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Workers in Mexico's maquiladoras (assembly plants) are mainly young, single women, many of whom could benefit from emergency contraceptive pills (ECPs). Because ECPs are readily available in Mexico, women who know about the therapy can obtain it easily. Do maquiladora workers know about the method? Could worksite programs help increase awareness? To investigate these questions, we conducted a five‐month intervention during which workers in three maquiladoras along the Mexico‐United States border could attend educational talks on ECPs, receive pamphlets, and obtain kits containing EC supplies. Among the workers exposed to our intervention, knowledge of ECPs increased. Reported ECP use also increased. Although our intervention apparently increased workers’ knowledge and use, the factory proved to be a difficult intervention setting. Problems we experienced included a factory closure and management/staff opposition to certain project elements. Future studies should continue to investigate work‐site interventions and other strategies to reach workers.  相似文献   

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目的 了解四川省西昌市社区女性性工作者梅毒感染状况及其影响因素.方法 在西昌市社区中招募女性性工作者404人,调查其社会人口学、高危行为特征,并进行人类免疫缺陷病毒(HIV)和梅毒抗体检测.结果 调查对象中,近1个月与嫖客发生性行为时从未使用安全套的比例为1.0%;HIV、梅毒、乙肝、丙肝感染率分别为1.5%、12.1%、7.9%、1.2%;多因素logistic回归分析显示,少数民族(OR=3.091,95% CI=1.506~6.347)、从事性服务工作时间≥4年(OR=3.012,95% CI=1.447 ~6.266)、兼职(OR=3.856,95% CI=1.463 ~10.165)是女性性工作者梅毒感染的危险因素.结论 西昌市社区女性性工作者梅毒感染率较高,作为性病传播的桥梁人群,应采取有效措施予以干预.  相似文献   

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Objectives. We examined the efficacy of a brief behavioral intervention to promote condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico.Methods. We randomized 924 female sex workers 18 years or older without known HIV infection living in Tijuana and Ciudad Juarez who had recently had unprotected sex with clients to a 30-minute behavioral intervention or a didactic control condition. At baseline and 6 months, women underwent interviews and testing for HIV, syphilis, gonorrhea, and chlamydia.Results. We observed a 40% decline in cumulative sexually transmitted illness incidence (P = .049) in the intervention group. Incidence density for the intervention versus control groups was 13.8 versus 24.92 per 100 person-years for sexually transmitted illnesses combined (P = .034) and 0 versus 2.01 per 100 person-years for HIV (P < .001). There were concomitant increases in the number and percentage of protected sex acts and decreases in the number of unprotected sex acts with clients (P < .05).Conclusions. This brief behavioral intervention shows promise in reducing HIV and sexually transmitted illness risk behaviors among female sex workers and may be transferable to other resource-constrained settings.Although commercial sex is quasi legal in the zonas rojas (red light districts) of most Mexican cities, HIV prevalence among female sex workers has been low in most parts of the country.1 For example, among female sex workers in Mexico City and at the Mexico–Guatemala border, HIV prevalence was 0.6% in 19972 and in 1998.3 More recently, reports suggest that HIV prevalence is rising among female sex workers on the Mexico–US border. In a sample of 415 female sex workers in Tijuana in 1991, HIV prevalence was 0.5%,4 but in our more recent study of 924 female sex workers in Tijuana (bordering San Diego, CA) and Ciudad Juarez (bordering El Paso, TX), HIV prevalence was 6.0%.5 In the same study, prevalences of gonorrhea, chlamydia, and syphilis titers consistent with active infection were 6.4%, 13.0%, and 14.2%, respectively.In Mexican culture, sex with female sex workers is tolerated as a display of virility and machismo at all socioeconomic levels.68 The sexually permissive environment in Mexican border cities also attracts large numbers of “sex tourists” from the United States and other countries who are attracted by newspaper advertisements and Web sites advertising prostitution.9 More than two thirds of female sex workers in Tijuana and Ciudad Juarez report having US clients, and these women have a higher prevalence of sexually transmitted infections (STIs) and higher levels of transmission risk behaviors, including sex without a condom and injection use of drugs.10Mexican law requires female sex workers to obtain a permit if they wish to work without prosecution in Tijuana''s zona roja, but more than half work without permits. In Ciudad Juarez, permits are not required. In both cities, female sex workers operate out of multiple venues including cantinas, bars, nightclubs, motels, and street corners. Seventy percent of these female sex workers were born in other Mexican states or Central America,11 and most entered prostitution out of economic necessity. Extreme poverty may compromise their ability to turn down offers of higher payments for unprotected sex.12,13In border regions, where sex work is tolerated and HIV prevalence is rising, there is a clear need to ensure that condoms are consistently used during commercial sex transactions to prevent outbreaks of HIV or STIs in both countries. We developed a brief behavioral intervention to enhance condom use negotiation among Mexican female sex workers.11 Here, we report its first results and examine its efficacy in Tijuana and Ciudad Juarez.  相似文献   

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《Global public health》2013,8(4):405-416
Abstract

In Tijuana, Mexico, sex work is regulated by the municipal government, through registration cards issued to female sex workers (FSWs) for an annual fee. Registration has been associated with decreased drug use and increase condom use and HIV testing. Previously, it was demonstrated that FSWs operating in bars were more likely than street-based FSWs to be registered. This implies that certain venues may be more accessible to local authorities for the enforcement of this type of programme. Taking a novel multilevel approach, we examined whether venue characteristics of bars reflecting greater organised management and visibility affect registration status of FSWs. In an analysis of venue-level characteristics, predictors of being registered were availability of free condoms at work and distance to the main sex strip; however, these were not independently associated after inclusion of FSWs' income, illicit drug use and history of HIV testing. Our findings suggest that sex work regulations may inadvertently exclude venues in which the more vulnerable and less visible FSWs, such as injection drug users and those with limited financial resources, are situated. Efforts to revise or reconsider sex work regulations to ensure that they best promote FSWs' health, human and labour rights are recommended.  相似文献   

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《Global public health》2013,8(4):436-454
Deported injection drug users (IDUs) in Mexico may be vulnerable to HIV infection following expulsion from the USA. We examined factors associated with HIV risk perception among a sample of deportees in Tijuana. From January to April 2010, 313 male IDUs who reported ever being deported from the USA completed a questionnaire. Overall, 35% (N = 110) of deportees perceived HIV risk. In multivariate logistic regression analyses, factors independently associated with HIV risk perception included ever having a steady female partner in Tijuana post-deportation (adjusted odds ratio [AOR]: 2.26; 95% confidence interval [CI]: 1.01–5.07) and years spent in a US prison (AOR: 1.29 per year; 95% CI: 1.13–1.48). Conversely, years of drug injection use (AOR: 0.95 per year; 95% CI: 0.91–0.99), ever witnessing family members use drugs prior to first migration trip (AOR: 0.24; 95% CI: 0.09–0.65), years of residence in the USA (AOR: 0.91 per year; 95% CI: 0.84–0.98) and being a Tijuana native (AOR: 0.40; 95% CI: 0.16–0.99) were negatively associated with HIV risk perception. US–Mexico border cities that receive deported migrants should target HIV prevention interventions to specific subgroups, including drug-using male deportees. Interventions should consider migrant's time in the USA, the role of their social networks, and reducing missed opportunities for HIV testing/education.  相似文献   

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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.  相似文献   

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Maquiladoras are plants on the Mexican side of the United States-Mexico border which are used largely by U.S. manufacturers to assemble premanufactured parts. We examined reproductive outcomes of women employed in electronics (N = 120) and garment (N = 121) maquiladora work compared to women employed in the service sector (N = 119) in Tijuana. Mexico. Women recruited by community health workers were interviewed about their reproductive history, sociodemographic characteristics, health behaviors, and characteristics of their current job. Length of regular menstrual cycle in the past year as well as time of conception and rates of fetal loss in the most recent pregnancy were similar across occupational groups. However, infants of garment maquiladora workers were 653 g lighter (95% confidence interval [CI]: ?1,041 g, ?265 g) and infants of electronic maquiladora workers were 337 g lighter (95% CI: ?682 g. 9 g) than infants of service workers after adjusting for potential confounders. The cause of these differences remains unclear. © 1993 Wiley-Liss, Inc.  相似文献   

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Setting:

Sex Workers Outreach Programme Clinic, Korogocho, Nairobi, Kenya.

Objective:

In a cohort of sex workers, to determine 1) the prevalence of cervical intra-epithelial neoplasia (CIN) and its association with human immunodeficiency virus-1 (HIV-1) infection, and 2) the incidence rate of CIN during the 3-year follow-up from December 2009 to December 2012.

Design:

Prospective nested cohort study.

Results:

Of the 350 women enrolled, the median age was 29 years (range 18–49); 84 (24%) were HIV-1-infected. At enrollment, 54 (15%) had an abnormal cytology, 39 (11%) had low-grade intra-epithelial lesions (LSIL) and 15 (4%) high-grade intraepithelial lesions (HSIL). HIV-1-infected women were 2.7 times (95%CI 1.7–4.4) more likely to have CIN than non-HIV-1-infected women. Among HIV-1-infected women, the prevalence of LSIL and HSIL was 2.5 times (95%CI 1.2–5.1) and seven times (95%CI 2.3–23.3) greater than among non-HIV-infected women. During the follow-up period, 39 (11%) women had incident CIN (6.6/100 person years [py]), with no difference by HIV status, i.e., respectively 7.9/100 py and 6.3/100 py in HIV-1-infected and non-HIV-1-infected women.

Conclusion:

The prevalence and incidence of CIN among HIV-1-infected sex workers was high; early, regular screening and follow-up of this life-threatening condition is therefore recommended.  相似文献   

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HIV vulnerability depends upon social context. Based on broader debates in social epidemiology, political economy, and sociology of health, Rhodes’ (2002) “risk environment” framework provides one heuristic for understanding how contextual features influence HIV risk, through different types of environmental factors (social, economic, policy, and physical) which interact at different levels of influence (micro, macro). Few data are available on the “risk environment” of male clients of female sex workers (FSWs); such men represent a potential “bridge” for transmission of HIV and other sexually transmitted infections from high- to low-prevalence populations. Using in-depth interviews (n = 30), we describe the HIV risk environment of male clients in Tijuana, Mexico, where disproportionately high HIV prevalence has been reported among FSWs and their clients. A number of environmental themes influence risky sex with FSWs and the interplay between individual agency and structural forces: social isolation and the search for intimacy; meanings and identities ascribed to Tijuana’s Zona Roja (red light district) as a risky place; social relationships in the Zona Roja; and economic roles. Our findings suggest that clients’ behaviors are deeply embedded in the local context. Using the HIV “risk environment” as our analytic lens, we illustrate how clients’ HIV risks are shaped by physical, social, economic, and political factors. The linkages between these and the interplay between structural- and individual-level experiences support theories that view structure as both enabling as well as constraining. We discuss how the “embeddedness” of clients’ experiences warrants the use of environmental interventions that address the circumstances contributing to HIV risk at multiple levels.  相似文献   

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Objectives

We wanted to determine the age-specific prevalence of selected sexually transmitted infections while assessing the risk factors among hidden female sex workers (HFSW).

Methods

One hundred HFSW over 15 years of age were recruited in an impoverished area of Antananarivo, Madagascar. After oral informed consent, blood and endocervical swabs were tested for specific antigens, antibodies, and pathogens using molecular, serologic, and microscopic examinations. A risk factor analysis was conducted with odds ratios and 95% confidence intervals.

Results

Thirty-two percent, 27, 12, and 7% of HFSW were infected respectively with Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis. Specific antibodies against, syphilis were detected in 11%. None were HIV-positive. The main factors associated with STI were: young age, being married, lower education level, early age for first intercourse, and a history of genital infection.  相似文献   

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目的 了解云南省昆明市中低收入女性性工作者(FSWs)无保护商业性行为状况及影响因素,为云南省该人群艾滋病(AIDS)综合防治提供建议。方法 利用自制问卷对昆明市4个城区561名中低收入FSWs进行调查,拟合多因素logistic回归模型探讨不安全性行为的影响因素。结果 FSWs最近3个月与嫖客发生无保护性行为的比例为58.1%(326/561);单因素分析结果表明,FSWs与嫖客发生无保护性行为有统计学意义的变量为年龄(P=0.000)、月收入(P=0.044)、从事本行业年限(P=0.001)、对健康状况关心与否(P=0.000)、最担心的疾病(P=0.000)、是否遭受过职业侵害(P=0.016)、AIDS知识得分(P=0.010)、性服务场所(P=0.000)、每月平均工作天数(P=0.000);多因素logistic回归分析结果表明,年龄(OR=0.470,95%CI=0.313~0.704)、健康状况关心与否(OR=4.249,95%CI=2.680~6.735)、最担心的疾病(OR=0.231,95%CI= 0.090~0.591)、AIDS知识得分(OR=2.371,95%CI= 1.400~4.014)、性服务场所(OR=0.852,95%CI= 0.728~0.998)、每月平均工作天数(OR=1.755,95%CI=1.099~2.801)是FSWs不安全性行为的独立影响因素。 结论 中低收入FSWs的无保护性行为更容易受到年龄、健康信念、从事本行业年限、性服务场所、每月平均工作天数以及是否受过职业侵害等因素的影响。  相似文献   

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Some quantitative behavioral studies in the USA have concluded that bisexually behaving Latino men are less likely than White men to disclose to their female partners that they have engaged in same-sex risk behavior and/or are HIV-positive, presumably exposing female partners to elevated risk for HIV infection. Nevertheless, very little theoretical or empirical research has been conducted to understand the social factors that promote or inhibit sexual risk disclosure among Latino men who have sex with men (MSM), and much of the existing literature has neglected to contextualize disclosure patterns within broader experiences of stigma and social inequality. This paper examines decisions about disclosure of sex work, same-sex behavior, and sexual risk for HIV among male sex workers in two cities in the Dominican Republic. Data derive from long-term ethnography and qualitative in-depth interviews with 72 male sex workers were used to analyze the relationships among experiences of stigma, social inequality, and patterns of sexual risk disclosure. Thematic analysis of interviews and ethnographic evidence revealed a wide range of stigma management techniques utilized by sex workers to minimize the effects of marginality due to their engagement in homosexuality and sex work. These techniques imposed severe constraints on men's sexual risk disclosure, and potentially elevated their own and their female partners' vulnerability to HIV infection. Based on the study's findings, we conclude that future studies of sexual risk disclosure among ethnic minority MSM should avoid analyzing disclosure as a decontextualized variable, and should seek to examine sexual risk communication as a dynamic social process constrained by hierarchical systems of power and inequality.  相似文献   

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BACKGROUND: The primary objective was to estimate the lifetime prevalence of abortion and the secondary objective was to describe the use of contraceptive methods among female sex workers (FSW) in Bogota, Colombia. STUDY DESIGN: A cross-sectional survey was conducted among FSW. Information on sociodemographic characteristics, contraceptive methods, number of abortions, reasons for abortions and sexual practices was collected. RESULTS: A total of 514 FSW were enrolled. Of these, 264 (53%) had a lifetime abortion. Age, years in sex work and a previous sexually transmitted infection were associated with abortion. A total of 89 FSW(17%) reported no contraception method. Oral contraceptives, use of condoms, female sterilization and intrauterine device insertion were the most common methods of contraception. Women who were poorer, who initiated sex work at a younger age and who reported use of illegal drugs were associated with inconsistent contraception. CONCLUSION: A high lifetime prevalence of abortion and inconsistent contraception was found among FSW in Bogota. There is a need for effective and practical contraceptive methods of family health planning among FSW in Colombia.  相似文献   

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We performed this study to examine the association of sexual coercion with HIV-related risk behaviors and suicidal thoughts and attempts among female sex workers (FSWs) in Guangxi, China. Four hundred fifty-four FSWs in 57 entertainment establishments (including shampooing salons, massage parlors, and restaurants) were interviewed between March and May 2004. Fifteen percent of the women reported having been coerced into sex in the last 6 months. The prevalence of suicidal thoughts and suicide attempts in the last 6 months were 14.3% and 8.4%, respectively. Sexual coercion was significantly associated with both an increased rate of HIV-related risk behavior, and suicidal thoughts and attempts among FSWs. Therefore, along with the awareness and intervention programs, efforts should be taken to reduce the exposure of FSWs to sexual coercion and to improve the mental health of FSWs.  相似文献   

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This study examined correlates of unprotected vaginal and anal sex (UVA) with male clients among female sex workers (FSWs). Baseline data were gathered from 1089 FSWs recruited from 13 cities across Mexico enrolled in an evidence-based sexual risk reduction intervention. We used generalised estimating equations (GEE) to predict total UVA while controlling for the nested structure of the data. Total UVA with clients in the past month was examined in relation to selected sociodemographic, substance-use, and micro- and macro-environmental factors. A greater number of UVA acts was associated with three micro-level environmental factors (i.e. never getting condoms for free, unaffordability of condoms, greater number of clients per month), and three macro-level environmental factors (i.e. lower health and higher education indices, greater population size of city). These findings suggest the development of social and structural approaches to HIV prevention for FSWs in Mexico, including modification of venue-based policies that pressure FSWs to maximise client volume, changes to the work environment that promote availability and affordability of condoms, and improved population health. Moreover, our findings call for the development of context-specific HIV interventions that take into account variations in the sexual risk behaviours and HIV risk environments of FSWs throughout Mexico.  相似文献   

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