Drivers of HIV Infection Among Cisgender and Transgender Female Sex Worker Populations in Baltimore City: Results From the SAPPHIRE Study
Drivers of HIV Infection Among Cisgender and Transgender Female Sex Worker Populations in Baltimore City: Results From the SAPPHIRE Study
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DOI：
10.1097/qai.0000000000001959
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发表时间：
2019-04-15
影响因子：
3.6
通讯作者：
Footer, Katherine H. A.
中科院分区：
文献类型：
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作者：
Sherman, Susan G.;Park, Ju Nyeong;Footer, Katherine H. A.
目的：确定和比较顺性别女性性工作者（CFSW）和跨性别女性性工作者（TFSW）感染HIV的危险因素。设计：队列研究的基线数据（蓝宝石）的街道为基础的CFSW和TFSW在巴尔的摩，MD。妇女被问及个人（如吸毒）、人际关系（如性虐待）和结构性（如住房）风险因素，并询问他们的性工作风险环境。对妇女进行艾滋病毒/性传播感染检测。我们使用逻辑回归来确定每个人群中流行HIV的关键风险因素。结果：我们在2016年至2017年期间招募了262名CFSW和62名TFSW。与TFSW相比，CFSW更可能是白色（66%比0%），最近无家可归（62%比23%，P < 0.001），经常饿着肚子睡觉（54%比16%，P < 0.001），注射毒品（71%比4%，P < 0.001）。TFSW的HIV感染率是CFSW的8倍（40%比5%，P < 0.001）。所有参与者都报告说，一生中遭受身体暴力和性暴力的比例很高。在CFSW中，注射可卡因[校正比值比（aOR）= 3.65，95%置信区间（CI）：1.12至11.88]、食物不安全（aOR = 1.92，95% CI：1.22至3.04）和性工作>5年（aOR = 5.40，95% CI：2.10至13.90）与HIV独立相关。儿童期性虐待（aOR = 4.56，95%CI：1.20 ~ 17.32），由于缺乏机会而从事性工作（aOR = 4.81，95%CI：1.29 - 17.90），性工作>5年（aOR = 5.62，95%CI：1.44 ~ 21.85）与TFSW中HIV感染独立相关。虽然两个群体不同，但都有广泛的童年虐待和晚年结构性脆弱的历史，这促使她们从事街头性工作，并使她们面临艾滋病毒风险。
Objective: To determine and compare risk factors for HIV infection among cisgender female sex workers (CFSWs) and transgender female sex workers (TFSWs).Design: Baseline data from a cohort study (SAPPHIRE) of street-based CFSW and TFSW in Baltimore, MD.Methods: Women were queried about individual (eg, drug use), interpersonal (eg, sexual abuse), and structural (eg, housing) risk factors and questioned on their sex work risk environment. Women were tested for HIV/sexually transmitted infections. We used logistic regression to identify key risk factors for prevalent HIV in each population.Results: We recruited 262 CFSW and 62 TFSW between 2016 and 2017. Compared with TFSW, CFSW were more likely to be white (66% vs. 0%), recently homeless (62% vs. 23%, P < 0.001), regularly gone to sleep hungry (54% vs. 16%, P < 0.001), and to inject drugs (71% vs. 4%, P < 0.001). HIV prevalence was 8 times greater in TFSW than in CFSW (40% vs. 5%, P < 0.001). All participants reported high rates of lifetime physical and sexual violence. Cocaine injection [adjusted odds ratio (aOR) = 3.65, 95% confidence interval (CI): 1.12 to 11.88], food insecurity (aOR = 1.92, 95% CI: 1.22 to 3.04), and >5 years in sex work (aOR = 5.40, 95% CI: 2.10 to 13.90) were independently associated with HIV among CFSW. Childhood sexual abuse (aOR = 4.56, 95% CI: 1.20 to 17.32), being in sex work due to lack of opportunities (aOR = 4.81, 95% CI: 1.29 to 17.90), and >5 years in sex work (aOR = 5.62, 95% CI: 1.44 to 21.85) were independently associated with HIV among TFSW.Conclusions: Although distinct, both populations share a history of extensive childhood abuse and later life structural vulnerability, which drive their engagement in street-based sex work and their HIV risk profiles.