Global epidemiology of HIV among female sex workers: influence of structural determinants.
Global epidemiology of HIV among female sex workers: influence of structural determinants.
复制标题
DOI：
10.1016/s0140-6736(14)60931-4
复制
发表时间：
2015-01-03
期刊：
影响因子：
168.9
通讯作者：
Boily, Marie-Claude
中科院分区：
文献类型：
--
作者：
Shannon, Kate;Strathdee, Steffanie A.;Goldenberg, Shira M.;Duff, Putu;Mwangi, Peninah;Rusakova, Maia;Reza-Paul, Sushena;Lau, Joseph;Deering, Kathleen;Pickles, Michael R.;Boily, Marie-Claude
女性性工作者（FSW）在全球范围内承担着不成比例的艾滋病毒感染负担。尽管开展了数十年的研究和方案活动，但人们对艾滋病毒的流行病学以及结构性决定因素在减轻或加剧艾滋病毒流行和获得性工作者护理方面的作用知之甚少。我们回顾了现有的艾滋病毒感染率和发病率，安全套的使用，以及结构性决定因素在这一组公布的数据。在204项独特的研究中，只有87项（43%）明确研究了艾滋病毒的结构决定因素。大多数研究来自亚洲，很少来自艾滋病毒负担沉重的地区，如撒哈拉以南非洲，俄罗斯和东欧。为了进一步探索结构决定因素对流行病进程的潜在影响，我们使用了确定性传播模型来模拟通过集中和普遍流行的地区的结构变化以及FSW中的高艾滋病毒流行率来避免潜在的艾滋病毒感染。该模型表明，在未来十年内，仅消除性暴力就可以通过其对FSW及其客户的非安全套使用的直接和持续影响，避免肯尼亚17%的艾滋病毒感染（95%不确定性区间[UI] 1-31）和加拿大20%的艾滋病毒感染（95% UI 3-39）。在肯尼亚，扩大性工作者及其客户获得抗逆转录病毒治疗的机会，使其符合世界卫生组织规定的CD 4细胞计数低于500个细胞/μL的标准，可以避免34%（95% UI 25-42）的感染，即使是性工作者主导的外联活动的适度覆盖，也可以在未来十年内避免20%（95% UI 8-36）的感染。性工作合法化将对所有环境中的艾滋病毒流行过程产生最大影响，在未来十年内避免33-46%的艾滋病毒感染。多管齐下的结构性和社区主导的干预措施对于增加获得预防和治疗的机会以及促进全世界性工作者的人权至关重要。
Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1–31) and 20% in Canada (95% UI 3–39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25–42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8–36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33–46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.