Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection
Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection
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DOI：
10.1016/j.socscimed.2004.02.003
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发表时间：
2004-10-01
影响因子：
5.4
通讯作者：
Harlow, SD
中科院分区：
文献类型：
--
作者：
Dunkle, KL;Jewkes, RK;Harlow, SD
长期以来，性工作者一直被认为是艾滋病毒感染的高危人群，但迄今为止，很少有定量研究探讨艾滋病毒风险与普通人群中女性为物质利益交换性行为之间的关系。本研究的目的是估计在南非索韦托产前诊所就诊的妇女中这种交易性行为的流行程度，确定与报告交易性行为相关的人口统计学和社会变量，并确定交易性行为与艾滋病毒血清状态之间的关系。我们对在索韦托四家保健中心接受常规产前艾滋病毒检测的寻求产前护理的妇女进行了横断面研究。私人面对面访谈涉及社会人口统计学、性史和基于性别的暴力经历。21.1%的参与者报告曾与非主要男性伴侣发生过性关系，以换取物质物品或金钱。报告过去遭受过男性亲密伴侣的暴力、有问题的药物使用、居住在城市、曾经赚钱或居住在不合标准的住房中的妇女更有可能报告交易性行为，而报告第一次性交推迟、已婚或受过高等教育的妇女报告交易性行为的可能性较小。在控制男性性伴侣的终生数量和女性性活跃的时间长度后，交易性行为与HIV血清阳性相关（OR= 1.54, 95% CI: 1.07, 2.21）。报告有非主要伴侣但没有交易性行为的妇女，其HIV血清阳性的几率并没有增加（OR= 1.04, 95% CI: 0.75, 1.43）。我们的结论是，交易性行为可能会增加妇女感染艾滋病毒的风险，并与基于性别的暴力、药物使用和社会经济劣势有关。研究、政策和方案倡议应考虑交易性行为在妇女感染艾滋病毒风险中的作用，并注意暴力、贫穷和药物使用在塑造妇女性行为方面的交叉作用。(C) 2004 Elsevier Ltd.版权所有。
Sex workers have long been considered a high-risk group for HIV infection, but to date little quantitative research has explored the association between HIV risk and exchange of sex for material gain by women in the general population. The objective of this study was to estimate the prevalence of such transactional sex among women attending antenatal clinics in Soweto, South Africa, to identify demographic and social variables associated with reporting transactional sex, and to determine the association between transactional sex and HIV serostatus. We conducted a cross-sectional study of women seeking antenatal care in four Soweto health centres who accepted routine antenatal HIV testing. Private face-to-face interviews covered socio-demographics, sexual history and experience of gender-based violence. 21.1% of participants reported having ever had sex with a non-primary male partner in exchange for material goods or money. Women who reported past experience of violence by male intimate partners, problematic substance use, urban residence, ever earning money, or living in substandard housing were more likely to report transactional sex, while women who reported delayed first coitus, were married, or had a post-secondary education were less likely to report transactional sex. Transactional sex was associated with HIV seropositivity after controlling for lifetime number of male sex partners and length of time a woman had been sexually active (OR= 1.54, 95% CI: 1.07, 2.21). Women who reported non-primary partners without transactional sex did not have increased odds of being HIV seropositive (OR= 1.04, 95% CI: 0.75, 1.43). We conclude that transactional sex may place women at increased risk for HIV, and is associated with gender-based violence, substance use and socio-economic disadvantage. Research, policy and programmatic initiatives should consider the role of transactional sex in women's HIV risk, with attention to the intersecting roles of violence, poverty, and substance use in shaping women's sexual behaviour. (C) 2004 Elsevier Ltd. All rights reserved.