Current and recent drug use intensifies sexual and structural HIV risk outcomes among female sex workers in the Russian Federation.
Current and recent drug use intensifies sexual and structural HIV risk outcomes among female sex workers in the Russian Federation.
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DOI：
10.1016/j.drugpo.2015.04.017
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发表时间：
2015-08
期刊：
影响因子：
--
通讯作者：
Decker MR
中科院分区：
文献类型：
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作者：
Wirtz AL;Peryshkina A;Mogilniy V;Beyrer C;Decker MR
女性性工作者（FSW）和注射毒品者（PWID）感染艾滋病毒的风险很高，FSW-PWID的风险更高。与艾滋病毒有关的研究往往侧重于主要的传播方式-分别是性工作者性接触传播或注射毒品传播-而对性工作者和注射毒品使用如何与性工作者所经历的风险环境共同相关知之甚少。我们调查了俄罗斯三个城市的FSW之间的这种关系。2011年，在托木斯克、克拉斯诺亚尔斯克和喀山通过受调查者驱动的抽样招募了女性性工作者（N=754），并完成了一项调查和快速艾滋病毒筛查。多变量模型评估了注射史的作用（分类为活跃：过去6个月，前：过去6个月之前，从未）与一组性和结构性艾滋病毒风险结果。注射吸毒者很常见：11%的人主动注射毒品，11%的人以前是注射者。与非注射者相比，HIV感染在活跃注射者（AOR：6.7; 95%CI：2.4-18.9）和前注射者（AOR：4.5; 95%CI：1.7-11.6）中最普遍。约6-8%的非注射性工作者报告最近遭受过身体暴力或性暴力，23%的人报告遭受过警察勒索。与这些非注射者相比，主动注射与无保护的肛交（AOR：2.8，95%CI：1.2-6.4），客户暴力（AOR：7.3，95%CI：2.1-24.7）和警察勒索（AOR：3.0，95%CI：1.5-5.9%）相关。自我报告的性和结构性风险的结果也更普遍的活跃相比，前注射器，但是，前和非注射器之间存在的差异不大。FSW经历性，结构和艾滋病毒风险的结果，这些风险被放大积极注射FSW。停止注射毒品的FSW表现出的风险特征更接近那些没有注射史的性工作者。艾滋病毒预防方案和外展活动可以提供机会，包括减少伤害的干预措施和与FSW治疗的联系，使FSW转向风险较低的环境。
Female sex workers (FSW) and people who inject drugs (PWID) are at high risk for HIV infection, with FSW-PWID at even greater risk. HIV-related research often focuses on the primary mode of transmission –sexual or parenteral transmission for FSW and PWID, respectively- with less known on how sex work and injection drug use (IDU) are collectively associated with the risk environment experienced by sex workers. We investigated this relationship among FSW in three Russian cities. In 2011, FSWs (N=754) in Tomsk, Krasnoyarsk, and Kazan were recruited via respondent-driven sampling and completed a survey and rapid HIV screening. Multivariable models evaluated the role of injection history (classified as active: last 6 months, former: prior to last 6 months, and never) with a set of sexual and structural HIV risk outcomes. IDU was common: 11% actively injected drugs and 11% were former injectors. HIV infection was most prevalent among active injectors (AOR: 6.7; 95% CI:2.4–18.9) and former injectors (AOR:4.5; 95%CI:1.7–11.6), compared to non-injectors. Some 6–8% of non-injecting FSWs reported recent physical or sexual client violence and 23% police extortion. Compared to these non-injectors, active injecting was associated with unprotected anal sex (AOR: 2.8, 95%CI:1.2–6.4), client violence (AOR: 7.3, 95%CI:2.1–24.7), and police extortion (AOR: 3.0 95%CI:1.5–5.9%). Self-reported sexual and structural risk outcomes were also more prevalent among active compared to former injectors; however, few differences existed between former and non-injectors. FSW experience sexual, structural, and HIV risk outcomes and these risks are amplified for actively injecting FSWs. FSW who stopped injecting drugs demonstrated risk profiles closer to those of sex workers who had no history of injection. HIV prevention programs and outreach can provide opportunities to include harm reduction interventions and linkage to treatment for FSW to move FSWs towards lower risk environments.