青海省2009-2010年女性性服务者人群行为监测主要指标分析

目的分析青海省女性性服务者(FSW)艾滋病相关行为变化及艾滋病病毒(HIV)感染流行趋势,为艾滋病综合防治和科学干预提供信息和依据。方法对2009-2010年连续开展监测的2个女性性工作者监测点,以重复横断面调查的方法,对社区娱乐场所及街头的女性性服务者进行问卷调查并采血。结果 2009-2010年连续开展监测的2个女性性服务者监测点中,2年间监测对象最近一次商业性行为安全套使用率分别为84.3%和83.8%;最进一个月商业性行为坚持使用安全套的比例分别为75.8%和69.9%;1个监测点发现监测对象中有注射吸毒现象;艾滋病传播途径知晓率分别为81.6%和75.8%;接受过HIV检测并知晓检测结果者的比例分别为41.1%和44.3%;最近一年内接受过干预服务者的比例分别为77.2%和80.1%;HIV阳性检出率分别为0和0.25%;梅毒阳性检出率分别为1.6%和1.8%;丙型肝炎阳性检出率分别为0.5%和0.1%。结论女性性服务者安全套使用率和艾滋病知识知晓率有待进一步提高。HIV感染率总体水平低,部分女性性服务者有注射吸毒行为。     

Pornography,Sexual Enhancement Products,and Sexual Risk of Female Sex Workers and their Clients in Southern India

Despite their large numbers, and important role in the HIV epidemic in India, male clients of female sex workers (FSWs) are a difficult to reach population and little is known about their sexual behaviors. Using data from an integrated behavioral and biological assessment of 684 clients in Bangalore in 2012, we examined factors associated with their reports of having sex with three or more different female sex workers in the last month, and anal sex with sex workers. We included sociodemographic and sexual behavior factors and, for the first time in client studies in India, included data on the use of pornography and sexual enhancement products (SEPs) such as pills, oils, and sprays, in our multivariable analyses of client risk. Seventy-eight percent of clients had seen pornographic material and 8 % reported ever having used SEPs. The profiles of men practicing the two risk behaviors examined were quite different. Travel in the past year, drunkenness in the past month, young age at first commercial sex, non-use of condoms at last sex, and finding sex workers in public places (but not use of pornography and SEPs) were independently associated with multiple partnering. Sex with a man or transsexual, being a white collar worker, seeking out FSWs at home, pornography and SEP use, and condom use at last FSW sex, were all independently associated with anal sex with an FSW. More research is needed to better understand the links between pornography and SEPs, and HIV risk behaviors, and HIV prevention programs need to be cognizant of the importance of ensuring that condom use is adequately promoted and supported in the context of anal sex in female sex worker–client interactions.     

Unpacking the ‘structural’ in a structural approach for HIV prevention among female sex workers: A case study from China

Interventions for HIV prevention among female sex workers (FSWs) in China focus on HIV/sexually transmitted infection (STI) and individual behaviour change. An occupational health framework facilitates intervention across an array of health issues FSWs face including HIV/STI, violence, reproductive health, stigma and substance use. Through a case study of a community-based Jiaozhou (JZ) FSW programme, we developed a conceptual framework incorporating global discussions of structural approaches to HIV prevention with the specific social and structural contexts identified among FSWs in China. Based on ethnographic fieldwork between August 2010 and May 2013, we describe the evolution of this programme to its current occupational health focus and unpack the intervention strategies. We describe the critical features of the programme that have fostered success among FSWs including high-quality clinical services provided within a welcoming setting, responsive outreach work through staff and trained FSW peers, interpersonal and community-level engagement aimed at changing the local social and structural environments of sex work and tailored health education materials. This intervention differs from other projects in China by adopting a more holistic approach to FSW health that incorporates social issues. It also demonstrates the feasibility of structural interventions among FSWs even within an environment that has strong anti-prostitution policies.     

Understanding the diversity of male clients of sex workers in China and the implications for HIV prevention programmes

Male clients of sex workers have been overlooked in China's HIV prevention efforts. This study aims to examine men's practices and attitudes toward extramarital sexual relationships, motivations for visiting female sex workers (FSWs), perceptions of sexually transmitted infection (STI)/HIV risk and risk prevention strategies used. One hundred and eighty-six clients of FSWs with varying socio-economic statuses were interviewed in different sex work settings. Men described no conflict between their role as a client and a responsible family provider. They described social pressure from peers and business partners to visit FSWs, sexual pleasure and companionship as motivators to seek commercial sex. While some men reported no risks associated with visiting FSWs, others identified risks such as being arrested by the police, robbed by gangs and threatening the health of their families by contracting a STI. This study underscores the diversity of FSW clients and the need to understand the beliefs and behaviours of different client types to develop appropriate HIV prevention programmes. It also demonstrates the feasibility of recruiting different types of male clients, a hard-to-reach population for Chinese HIV prevention efforts.     

Mortality and potential years of life lost attributable to alcohol consumption in Canada in 2005

Background

Female sex workers (FSWs) are vulnerable to sexually transmitted infections (STIs) and encounter socio-economic and health problems, including STIs/HIV, unintended pregnancy and complications from unsafe abortion, stigma, violence, and drug addiction. Reducing risks associated with sex work requires an understanding of the social and cultural context in which sex workers live and work. This study aimed to explore the working environment and perceived risks among FSWs in Savannakhet province in Laos.

Methods

Five focus group discussions (FGDs) and seven interviews were conducted with FSWs in Kaysone Phomvihan district in Laos. Latent content analysis was used to analyze the transcribed text.

Results

The results revealed that the FSWs were aware of risks but they also talked about benefits related to their work. The risks were grouped into six categories: STIs/HIV, unintended pregnancy, stigma, violence, being cheated, and social and economic insecurity. The reported benefits were financial security, fulfilling social obligations, and sexual pleasure. The FSWs reported using a number of strategies to reduce risks and increase benefits.

Conclusions

The desire to be self-sufficient and earn as much money as possible put the FSWs in disadvantaged and vulnerable situations. Fear of financial insecurity, obligations to support one??s family and the need to secure the future influenced FSWs?? decisions to have safe or unsafe sex. The FSWs were, however, not only victims. They also had some control over their lives and working environment, with most viewing their work as an easy and good way of earning money.     

南充市高坪区FSW人群的艾滋病相关知识、态度、行为调查

目的为了解FSW人群与艾滋病传播相关的知识、态度和行为趋势,收集分析艾滋病相关信息,敏感及时地反映艾滋病的流行趋势,以便制定和实施行为干预措施,减少艾滋病的传播危险因素。方法在公安部门的配合下,培训娱乐场所业主,由业主组织FSW人员到指定地点接受问卷调查和HIV抗体检测,将所获得的数据录入Epi-data2.1数据库统计分析。结果共调查200名FSW人员,对8个问题的总回答正确率为53.88%,对艾滋病的血液传播、性传播、母婴传播3种主要途径的正确知晓率分别为65.50%、50.50%和64.50%;对与艾滋病感染者或患者一起吃饭、蚊虫叮咬不会传播艾滋病的正确知晓率分别为53.00%和38.50%。FSW人员获得艾滋病相关知识的主要渠道是电视,占调查人数的69.00%;在与客人发生性行为时每次都使用安全套占14.00%。经HIV抗体检测,200名FSW人员均为阴性。结论南充市高坪区FSW人群艾滋病相关知识知晓率低。自我保护意识差,存在艾滋病感染和传播的高危险性。加强高危险人群艾滋病预防知识宣传培训,实施有效地行为干预措施,遏制艾滋病流行仍是持久的艰巨任务。     

2013-2016年四川省大竹县艾滋病暗娼哨点监测结果分析

目的 了解大竹县暗娼人群对艾滋病相关知识知晓情况、艾滋病相关行为及艾滋病病毒(HIV)流行趋势情况,为制定合理的干预措施和有效防治策略提供科学依据。 方法 2013-2016年,对大竹县暗娼人群开展问卷调查并采集血液进行HIV、梅毒和丙肝抗体检测。并对其艾滋病知晓率情况、相关行为特征及HIV感染情况进行描述性分析。 结果 2013-2016年共完成监测1 422人,监测对象艾滋病知识知晓率为97.1%,2013-2016年知晓率差异有统计学意义(χ²=36.22,P<0.01);最近一次发生商业性行为时安全套使用率为98.7%,近1个月发生商业性行为时安全套坚持使用率为92.7%;近一年接受了任何一种预防干预服务的比例为94.6%;暗娼人群HIV阳性检出率为1.5%,其中高、中和低档次暗娼HIV抗体阳性检出率分别为0%、0.7%和7.3%,差异有统计学意义(χ²=53.97,P<0.01)。 结论 虽然四川省大竹县暗娼人群的艾滋病知晓率较高,接受预防干预服务的比例较高,但是中低档暗娼人群的HIV感染率仍然较高,需进一步加大干预措施针对性和覆盖面,控制艾滋病在大竹县的传播流行。     

Conflicting identities between sex workers and motherhood: A systematic review

Being a mother is a traditional and central role for women. However, due to criminalization, social stigma and marginalized lifestyles, female sex workers (FSWs) may encounter disadvantages and social inequality. The aim of this review was to synthesize the results of studies focused on the challenges that FSWs face in negotiating their maternal identity with their stigmatized identity as sex workers. A total of 21 studies published from 2002 to 2016 were included in this review. Textual narrative and a thematic synthesis approach were adopted to synthesize key themes. Two common themes across countries were identified: conflicting identities between the jobs as sex workers and motherhood and responses to social expectations of ideal motherhood. Given the challenges that FSWs face with motherhood, comprehensive services, including health, family, social, and legal services, are needed to support FSWs as individuals and as mothers. A more holistic approach is recommended to address their physical, emotional, financial, and social problems faced by FSWs. Services should be offered in a friendly and non-judgmental manner. Further, to advance the health and safety of FSWs and their children, prostitution law may need to move toward decriminalization of sex work and educate the general public about respecting FSWs.     

靖江市2006-2011年女性性服务者哨点监测结果分析

目的 分析江苏省靖江市女性性服务者艾滋病相关行为变化及艾滋病病毒(HIV)感染流行趋势,为艾滋病综合防治和科学干预提供科学依据。方法 2006-2011年连续进行暗娼综合监测,在监测期内以重复横断面调查的方法对社区娱乐场所及街头的暗娼人群进行问卷调查并采血,每年的样本量约为400人。结果 6年间共监测女性性服务者2 407人,HIV和梅毒感染率分别为0~0.2%(1/406)和0~4.5%(17/381);最近1个月商业性行为坚持使用安全套的比例为71.8%(293/408)~86.3%(341/395);吸毒比例为0.2%(1/407)~7.6%(31/408),呈逐年升高的趋势(Z=6.65,P<0.000 1);艾滋病知晓率为89.2%(340/381)~94.3%(384/407);艾滋病干预覆盖率为64.3%(245/381)~96.8%(395/408),呈逐年升高趋势(Z=15.04,P<0.000 1);近1年参加过HIV检测且知道检测结果的比例为30.6%(121/395)~74.1%(304/410),呈逐年升高趋势(Z=14.42,P<0.000 1)。结论 靖江市女性性服务者商业性行为坚持使用安全套的比例有待进一步提高;其HIV感染率总体较低,但吸毒等高危行为有上升趋势,需不断进行干预和综合防治工作。     

Stress in the sex trade and beyond: Women working in the sex trade talk about the emotional stressors in their working and home lives

There is an extensive body of research literature on female sex trade workers’ risks of sexually transmitted infections including the human immunodeficiency virus (HIV). We also have a vast literature on the physical assaults and violence experienced by female sex trade workers while working. However, we know relatively little about other aspects of the women's health, and especially the ways in which social relations within both their working and private lives affect their emotional health. This qualitative research, which is based on 68 semi-structured interviews with female sex trade workers who work in a variety of different settings, describes and examines the emotional stressors in female prostitutes lives, and shows how stressors permeate both their working and home lives. Although some of the women utilize various strategies to reduce the stressors and are not simply victims of their circumstances and the conditions that shape their lives, their stories point to a clear opening for a critical public health to support the development of programmes and policies that might respond to these issues and improve the health and well-being of many women who work in the industry.     

丰台区2006-2009年暗娼人群行为学和血清学分析

目的了解北京市暗娼人群艾滋病相关行为变化及艾滋病、梅毒感染流行趋势,为艾滋病综合防治和科学干预提供科学依据。方法于2006-2009年对810名社区暗娼及1 247名哨点监测暗娼人群进行血清学和行为学问卷调查。结果 2006-2009年社区暗娼人群HIV抗体检出率均为0,暗娼人群分别为0.4%(1/267)、0.4%(2/252)、0(0/236)、0(0/292);梅毒RPR(rapid plasma region test,RPR)阳性率社区暗娼人群分别为3.0%(5/167)、2.1%(4/192)、1.5%(3/195)、1.0%(2/198),暗娼分别为8.6%(23/267)、10.4%(47/452)、6.4%(15/236)、3.8%(11/292);最近一次安全套使用率社区暗娼人群分别为94.0%(186/198)、88.5%(179/202)、92.3%(192/208)、94.7%(191/202),暗娼人群分别为79.0%(211/267)、88.0%(398/452)、88.5%(209/236)、91.7%(268/292)。结论 2006-2009年丰台区暗娼人群安全套使用率逐年提高,HIV感染率总体处于较低水平;但艾滋病知识及检测知晓率有待进一步提高,低档次小场所的暗娼应成为预防干预工作的重点。     

A study of HIV/AIDS related knowledge,attitude and behaviors among female sex workers in Shanghai China

Background  

China is currently facing a rapid and widespread increase in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The activities of female sex workers (FSWs) have contributed to the mounting epidemic of HIV/AIDS and other sexually transmitted diseases (STDs). Therefore, this study aimed to assess the HIV/AIDS-related knowledge, attitude and risk behaviors among FSWs operating in Shanghai China.     

北京市石景山区女性性工作者阴道外用杀微生物剂可接受性初步研究

目的 探索女性性工作者对阴道外用杀微生物剂的使用意愿及其相关因素.方法 采用横断面设计,在北京市石景山区按方便抽样,选取54名女性性工作者进行问卷调查.主要评价指标包括杀微生物剂可接受性得分、危险性行为、安全套使用率、性病史、艾滋病/性病认知风险等.结果 被调查的女性性工作者对杀微生物剂的可接受性平均得分为2.73(范围1～4).可接受性的差异因不同性伴模式(P=0.049)、是否做过HIV检测(P=0.037)、是否担心感染性病(P=0.042)有统计学意义;使用及隐蔽使用杀微生物剂的意愿随不同类型性伴有统计学意义(P=0.001).结论 接受调查的女性性工作者对杀微生物剂的态度普遍较积极,但影响使用的因素尚待进一步研究.     

HIV-related risk behaviours and the correlates among rickshaw pullers of Kamrangirchar, Dhaka, Bangladesh: a cross-sectional study using probability sampling

Background  

National HIV serological and behavioural surveillance of Bangladesh repeatedly demonstrated a very high proportion of rickshaw pullers in Dhaka city, having sex with female sex workers (FSWs) and using illicit substances. However, no study has been conducted to identify the correlates of having sex with FSWs among this population. This study aimed to describe behavioural profile of rickshaw pullers in Dhaka city using probability samples and to identify the correlates for having sex with FSWs in order to focus HIV prevention intervention.     

Reducing harm from HIV/AIDS misconceptions among female sex workers in Tijuana and Ciudad Juarez, Mexico: A cross sectional analysis

ABSTRACT: BACKGROUND: HIV prevalence is increasing among female sex workers (FSWs) in Mexico's Northern border region, who experience multiple occupational risks. Improving vulnerable populations' education, empowerment, and access to preventive services are important components of harm reduction strategies. Given the increasing interest in adapting harm reduction principles from drug use to sex work and other public health responses to the HIV epidemic, we used a sex work harm reduction framework to guide our investigation of FSWs' HIV knowledge. METHODS: From 2004-2006, FSWs aged [greater than or equal to]18 years in Tijuana and Ciudad Juarez participated in a behavioral intervention study and completed structured interviews. Measures included HIV knowledge assessment and factors within each domain of our theoretical framework for sex work harms: (1) socio-demographic factors that may lead to sex work, (2) sex work characteristics and behaviors that may lead to harm, and (3) mutually reinforcing harms that lead to sex work and result from it (e.g., drug abuse). Negative binomial regression identified factors independently associated with suboptimal HIV knowledge (i.e., incorrect responses during the HIV knowledge assessment). RESULTS: Among 924 FSWs, the median proportion of incorrect responses was nearly one third (28 % incorrect). Examination of item responses revealed misconceptions regarding specific transmission and prevention mechanisms, including prevention of mother to child transmission. Suboptimal HIV knowledge was independently associated with older age, lower education, living in Tijuana (vs. Ciudad Juarez), inconsistent condom use for vaginal sex with male clients, and lacking prior HIV testing. CONCLUSIONS: Our application of a sex work harm reduction framework to the study of FSWs' HIV knowledge is an important first step in enhancing HIV prevention efforts in Northern Mexican border cities. Our findings imply that interventions should identify and discredit local HIV misconceptions to improve knowledge of specific HIV transmission routes and self-protective strategies (e.g., condom negotiation). Interventions will require materials appropriate for women from diverse socio-economic backgrounds and may benefit from innovative harm reduction approaches such as peer education and outreach.     

Occupational safety and HIV risk among female sex workers in China: a mixed-methods analysis of sex-work harms and mommies

Female sex workers (FSWs) in China are exposed to multiple work-related harms that increase HIV vulnerability. Using mixed-methods, we explored the social-ecological aspects of sexual risk among 348 FSWs in Beijing. Sex-work harms were assessed by property stolen, being underpaid or not paid at all, verbal and sexual abuse, forced drinking; and forced sex more than once. The majority (90%) reported at least one type of harm, 38% received harm protection from 'mommies' (i.e., managers) and 32% reported unprotected sex with clients. In multivariate models, unprotected sex was significantly associated with longer involvement in sex work, greater exposure to harms, and no protection from mommies. Mommies' protection moderated the effect of sex-work harms on unprotected sex with clients. Our ethnography indicated that mommies played a core role in sex-work networks. Such networks provide a basis for social capital; they are not only profitable economically, but also protect FSWs from sex-work harms. Effective HIV prevention interventions for FSWs in China must address the occupational safety and health of FSWs by facilitating social capital and protection agency (e.g., mommies) in the sex-work industry.     

中国1995-2009年艾滋病哨点监测主要人群艾滋病病毒感染流行趋势分析

目的 分析中国吸毒者、暗娼、性病门诊就诊者、男男性行为者、孕产妇5类人群的艾滋病病毒(HIV)感染流行趋势,为艾滋病综合防治和科学干预提供信息和依据.方法 1995-2009年,在哨点监测期内以重复横断面调查的方法对吸毒者、暗娼、性病门诊就诊者、男男性行为者、孕产妇5类人群进行监测(采血及问卷调查).结果 吸毒人群HIV抗体阳性检出率(中位数)在疫情较重省份从1996年开始呈快速上升,1999-2000年达到高点(19.2%),2001-2003年逐步下降,2004年后趋于平稳状态;在疫情居中省份从2001年开始呈小幅上升,2004年达到相对高点(2.9%)后趋于平稳,近两年又呈小幅下降趋势;在疫情较轻省份一直处于低水平.暗娼人群HIV抗体阳性检出率(中位数)在疫情较重省份从1999年开始小幅上升并达到高点(1.5%),之后下降并维持在较低水平;在疫情居中省份和较轻省份一直处于低水平.性病门诊就诊人群HIV抗体阳性检出率(中位数)一直维持在较低水平,低于0.7%.男男性行为人群HIV抗体阳性检出率近两年均大于1%,部分哨点大于10%,且呈快速上升趋势,成为近年来推动艾滋病疫情发展的重要原因之一.孕产妇人群HIV抗体阳性检出率(中位数)在疫情较重省份从1997年开始呈缓慢上升,之后趋于平稳状态(0.3%);在疫情居中省份和较轻省份一直处于低水平.结论 男男性行为人群HIV抗体阳性检出率呈上升趋势;吸毒者、暗娼、性病门诊就诊者、孕产妇人群的HIV抗体阳性检出率都趋于相对平稳状态.吸毒人群疫情仍集中在疫情较重的6个省份.暗娼和性病门诊就诊人群疫情总体仍处于较低水平,但流行范围在不断扩大.

Abstract：

Objective To effectively monitor the time trend of HIV prevalence and epidemic among injecting drug users ( IDUs ), female sex workers (FSWs), sexually transmitted disease (STD)clinic attendants, men who have sex with men (MSM) and pregnant women etc., to provide information for evaluation on strategies regarding comprehensive HIV prevention and effectiveness of intervention, in China. Methods Cross-sectional studies had been repeatedly conducted on sentinel surveillance program with uniformed questionnaire and collection of venous blood specimen among IDUs, FSWs, STD clinic attendants, MSM and pregnant women, from 1995 to 2009. Results HIV prevalence (median) among IDUs had been increasing rapidly since 1996, reaching the plateau (19.2%) in 1999-2000, then gradually decreasing in 2001-2003, and leveling off since 2004 in those relatively hard-hit epidemic provinces. HIV prevalence among drug users had increased a bit since 2001, achieving high level (2.9%) in 2004 before leveling off, showing a slight downward trend in the past two years among the medially-hit epidemic provinces, while it maintained at a low level in those low epidemic provinces. HIV prevalence (median) among FSWs had been slightly increasing,reaching a high level ( 1.5% ) in 1999, then decreased and maintained at a low level in relatively hard-hit provinces. HIV prevalence among FSWs maintained at a low level in medially-hit and low epidemic provinces. HIV prevalence(median) among STD clinic attendants had been maintained at a lower level, lower than 0.7%. HIV prevalence among MSM had been consistently greater than 1%, and was increasing year by year, becoming one of the most important drivers of the HIV/AIDS epidemic over the past years. HIV prevalence (median) among pregnant women had slightly been increasing since 1997, then leveling off over the past years in those relatively hard-hit provinces (0.3%). HIV prevalence among pregnant women had maintained at a low level in the medial and low epidemic provinces. Conclusion Data from sentinel surveillance programs showed a leveling-off situation on HIV prevalence rates among IDUs, FSWs, sexually transmitted infections clinic patients and pregnant women. However, HIV prevalence among MSM had increased significantly since 2005, indicating the high speed of transmission among this population. Epidemic among IDUs had still been concentrated in those relatively hard-hit epidemic provinces. As for FSWs and STD patients, the overall epidemic remained at low level, but the areas of epidemic kept expanding.     

Occupational safety and HIV risk among female sex workers in China: A mixed-methods analysis of sex-work harms and mommies

Abstract

Female sex workers (FSWs) in China are exposed to multiple work-related harms that increase HIV vulnerability. Using mixed-methods, we explored the social-ecological aspects of sexual risk among 348 FSWs in Beijing. Sex-work harms were assessed by property stolen, being underpaid or not paid at all, verbal and sexual abuse, forced drinking; and forced sex more than once. The majority (90%) reported at least one type of harm, 38% received harm protection from ‘mommies' (i.e., managers) and 32% reported unprotected sex with clients. In multivariate models, unprotected sex was significantly associated with longer involvement in sex work, greater exposure to harms, and no protection from mommies. Mommies' protection moderated the effect of sex-work harms on unprotected sex with clients. Our ethnography indicated that mommies played a core role in sex-work networks. Such networks provide a basis for social capital; they are not only profitable economically, but also protect FSWs from sex-work harms. Effective HIV prevention interventions for FSWs in China must address the occupational safety and health of FSWs by facilitating social capital and protection agency (e.g., mommies) in the sex-work industry.     

The effect of sex work regulation on health and well‐being of sex workers: Evidence from Senegal

Senegal is the only African country where sex work is legal and regulated by a health policy. Senegalese female sex workers (FSWs) are required to register with a health facility and to attend monthly routine health checks aimed at testing and treating sexually transmitted infections (STIs). Compliance to those routine visits is recorded on a registration card that must be carried by FSWs in order to avoid sanctions in case of police arrests. Although this policy was first introduced in 1969 to limit the spread of STIs, there is no evidence so far of its impact on FSWs' health and well‐being. The paper aims to fill this gap by exploiting a unique data set of registered and unregistered Senegalese FSWs. Using propensity score matching, we find that registration has a positive effect on FSWs' health. However, we find that registration reduces FSWs' subjective well‐being. This finding is explained by the fact that registered FSWs are found to engage in more sex acts, in riskier sex acts, have less social support from their peers, and are more likely to experience violence from clients and police officers. We prove that those results are robust to the violation of the conditional independence assumption, to misspecification of the propensity score model, and that covariate balance is achieved. The results suggest that more efforts should be deployed to reduce the stigma associated with registration and to address the poor well‐being of FSWs, which is counterproductive to HIV prevention efforts.