Structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition among female bar workers in Dar es Salaam, Tanzania
Structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition among female bar workers in Dar es Salaam, Tanzania
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DOI：
10.1080/09540121.2019.1612018
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发表时间：
2019-09-02
影响因子：
1.7
通讯作者：
Spiegelman, Donna
中科院分区：
文献类型：
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作者：
Barnhart, Dale A.;Harling, Guy;Spiegelman, Donna
在撒哈拉以南非洲，女性酒吧工作人员(FBW)经常充当非正式的性工作者。关于坦桑尼亚达累斯萨拉姆(DSM)的孕妇中艾滋病毒和艾滋病毒相关危险因素的流行情况，人们知之甚少。使用经过修改的结构性HIV决定因素框架，我们确定了HIV感染的结构性、人际关系、心理社会和行为风险因素。我们比较了从帝斯曼随机抽样的66名家庭女工与2016年人口与健康调查和2011-2012年艾滋病指标调查中具有代表性的女性帝斯曼居民的艾滋病毒和艾滋病毒相关风险因素的患病率。与DSM中的其他女性相比，FBW的所有四组危险因素的患病率都较高。关键风险因素包括性别和经济不平等(结构性)；性暴力和谈判使用避孕套的挑战(人际)；抑郁、创伤后应激障碍和低社会支持(心理)；以及无保护性行为史、多性伴和高饮酒(行为)。新生儿(7.1%，95%可信区间3.7-13.3%)和调查对象(7.7%，95%可信区间：5.3-11.1%)之间的HIV感染率没有差异，这可能是因为胎儿工作者对艾滋病毒预防策略的参与度较高，尽管不是最理想的。暴露于HIV相关危险因素的增加，但HIV感染率较低，这表明经济、心理社会和生物医学干预可能会在DSM的FBW中预防HIV。
In sub-Saharan Africa, female bar workers (FBWs) often serve as informal sex workers. Little is known about the prevalence of HIV and HIV-related risk factors among FBWs in Dar es Salaam (DSM), Tanzania. Using an adapted Structural HIV Determinants Framework, we identified structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition. We compared the prevalence of HIV and HIV-related risk factors among a random sample of 66 FBWs from DSM to an age-standardized, representative sample of female DSM-residents from the 2016 Demographic and Health and 2011-2012 AIDS Indicator Surveys. Compared to other women in DSM, FBWs had elevated prevalence of all four groups of risk factors. Key risk factors included gender and economic inequalities (structural); sexual violence and challenges negotiating condom use (interpersonal); depression, post-traumatic stress disorder, and low social support (psychosocial); and history of unprotected sex, multiple sex partners, and high alcohol consumption (behavioral). HIV prevalence did not differ between FBWs (7.1%, 95% CI 3.7-13.3%) and survey respondents (7.7%, 95% CI: 5.3-11.1%), perhaps due to FBWs' higher - though sub-optimal - engagement with HIV prevention strategies. Elevated exposure to HIV-related risk factors but low HIV prevalence suggests economic, psychosocial, and biomedical interventions may prevent HIV among FBWs in DSM.