. Subsequent phases - the negotiation of services and the performance of sex - they argued to be under worker control. The men considered that they acquiesced in worker control because they saw themselves as respectful of a woman's right to control her body and because they considered themselves attentive to workers’ sexual pleasure. At the same time, this acquiescence was considered to exculpate them from any responsibility for safer sex practice. Thus while the men argued they were consistent condom users, they held their partners responsible for ensuring this consistent condom use: women supplied condoms, and were held accountable for any condom failures. The discourse of these men therefore functioned both to present clients benignly and to exculpate them from any responsibility for ensuring the safety of the commercial sex encounter.     

HIV-Risk Behavior Among the Male Migrant Factory Workers in a North Indian City

Background:Male migrants act as a bridge for transmitting infection from core risk groups to general population and hence this group becomes essential for the HIV control program. Migrant workers constitute a large proportion of workforce in India and HIV/AIDS epidemic in them would cause huge economic losses.Objectives:The aim of this study was to ascertain the HIV-risk behavior among male migrant factory workers.Results:A total of 755 male subjects completed the interview. About 21.5% had experienced non-spousal sexual intercourse in last one year. Nearly 60% did not use a condom at the last non-spousal sex. Factors associated with recent non-spousal sex were being unmarried, younger age at migration, recent migration to Haryana, greater number of places migrated and lesser total duration of migration and those associated with non-use of condom at the last non-spousal sex were older age, lower education, lesser number of places migrated and lower level of HIV/AIDS knowledge.Conclusion:Unprotected, recent non-spousal sex was common among male migrants, which could increase their HIV/AIDS vulnerability.     

宁明县3类人群艾滋病哨点监测结果分析

目的 了解中越边境地区 - 宁明县静脉吸毒、暗娼、孕（产）妇三类人群艾滋病知识水平、相关行为特征及艾滋病病毒感染情况,为今后艾滋病防治工作提供科学依据。方法 根据全国哨点监测实施方案的要求,对三类人群进行问卷调查和血清艾滋病病毒、梅毒、丙型肝炎病毒检测。 结果 2011 - 2013年共监测静脉吸毒者944人,艾滋病病毒阳性率10.49%,梅毒阳性率17.27%,丙型肝炎病毒阳性率71.4%,艾滋病知晓率88.03%,47.67%曾共用注射器吸毒,42.58%最近1次商业性行为不使用安全套。共监测暗娼1 202人,艾滋病病毒阳性率1.58%,梅毒阳性率9.48%,丙型肝炎病毒阳性率2.7%,87.02%最近一次与固定性伴性行为不使用安全套,最近一次商业性行为使用安全套率中国籍95.49%高于越南籍78.26%,差异有统计学意义,艾滋病知晓率中国籍98.56%高于越南籍86.57%,差异有统计学意义。共监测孕(产)妇1 200人,艾滋病病毒阳性率0.5%,梅毒阳性率0.83%,HCV丙型肝炎病毒阳性率0.25%,艾滋病知识知晓率75.83%。结论 宁明县静脉吸毒和暗娼人群艾滋病性病感染率高,高危行为普遍,应加强对其行为干预,特别是注重越南籍暗娼干预,同时应开展阻断母婴传播,控制艾滋病的流行蔓延。