Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya
Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya
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DOI：
10.1186/1471-2458-8-143
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发表时间：
2008-04-29
影响因子：
4.5
通讯作者：
Temmerman, Marleen
中科院分区：
文献类型：
--
作者：
Luchters, Stanley;Chersich, Matthew F.;Temmerman, Marleen
背景：自2000年以来，在肯尼亚蒙巴萨的女性性工作者（FSW）中，同伴介导的干预通过提高对艾滋病毒血清状况的知识、态度和认识，促进了行为改变，并旨在通过促进早期性传播感染治疗来预防艾滋病毒和其他性传播感染（STI）。这些干预措施的影响在参加同伴教育的人群和FSW人口水平上进行了评估。方法：于2000年进行干预前调查，采用滚雪球抽样法对503名FSW进行调查。此后，同伴教育者提供性传播感染/艾滋病毒教育、避孕套，并促进艾滋病毒检测、治疗和护理服务。2005年，使用相同的调查方法收集数据，允许与历史对照进行比较，并在接受或未接受同伴干预的FSW之间进行比较。结果：在五年内，性工作主要成为一种全职活动，平均性伴侣增加（2.8 vs 4.9/周；P < 0.001）。客户一致使用安全套的比例从28.8%（145/503）增加到70.4% (356/506;P < 0.001)，拒绝不愿意使用安全套的客户的可能性也增加了（OR = 4.9, 95% CI = 3.7-6.6）。2005年，接受同伴干预的性工作者（28.7%,145/506）与未接受同伴干预的性工作者相比，更一致地使用安全套（86.2%对64.0%;AOR = 3.6, 95% CI = 2.1-6.1）。这些差异在同伴干预暴露程度较高的FSW中更大。参加4次同侪教育的女性中，HIV患病率为25%(17/69)，而参加1-3次同侪教育的女性中，HIV患病率为34% (25/73)（P = 0.21）。2000年总体艾滋病毒感染率为30.6%(151/493)，2005年为33.3% (166/498)（P = 0.36）。结论：同伴介导的干预与保护性行为的增加有关。虽然同伴介导的干预措施仍然很重要，但需要更高的覆盖率和更有效的干预措施，以降低总体脆弱性和风险。
Background: Since 2000, peer-mediated interventions among female sex workers (FSW) in Mombasa Kenya have promoted behavioural change through improving knowledge, attitudes and awareness of HIV serostatus, and aimed to prevent HIV and other sexually transmitted infection (STI) by facilitating early STI treatment. Impact of these interventions was evaluated among those who attended peer education and at the FSW population level.Methods: A pre-intervention survey in 2000, recruited 503 FSW using snowball sampling. Thereafter, peer educators provided STI/HIV education, condoms, and facilitated HIV testing, treatment and care services. In 2005, data were collected using identical survey methods, allowing comparison with historical controls, and between FSW who had or had not received peer interventions.Results: Over five years, sex work became predominately a full-time activity, with increased mean sexual partners (2.8 versus 4.9/week; P < 0.001). Consistent condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; P < 0.001) as well as the likelihood of refusing clients who were unwilling to use condoms (OR = 4.9, 95% CI = 3.7-6.6). In 2005, FSW who received peer interventions (28.7%, 145/506), had more consistent condom use with clients compared with unexposed FSW (86.2% versus 64.0%; AOR = 3.6, 95% CI = 2.1-6.1). These differences were larger among FSW with greater peer-intervention exposure. HIV prevalence was 25% (17/69) in FSW attending = 4 peer-education sessions, compared with 34% (25/73) in those attending 1-3 sessions (P = 0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498) in 2005 (P = 0.36).Conclusion: Peer-mediated interventions were associated with an increase in protected sex. Though peer-mediated interventions remain important, higher coverage is needed and more efficacious interventions to reduce overall vulnerability and risk.