对娱乐场所服务小姐开展性病群体治疗的研究

目的探讨为低档性服务小姐提供以性病群体治疗为特色的综合干预的有效性、可行性和可接受性。方法采用对照研究，治疗组（206例）每月给予阿奇霉素和环丙沙星及针对阴道感染的药物，同时开展健康教育等干预活动，连续3个月，观察干预前后性病感染率的变化；对照组（201例）除不发药外，其他干预活动照样进行。结果治疗组在干预前沙眼衣原体和淋球菌的感染率分别为34．5％、23.8％，干预后为37．9％、22．9％；干预前后无显著差异。对照组在干预前为33．3％、25．4％，干预后为53．1％、25．0％，沙眼衣原体感染率显著上升（P〈0．05）。干预后两组沙眼衣原体感染率比较有显著性差异（P〈0．05）。多数（78．6％）小姐表示服药能接受，60．1％的小姐表示不愿今后持续服药。结论群体治疗可减缓沙眼衣原体感染的上升趋势，但需与健康教育、安全套促进、咨询服务等综合干预措施相结合，群体治疗应该作为综合干预措施的组成部分加以实施。     

外展服务方式对公共娱乐场所性服务小姐行为转变之效果评价--中国武汉/世界卫生组织100%使用安全套试点项目

目的 探索对公共娱乐场所性服务小姐健康行为干预的健康教育模式，为在公共娱乐场所全面推广100％使用安全套提供有参考价值的依据。方法 运用流行病学定量研究和社会学定性研究相结合的方法。以外展服务的方式到公共娱乐场所开展多种形式的健康教育干预活动。采取干预前后重复横段面知识、态度、行为、习惯(KABP)问卷调查形式。了解外展服务对性服务小姐知识、态度和行为的影响程度及安全套使用率变化情况，定期体检以掌握性服务小姐性传播疾病／艾滋病(趼D／AIDs)感染率变化。对本项目所采用的外展健康教育方式的可行性及有效性进行评估。结果 干预后评估表明：性服务小姐的预防STD／AIDS知识、态度和行为发生显著变化，她们与客人沟通协商使用安全套的能力有显著的提高。性服务小姐自我报告最近1次商业性行为中安全套使用率从60．5％(干预前)上升到94．5％(干预后)，衣原体和梅毒感染率分别从21.8％和6．5％(干预前)下降到14．5％和1．8％(干预后)。结论 摸索出一套适用于公共娱乐场所的外展服务干预模式。表明在我国公共娱乐场所全面推广100％使用安全套是切实可行且卓有成效的。     

娱乐场所服务小姐性病感染影响因素调查

目的了解影响娱乐场所服务小姐性病感染的主要因素,以利提高性病艾滋病干预的效果。方法对福州市区18家中高档娱乐场所的149名服务小姐进行性病检查、治疗和访谈。结果查出衣原体和(或)淋菌感染共42例,检出率28.2%。有“主诉阴道分泌物异常”、“体检见阴道有脓性分泌物”、“宫颈口有脓性分泌物”表现的小姐,衣原体和(或)淋菌感染率较高。最近1次使用安全套者比未使用者衣原体和(或)淋菌感染检出率略低。结论“阴道分泌物异常”、“阴道有脓性分泌物”、“宫颈口有脓性分泌物”3种临床表现是服务小姐感染衣原体、淋菌的影响因素。为提高性病艾滋病干预效果,在干预时,可针对有上述3种临床表现的服务小姐给予性病治疗药物,开展预防性治疗,以便通过及时降低性病感染率控制艾滋病传播。鉴于安全套使用也是性病感染的影响因素,应在服务小姐中积极推广使用安全套。     

公共娱乐场所性服务小姐卫生保健服务模式探讨

目的 探讨针对公共娱乐场所性服务小姐开展卫生保健服务的模式及可行性。方法 选取2个城镇为项目现场，分别建立试点门诊，开展外展宣传并提供性传播疾病及生殖健康相关问题的规范治疗服务。结果 以医院为基础的项目门诊运转顺利，能够较好提供卫生保健服务；而在公共娱乐场所集中区单独建立的门诊难以维持运转。结论 针对公共娱乐场所性服务小姐开展卫生保健服务不宜孤立进行，应提供综合性的卫生服务。     

2002年乌鲁木齐市娱乐场所257名服务小姐性传播疾病感染及行为调查

为了解乌市娱乐场所服务小姐中性病、艾滋病的感染情况及有关知识、态度和行为，2002年由专业人员对服务小姐进行问卷调查并采集血液和阴道分泌物，按国标方法检测检验。结果显示性病检出率为54％，非淋菌性尿道炎占首位，检出率为28％，未检出HIV阳性感染；在行为方面艾滋病、性病知识知晓率较低，自我保护意识差，求医行为受知识水平和医疗环境等多种因素的影响，表明娱乐场所性病管理工作急需加强，应针对该人群广泛开展健康教育和健康促进，改变高危行为，提高自我保护意识，以降低艾滋病性病的危害。     

在流动小姐中开展艾滋病健康教育效果分析

为了评价在流动小姐中开展预防艾滋病、性病健康教育的效果，我们对旅服部门中的流动小姐于开展教育干预前、后两次分别对她们进行艾滋病、性病的知识、态度、信念、行为（下称ＫＡＢＰ）调查。基线调查结果表明，这组人群知道艾滋病三条传播途径者为７３％～７８％，知道安全性行为者占４４．３％。能在性活动中使用避孕套预防疾病者为１９．２％。接受健康教育之后，对艾滋病的知识提高了１１．３～１８．８个百分点。对性病的知识提高了２．５～１３．４个百分点。使用避孕套的比例较干预前增加了５～９个百分点。说明一次性干预尽管有效，但作用甚微。     

在流动小姐中开展艾滋病健康教育效果分析

为了评价在流动小姐中开展预防艾滋病，性病健康教育的效果，我们对旅服部门中的流动小姐于开展教育干预前、后两次分别对她们进行艾滋病、性病的知识、态度、信念、行为调查。基线调查结果表明，这组人群知识艾滋病三条传播途径者为７３％￣７８％，知识安全性者占４４．３％。     

性病门诊再感染病例分析

目的 了解性病门诊病人再感染性传播疾病(STD)情况及预防存在的问题，探讨加强性病门诊预防服务的必要性。方法 收集2002年3～8月江苏省2个市皮肤病性病防治所性病门诊初诊病例进行分析。结果 266例初诊STD病人中，有80例(30．1％)曾患淋病，再感染以淋病居多，平均83．8％。此80例中，有76．3％的人近3个月有≥2个临时性伴侣；有92．5％的男性最近一次性行为是与临时性伴侣性交。在266例中，有96．7％的人与临时性伴侣未使用安全套。结论 STD病人多有无保护的危险性行为，门诊医务人员在提供性病诊疗服务时应重视加强预防服务，尤其是对再感染者应强化有关使用安全套及自我防护的宣传指导，促进STD病人提高自我保护能力，减少再感染的机会。     

娱乐场所服务人员AIDS健康教育和行为干预效果

目的探索有效遏制艾滋病病毒(HIV)通过娱乐场所服务人群向一般人群传播的方法,为预防控制艾滋病(AIDS)提供科学依据。方法对石景山地区娱乐场所服务人员进行AIDS健康教育和行为干预,分别对408名性服务人员在干预前和干预后第3、6、9、15个月,共5次进行现场艾滋病性病相关知识问卷调查,尖锐湿疣(CA)感染率随访跟踪,并进行干预前后效果比较。结果 AIDS预防基本知识题知晓正确率,干预后依次为67.07%、79.77%、90.53%、87.61%,明显高于干预前的51.62%。安全套坚持使用率由干预前52.94%逐步上升至干预后60.98%、70.11%、77.33%、81.25%。CA感染率由干预前的8.82%逐步下降至干预后的6.10%、4.60%、2.67%、1.04%。安全套坚持使用率与性病感染率呈负相关(r=-0.98,P<0.05)。结论对娱乐场所服务人员开展健康教育和行为干预,能有效提高他们艾滋病防治知识知晓率和安全套使用率,但如何建立长期发展的干预机制,有待进一步研究。     

动员医疗机构参与性病艾滋病防治工作的效果评价

目的评估性病门诊医务人员参与性病艾滋病干预工作,针对不同高危人群提供性病、生殖健康服务的效果。方法选择卫九、艾滋病综合防治示范区和全球基金艾滋病防治项目地区有条件的医疗机构,根据性病门诊规范服务的要求,改善门诊服务,开展针对门诊就诊者的干预服务和现场高危人群的医疗服务。结果在三个项目中,医务人员规范化服务培训率、性病门诊干预服务提供率和外展服务性病门诊医务人员参与率,均有了不同程度的提高全球基金项目中,门诊主动提供艾滋病检测咨询(PITC)服务率从基线的10.4%,上升到项目后的96.4%。示范区和全球基金项目中,高危人群性病预防知识知晓率,分别由基线的31.02%、45.52%上升到72.40%和87.86%。结论从三个项目的实施情况来看,动员医疗机构主动参与到针对高危人群的性病、生殖健康干预工作,并提供转介服务是可行的,而且取得了较好的效果。     

Social Factors Related to Risk for Violence and Sexually Transmitted Infections/HIV Among Asian Massage Parlor Workers in San Francisco

Asian women who work at massage parlors in San Francisco have high levels of riskfor sexually transmitted infections (STIs), including HIV, and being victims of violence, which jeopardizes their health and wellbeing. On the basis of mapping, the targeted districts in San Francisco where massage parlors were located, 23 massage parlors were identified where commercial sex activity took place. Using snowball-sampling methods, 43 Asian female massage parlor workers were recruited for focus groups; 21 participants were Vietnamese and 22 were Thai. Qualitative analyses revealed frequent exposure to violence including verbal or physical abuse from customers and gang members, as well as persistent HIV risk behaviors associated with multiple daily sex partners, inconsistent condom use with customers, and forced sex. Social factors related to gender, immigration status, and socioeconomic status appeared to be closely tied to the health and wellbeing of Asian masseuses. Study findings suggest that individualized as well as community-level interventions are necessary to improve these womens health and decreasetheir prolonged exposure to risks for STIs and violence.     

西部地区50个县（区）不同活动场所暗娼人群艾滋病行为学监测结果分析

目的了解我国西部地区50个县（区）不同活动场所暗娼（FSW）人群的艾滋病病毒（HIV）抗体阳性检出率和行为学指标情况。方法通过高危人群规模估计,对不同场所内FSW人群进行分层随机抽样和一对一问卷调查,收集高危行为信息,检测血清HIV抗体。结果 15 526名调查对象中,第一类来自宾馆、酒店、桑拿、洗浴中心、夜总会、卡拉OK厅、歌舞厅、酒吧等,占48.04%;第二类来自洗脚屋、发廊、路边店、小饭店和街头站桩,占51.96%。年龄20～29岁者占60.96%;初中以下文化程度占83.77%。第二类FSW人群最近一次性交易时安全套使用率（68.9%）,最近一个月性交易时安全套使用率（37.07%）,艾滋病知识知晓率（17.53%）,最近一年接受预防服务率（67.31%）,均低于第一类。FSW人群HIV阳性率为1.58%。结论 FSW人群中艾滋病知识知晓率较低,存在商业性行为中不使用安全套等高危行为,尤其是在街头等第二类场所中的FSW,是监测和干预工作的重点人群。     

对北京部分男男性接触者HIV/AIDS的KABP调查

目的对北京部分男男性接触者(men have sex with men,MSM)进行HIV/AIDS的KABP调查,为今后在MSM中开展干预工作奠定基础.方法培训MSM中的志愿者,由他们到MSM活动场所酒吧、公园、浴池等地,对MSM进行自愿匿名的问卷调查,发放宣传品及安全套并提供自愿匿名的抗-HIV检测.结果MSM中固定性伴比例较低(36.9%),多性伴现象较普遍,一半以上的MSM(53.8%)与女性有过性接触;安全套使用率低;每次都用的进行口交者为6.2%,接受口交者为6.5%,进行肛交者为30.9%,接受肛交者为40.4%.有40.5%的人认为自己不可能感染HIV.有23.8%的人自诉曾出现过性病病症.MSM对艾滋病传播途径认识正确率较高(78.6%以上),但对性病/艾滋病相关知识的认识较差,正确率为36.9%～65.5%.MSM主动进行抗-HIV检测的较少,本次仅为11人(13.84%).其中1人为抗-HIV阳性.结论MSM的不安全的性行为使他们成为感染STD、HIV的高危人群,并将这一危险扩散到一般人群.     

Sexual safety practices of massage parlor-based sex workers and their clients

The Outreach and Research in Community Health Initiatives and Development (ORCHID) project examines social and structural factors that contribute to HIV/AIDS risk among women working in Vancouver's indoor sex industry and their clients. From 2006 to 2009, two mixed method studies were undertaken in ORCHID: one exploring experiences of women working in the indoor sex industry, mainly in massage parlors, and the other exploring experiences of men as sex “buyers.” Both studies emphasize sexual health and safety, risk and protective behaviors, and related contextual factors. No analyses examining the sexual health and safety practices of massage parlor-based sex workers and clients exist in the Canadian context. To address this gap, we analyze two survey datasets – with 118 sex workers and 116 clients. Upon comparing demographics of sex workers and clients, we discuss their condom use and sexually transmitted infections (STI) and HIV testing practices. Sex workers and clients reported high rates of condom use for vaginal/anal intercourse. While both groups reported lower rates of condom use for oral sex during sex transactions, clients did so to a greater extent (p < 0.001). Condom use with noncommercial sex partners was reported to be less consistent by both groups. STI testing was higher among sex workers than clients (p < 0.001). Initiatives targeting clients of massage parlor-based sex workers for STI education and testing are needed. Future research should investigate how different types of relationships between sex workers and clients impact their sexual safety practices.     

HIV risk among Asian women working at massage parlors in San Francisco.

The purpose of this paper is to describe working conditions, health outcomes, social, and psychological factors related to HIV risk among Asian women who work at massage parlors in San Francisco. We conducted environmental mapping to identify communities and massage parlors where Asian women work as masseuses, and conducted survey interviews with 100 masseuses using venue-based snowball sampling. Difficult work conditions contributed to participants' HIV risk, including multiple sex customers each workday, long working hours, physical and verbal abuse from customers, economic pressures, and poor access to health care. Inconsistent condom use for vaginal sex with customers was positively associated with their fatalistic ideas and weak norms toward practicing safe sex with customers. Interventions should address cultural and occupational contexts in which Asian masseuses engage in sex work, and should focus on altering massage parlor policies and work environments.     

Evaluation the enzyme immunosorbent assay IDEIA test detecting Chlamydia trachomatis in cervix.

A total of 87 cervical specimens of unselected female sex workers in massage parlors were tested by an enzyme amplified immunoassay IDEIA Chlamydia test and cell culture for the presence of Chlamydia trachomatis. The prevalence of C. trachomatis was 28 (32%) cases and 34 (39%) cases by the cell culture and the IDEIA Chlamydia test respectively. The IDEIA Chlamydia test demonstrated the sensitivity and specificity of 85.7% and 83% respectively, positive and negative predictive values of 70.5% and 92.4% respectively.     

Effect of interventions to control sexually transmitted disease on the incidence of HIV infection in female sex workers

OBJECTIVE: To compare the seroincidence of HIV infection among female sex workers in Abidjan, C?te d'Ivoire before and during an intervention study to control sexually transmitted diseases (STD) and to study the effect of two STD diagnosis and treatment strategies on the prevalence of STD and on the seroincidence of HIV infection. METHOD: A screening facility for STD and HIV had been available since October 1992 for female sex workers. From June 1994, women who were HIV seronegative or HIV-2 positive during the screening could enroll in the intervention study in which participants reported once a month to a confidential clinic where they received health education, condoms and STD treatment if indicated. Women in the study were randomized either to a basic STD diagnosis and treatment strategy, which included a gynecologic examination when symptomatic, or to an intensive strategy that included a gynecologic examination regardless of symptoms. An outcome assessment every 6 months included a gynecologic examination, HIV serology and laboratory tests for STD. RESULTS: Of 542 women enrolled in the study, 225 (42%) had at least one outcome assessment. The HIV-1 seroincidence rate during the intervention study was significantly lower than before the study (6.5 versus 16.3 per 100 person-years; P = 0.02). During the study, the HIV-1 seroincidence rate was slightly lower in the intensive than in the basic strategy (5.3 versus 7.6 per 100 person-years; P = 0.5). CONCLUSION: National AIDS control programs should consider adopting as policy the type of integrated approach used in this intervention study for HIV prevention in female sex workers.     

2006-2008年北京市暗娼人群梅毒和HIV感染率及梅毒感染率影响因素

目的了解暗娼人群梅毒、艾滋病病毒（HIV）感染率及梅毒感染率的影响因素。方法根据《国家级HIV综合监测点监测方案》,2006—2008年,每年对北京市性服务场所进行分层抽样,对抽中的性服务场所内的暗娼进行HIV抗体检测、梅毒快速血浆反应素试验（RPR）检测和问卷调查。结果2006、2007、2008年,暗娼人群HIV抗体阳性检出率分别为0．12％、0、0．04％,梅毒RPR阳性率分别为1．2％、1．4％和0．8％。影响梅毒阳性率的因素包括：文化程度、婚姻状况、从事性服务的时间、最近一周客人数、与固定性伴发生性行为时安全套使用情况。结论暗娼的性病艾滋病风险不仅来源于商业性行为,还可能来源于非商业性关系。在开展艾滋病行为干预工作时,需要提示暗娼注意与固定性伴性关系中的疾病风险,并鼓励她们坚持使用安全套。文化程度低的暗娼应成为预防干预工作的重点。     

Sex worker, client sex behaviour and condom use in Harare, Zimbabwe

One-hundred sex workers and 100 clients were interviewed at a bar/disco complex in Harare, Zimbabwe in 1989. Sociodemographic characteristics of sex workers and clients were examined. Almost a third of sex workers and nearly 90% of clients had engaged in commercial sex over 5 or more years. Sex workers reported that they worked an average of 4.6 nights a week, averaged 2.2 clients a night and charged a mean of Z$8.7 per session and Z$19.8 per night. Clients reported that they averaged 7.4 visits a month to a sex worker and paid a mean of Z$6.2 per session and Z$17.2 per night. Over half the sex workers said their last client was drunk and nearly two-thirds said he was a repeat client. Sex workers and clients were asked about the sex behaviours completed in their last paid sex act. Vaginal intercourse was reported by 98% of sex workers and clients alike. Manual stimulation of the sex worker's and client's genitalia was reported by roughly 80% of sex workers and clients. Oral and anal sex were rarely reported. Fifty-four percent of sex workers and 44% of clients reported using a condom in their last paid sex act. Client reports thus suggest that sex worker reports of sex acts and condom use with the last client possess considerable validity. Ethnographic approaches were used to study the social and work environment of sex workers. Ethnographic analysis demonstrated a lack of organisation among sex workers and a need to develop cohesive groups for successful health interventions. The study also highlighted the need to include clients in health interventions, the possible role of alcohol as an impediment to health interventions and the feasibility of using bar/disco security and the bar personnel as health educators.