Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics.
Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics.
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DOI：
10.1097/qai.0000000000001022
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发表时间：
2016-09-01
期刊：
影响因子：
--
通讯作者：
Shannon K
中科院分区：
文献类型：
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作者：
Duff P;Goldenberg S;Deering K;Montaner J;Nguyen P;Dobrer S;Shannon K
尽管全球证据表明，性工作者受艾滋病毒的影响不成比例，但关于性工作者中艾滋病毒携带者的艾滋病毒治疗结果的数据仍然很少。这项研究调查了加拿大温哥华大都会的街头和非街头的艾滋病毒携带者和接受抗逆转录病毒治疗(ART)的人群中无法检测到的血浆病毒载量(PVL)的相关性。分析利用了SWS(性工作者健康获取评估)纵向队列的数据(2010-2014)，以及与药物治疗计划(DTP)关于ART分配和结果的机密联系。双变量和多变量广义线性混合效应模型(GLMM)用于识别不可检测的PVL(<；50拷贝/ml)的纵向相关。在72名曾经使用过抗逆转录病毒疗法的HIV感染者中，38.9%的人在基线时有无法检测到的PVL。84.7%的人在研究期间至少有一次无法检测到PVL，而18.1%的人表现出持续的无法检测到的PVL。在多变量回归分析中，≥95%的药房再灌装依从性(调整后优势比=4.2 1；95%可信区间2.16~8.19)、确诊时间(调整后优势比=1.0 6；95%可信区间1.0 0~1.13)与未检出的PVL呈正相关。有亲密的男性伴侣(AOR=0.35；95%CI为0.16~0.78)和无家可归与未发现的PVL呈负相关(AOR=0.22；95%CI为0.10~0.47)。有必要更密切地考虑塑造SWS抗逆转录病毒治疗经验和影响治疗结果的社会和结构背景，包括亲密伙伴关系中的性别权力动态。迫切需要对暗娼中艾滋病毒护理的未来研究，以及结构性和社区主导的干预措施，以支持暗娼获得和保留护理。
Despite global evidence that sex workers (SWs) are disproportionately impacted by HIV, data on HIV treatment outcomes among SWs living with HIV remains sparse. This study examined the correlates of undetectable plasma viral load (pVL) among street- and off-street SWs living with HIV and on antiretroviral therapy (ART) in Metro Vancouver, Canada. Analyses drew on data (2010–2014) from a longitudinal cohort of SWs (An Evaluation of Sex Workers Health Access) and confidential linkages with the Drug Treatment Program (DTP) data on ART dispensation and outcomes. Bivariate and multivariable generalized linear mixed effects models (GLMM) were used to identify longitudinal correlates of undetectable pVL (<50 copies/ml). Of the 72 SWs living with HIV who had ever used ART, 38.9% had an undetectable pVL at baseline. While 84.7% had undetectable pVL at least once over the study period, 18.1% exhibited sustained undetectable pVL. In multivariable GLMM analyses, ≥95% pharmacy refill adherence (Adjusted Odds Ratio (AOR)=4.21; 95% Confidence Interval (CI) 2.16–8.19), length of time since diagnosis (AOR=1.06; 95%CI 1.00–1.13) were positively correlated with undetectable pVL. Having an intimate male partner (AOR=0.35; 95%CI 0.16–0.78) and homelessness were negatively correlated with undetectable pVL (AOR=0.22; 95%CI 0.10–0.47). There is a need to more closely consider the social and structural contexts which shape SWs’ experiences on ART and impact treatment outcomes, including the gendered power dynamics within intimate partnerships. Future research on HIV care among SWs is urgently needed, alongside structural and community-led interventions to support SWs’ access to and retention in care.