War-Related Abduction and History of Incarceration Linked to High Burden of HIV Among Female Sex Workers in Conflict-Affected Northern Uganda
War-Related Abduction and History of Incarceration Linked to High Burden of HIV Among Female Sex Workers in Conflict-Affected Northern Uganda
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DOI：
10.1097/qai.0000000000001030
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发表时间：
2016-09-01
影响因子：
3.6
通讯作者：
Shannon, Kate
中科院分区：
文献类型：
--
作者：
Goldenberg, Shira M.;Muzaaya, Godfrey;Shannon, Kate
目标：撒哈拉以南非洲的性工作者（SW）面临着不成比例的艾滋病毒负担和日益严重的人权侵犯问题。鉴于缺乏撒哈拉以南非洲地区，特别是受冲突影响的环境中，艾滋病毒在工作人员中的负担和相关性的证据，我们研究了结构性决定因素之间的关系。（例如，与战争有关的绑架，监禁）和艾滋病毒感染之间的冲突影响的SW在北方Uganda.Design：Cross-section community-based research study among female SW in conflict-affected Gulu，北方Uganda.Methods：2011年至2012年，对通过SW/同行领导的外联和时间地点抽样招募的参与者进行了访谈问卷和自愿艾滋病毒检测。HIV感染率计算，双变量和多变量Logistic回归被用来确定独立协会与HIV血清阳性率。结果：400 SW，135（33.75%）是HIV血清阳性，其中三分之一是新的/以前未确诊的HIV感染。在多变量分析中，在调整了性工作者的年龄和教育程度后，（调整优势比：1.93，95%可信区间：1.17 ~-3.20）与HIV血清阳性率和战时绑架史独立相关（调整的比值比：1.62，95%置信区间：1.00至2.63）结论：这项研究记录了高比率的未确诊的艾滋病毒感染和与战争有关的侵犯人权行为，监禁，并在受冲突影响的北方乌干达的SW之间的沉重的艾滋病毒负担之间的关联。这些调查结果突出表明，在撒哈拉以南非洲地区，冲突和边缘化妇女被定罪的严重危害。仍然迫切需要由社会工作者领导的干预措施，以解决冲突经历和政策转变，促进对艾滋病毒预防和护理采取基于权利的办法。
Objective:Sex workers (SWs) in sub-Saharan Africa face a disproportionate HIV burden and growing concerns of severe human rights violations. Given the dearth of evidence on the burden and correlates of HIV among SWs in sub-Saharan Africa, particularly within conflict-affected settings, we examined the relationship between structural determinants (eg, war-related abduction, incarceration) and HIV infection among conflict-affected SWs in Northern Uganda.Design:Cross-sectional community-based research study among female SWs in conflict-affected Gulu, Northern Uganda.Methods:Interview questionnaires and voluntary HIV testing were conducted with participants recruited through SW/peer-led outreach and time-location sampling from 2011 to 2012. HIV prevalence was calculated, and bivariable and multivariable logistic regression was used to identify independent associations with HIV seroprevalence.Results:Of 400 SWs, 135 (33.75%) were HIV seropositive; of whom one-third were new/previously undiagnosed HIV infections. In multivariable analysis, after adjusting for age of sex work entry and education, lifetime incarceration (adjusted odds ratio: 1.93, 95% confidence interval: 1.17 to -3.20) was independently associated with HIV seroprevalence, and history of wartime abduction (adjusted odds ratio: 1.62, 95% confidence interval: 1.00 to 2.63) was marginally associated (P = 0.051).Conclusions:This study documented a high rate of undiagnosed HIV infections and associations between war-related human rights violations, incarceration, and a heavy HIV burden among SWs in conflict-affected Northern Uganda. These findings highlight the serious harms of conflict and criminalization of marginalized women in sub-Saharan African contexts. SW-led interventions that address conflict experiences and policy shifts to promote a rights-based approach to HIV prevention and care remain critically needed.