Client demands for unsafe sex: the socioeconomic risk environment for HIV among street and off-street sex workers.
Client demands for unsafe sex: the socioeconomic risk environment for HIV among street and off-street sex workers.
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DOI：
10.1097/qai.0b013e3182968d39
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发表时间：
2013-08-01
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：
Deering KN;Lyons T;Feng CX;Nosyk B;Strathdee SA;Montaner JS;Shannon K
在加拿大温哥华的性工作者(SWS)中，这项研究确定了社会、毒品使用、性工作、环境结构和与客户相关的因素，这些因素与在客户要求不使用避孕套的性行为后被提供和接受更多的钱有关。使用510个SWS纵向队列的基线(2月10日至10月11日)数据进行的横断面研究。一个由两部分组成的多变量回归模型被用来确定与两种不同结果相关的因素：(1)在过去六个月里，被提供更多钱的人中，被提供更多钱的人；(2)在过去六个月里接受更多钱进行性行为的人。样本包括490个SWS。在多变量分析中，不使用避孕套的性行为者更有可能被提供更多的钱进行性行为，这些性行为者使用速力球、每周平均客户数量较多、难以获得避孕套以及有客户去其他性服务机构就诊。不戴避孕套而接受更多金钱进行性行为的性服务人员更有可能自我报告为性少数，他们经历过客户暴力和使用冰毒的次数少于日常(vs.no)，而主要在室内(与室外/公共场所)拉客的SWS较不可能。这些结果突显了性行为者对不使用避孕套的高需求。艾滋病毒预防工作应该将责任转移到客户身上，以减少为不安全的性行为提供更多资金。迫切需要一些方案来减轻性骚扰的社会和经济风险环境，同时取消对性工作的刑事制裁，以便能够在更安全的室内工作空间内使用避孕套。
Among sex workers (SWs) in Vancouver, Canada, this study identified social, drug use, sex work, environmental-structural and client-related factors associated with being offered and accepting more money after clients' demand for sex without a condom. Cross-sectional study using baseline (February/10-October/11) data from a longitudinal cohort of 510 SWs. A two-part multivariable regression model was used to identify factors associated with two separate outcomes: (1) being offered and (2) accepting more money for sex without a condom in the last six months, among those who had been offered more money. The sample included 490 SWs. In multivariable analysis, being offered more money for sex without a condom was more likely for SWs who used speedballs, had higher average numbers of clients per week, had difficulty accessing condoms and had clients who visited other SWs. Accepting more money for sex without a condom was more likely for SWs self-reporting as a sexual minority and who had experienced client violence and used crystal methamphetamine use less than daily (vs. none), and less likely for SWs who solicited for clients mainly indoors (vs. outdoor/public places). These results highlight the high demand for sex without a condom by clients of SWs. HIV prevention efforts should shift responsibility toward clients to reduce offers of more money for unsafe sex. Programs that mitigate the social and economic risk environments of SWs alongside the removal of criminal sanctions on sex work to enable condom use within safer indoor work spaces are urgently required.