CONDOM PROMOTION, SEXUALLY-TRANSMITTED DISEASES TREATMENT, AND DECLINING INCIDENCE OF HIV-1 INFECTION IN FEMALE ZAIRIAN SEX WORKERS
CONDOM PROMOTION, SEXUALLY-TRANSMITTED DISEASES TREATMENT, AND DECLINING INCIDENCE OF HIV-1 INFECTION IN FEMALE ZAIRIAN SEX WORKERS
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DOI：
10.1016/s0140-6736(94)93005-8
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发表时间：
1994-07-23
期刊：
影响因子：
168.9
通讯作者：
PIOT, P
中科院分区：
文献类型：
--
作者：
LAGA, M;ALARY, M;PIOT, P
在发展中国家城市地区的性工作者及其客户中控制性传播疾病，包括艾滋病毒-1，被认为是遏制艾滋病毒-1传播的宝贵和具有成本效益的干预措施。迄今为止，性病治疗方案与推广避孕套对HIV-1发病率的影响尚未得到衡量。在对扎伊尔金沙萨531名最初艾滋病毒-1阴性的女性性工作者进行包括推广避孕套以及每月性传播疾病筛查和治疗在内的干预期间，有70人感染了艾滋病毒-1（发病率为每100名妇女年8.0例）。随着时间的推移，观察到HIV-1发病率的下降，从前6个月的11.7/100下降到3年后6个月的4.4/100 （p = 0.003）。同时，在干预6个月和36个月后，客户定期使用安全套的比例分别从11%上升到52%和68%。多因素分析后，HIV-1血清转化的危险因素包括：在可能感染HIV-1期间，不规范使用安全套（RR 1.6 [95% Cl 1.1-2.8]）、淋病（RR 2.5[1.1-6.4]）、滴虫病（RR 1.7[1.1-2.8]）和生殖器溃疡（RR 2.5[1.1-6.4]）。在出诊率超过90%的妇女中，HIV-1的发病率为2.7/100例，而每月出诊率为76-90%、50-75%和低于50%的妇女中，HIV-1的发病率分别为7.1、20.3和44.1 /100例（p < 0.0001）。在控制了报告的避孕套使用情况和嫖客数量后，这些趋势仍然存在。这项研究证实了先前的发现，即性传播疾病促进了HIV-1的传播，并表明以诊所为基础的干预措施，包括性病护理和推广避孕套，可以导致女性性工作者中HIV-1发病率的大幅下降。
The control of sexually transmitted diseases, including HIV-1, among sex workers and their clients in urban areas in developing countries, is considered a valuable and cost-effective intervention to contain the spread of HIV-1. The effect of a programme of STD treatment combined with condom promotion on HIV-1 incidence has so far not been measured.During an intervention including condom promotion, as well as monthly sexually transmitted disease screening and treatment among 531 initially HIV-1 negative female sex workers in Kinshasa, Zaire, 70 became infected with HIV-1 (incidence of 8.0 per 100 women-years [wy]). A decline of HIV-1 incidence was observed over time, from 11.7/100 wy during the first 6 months, to 4.4/100 wy over the last 6 months, 3 years later (p = 0.003). Simultaneously, regular use of condoms with clients went up from 11% to 52% and 68%, after 6 and 36 months of intervention, respectively. Risk factors for HIV-1 seroconversion after multivariate analysis included irregular condom use (RR 1.6 [95% Cl 1.1-2.8]), gonorrhoea (RR 2.5 [1.1-6.4]), trichomoniasis (RR 1.7 [1.1-2.8]), and genital ulcer disease (RR 2.5 [1.1-6.4]), during the probable period of acquisition of HIV-1. In women who attended more than 90% of their clinic appointments, the HIV-1 incidence was 2.7/100 wy compared to 7.1, 20.3, and 44.1 per 100 wy among women who attended 76-90%, 50-75%, and less than 50% of the monthly appointments, respectively (p < 0.0001). These trends remained after controlling for reported condom use and number of clients.This study confirms earlier findings that STDs facilitate transmission of HIV-1 and shows that a clinic-based intervention consisting of STD care and condom promotion can result in a major decline of HIV-1 incidence among female sex workers.