Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican republic
Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican republic
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DOI：
10.2105/ajph.2004.042200
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发表时间：
2006-01-01
影响因子：
12.7
通讯作者：
Sweat, M
中科院分区：
文献类型：
--
作者：
Kerrigan, D;Moreno, L;Sweat, M
目标。我们评估了两种环境结构干预措施在降低多米尼加共和国女性性工作者感染艾滋病毒和性传播感染(STI)风险方面的有效性。在一年期间实施了两种干预模式：圣多明各的社区团结和普拉塔港的团结与政府政策相结合。通过干预前和干预后横断面行为调查、STI测试和参与者观察以及连续横断面STI筛查对两者进行评估。在圣多明各，与新客户使用安全套的比例显著增加(75.3%-93.8%；优势比[OR]=4.21；95%可信区间[CI]=1.55，11.43)。在普拉塔港，与正常性伴一起使用避孕套的人数显著增加(13.0%-28.8%；OR=2.97；95%CI=1.33，6.66)，性传播感染患病率降低(28.8%-16.3%；OR=0.50；95%CI=0.32，0.78)，性工作者对不安全性行为的口头拒绝显著增加(50.0%-79.4%；OR=3.86；95%CI=1.96，7.58)，参与性服务机构有能力在每月例行的性工作者筛查中实现无性传播感染的目标(OR=1.17；95%CI=1.12，1.22)。社区团结和政府政策相结合的干预措施显示，对降低女性性工作者的艾滋病毒和性传播感染风险具有积极的初步效果。
Objectives. We assessed the effectiveness of 2 environmental-structural interventions in reducing risks of HIV and sexually transmitted infections (STIs) among female sex workers in the Dominican Republic.Methods. Two intervention models were implemented over a 1-year period: community solidarity in Santo Domingo and solidarity combined with government policy in Puerto Plata. Both were evaluated via preintervention-postintervention cross-sectional behavioral surveys, STI testing and participant observations, and serial cross-sectional STI screenings.Results. Significant increases in condom use with new clients (75.3%-93.8%; odds ratio [OR] = 4.21; 95% confidence interval [CI]=1.55, 11.43) were documented in Santo Domingo. In Puerto Plata, significant increases in condom use with regular partners (13.0%-28.8%; OR=2.97; 95% CI=1.33, 6.66) and reductions in STI prevalence (28.8%-16.3%; OR=0.50; 95% CI=0.32, 0.78) were documented, as were significant increases in sex workers' verbal rejections of unsafe sex (50.0%-79.4%; OR=3.86;95% CI=1.96,7.58) and participating sex establishments' ability to achieve the goal of no STIs in routine monthly screenings of sex workers (OR=1.17; 95% CI=1.12, 1.22).Conclusions. Interventions that combine community solidarity and government policy show positive initial effects on HIV and STI risk reduction among female sex workers.