Sex work stigma and non-disclosure to health care providers: data from a large RDS study among FSW in Brazil
Sex work stigma and non-disclosure to health care providers: data from a large RDS study among FSW in Brazil
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DOI：
10.1186/s12914-019-0193-7
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发表时间：
2019-03-05
影响因子：
3
通讯作者：
da Silva, Francisca Sueli
中科院分区：
文献类型：
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作者：
Dourado, Ines;Crosland Guimaraes, Mark Drew;da Silva, Francisca Sueli
背景卫生服务中的污名化可能有害于求医的态度和做法。本研究调查了巴西女性性工作者（FSW）不向卫生保健提供者披露性工作的情况及其与卫生保健服务利用的关系。方法本研究采用横断面受访者驱动抽样，在巴西12个城市进行，以确定FSW中的艾滋病毒风险行为。我们首先评估了社会人口学、侵犯人权、卫生服务的获取和利用以及歧视变量与不向卫生保健提供者披露性取向问题之间的统计关联。其次，我们调查了FSW状态不披露与选定的预防性保健结果的关系：HIV检测、PAP涂片检查和暴露后预防（PEP）。采用多变量logistic回归计算校正优势比和95%置信区间。结果在4245名被招募的女服务员中，获得免费安全套的比例很高（82%），但接受性传播感染咨询的比例仅为24.4%。大多数女同性恋者（62.6%）定期使用非专业的公共保健服务，但在过去两年中只有51.5%进行过子宫颈抹片检查，在过去12个月内进行过艾滋病毒检测的不到40%。在从事危险行为的FSW中（49.6%），只有8.3%的人使用PEP。在侵犯人权方面，大约15%的人被要求将其收入的一部分交给工作场所的所有者，38%的人在18岁以下开始从事性工作，6%的人被要求定期提交其艾滋病毒检测结果。21.3%的人报告在保健服务中受到歧视，24.3%的人总是披露自己的性工作者身份。多变量logistic模型表明，不披露与四种医疗保健结果存在显著关联，即使在控制了年龄、教育水平、非政府组织隶属关系和常规使用的医疗保健类型之后，不披露性工作状况的妇女使用预防性保健服务的几率也较低。结论研究结果表明，卫生服务机构对性工作的污名化可能是性工作者控制性传播感染和应对艾滋病毒的主要障碍之一。必须打击卫生服务中对性工作者的污名化和歧视，以确保巴西公共卫生系统中适当利用现有的预防服务。
BackgroundStigma in health services may be detrimental to health seeking attitudes and practices. This study investigates non-disclosure of sex work to health care providers among female sex workers (FSW) in Brazil and its association with the utilization of health care services.MethodsThis study used cross-sectional respondent-driven sampling, carried out in 12 Brazilian cities to identify HIV risk behaviors among FSW. We first assessed statistical associations of sociodemographic, human right violations, health service access and utilization, and discrimination variables with non-disclosure of FSW status to health care providers as outcome. Secondly, we investigated the association of non-disclosure of FSW status with selected preventive health care outcomes: HIV testing, PAP smear exam, and post-exposure prophylaxis (PEP). Adjusted odds ratio with 95% confidence intervals were calculated by multivariable logistic regressions.ResultsAmong 4245 recruited FSW, a high percentage received free condoms (82%) but only 24.4% were counseled on STI. Most FSW used non-specialized public healthcare routinely (62.6%), but only 51.5% had a Pap smear exam in the last two years and less than 40% were tested for HIV in the last 12months. Among FSW who engaged in risky behavior (49.6%), only 8.3% used PEP. Regarding human rights violations, approximately 15% were required to give part of their earnings to owners of workplace establishments, 38% started sex work under 18years old and 6% were required to periodically present their HIV test results. 21.3% reported having faced discrimination in health services, and 24.3% always disclosed their FSW status. Multivariable logistic models indicated significant associations of non-disclosure on the four healthcare outcomes, with lower odds of using preventive health services among women who did not disclose their sex work status, even after controlling for age, educational level, NGO affiliation, and type of health care routinely used.ConclusionsOur results indicate that sex work stigmatization within health services may be one of the main barriers to STI control and HIV response among FSW. It is essential to combat stigmatization and discrimination against FSW in health services to guarantee the appropriate uptake of preventive services available in the public health system in Brazil.