Where Do Female Sex Workers Seek HIV and Reproductive Health Care and What Motivates These Choices? A Survey in 4 Cities in India, Kenya, Mozambique and South Africa.
Where Do Female Sex Workers Seek HIV and Reproductive Health Care and What Motivates These Choices? A Survey in 4 Cities in India, Kenya, Mozambique and South Africa.
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DOI：
10.1371/journal.pone.0160730
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Delva W
中科院分区：
文献类型：
--
作者：
Lafort Y;Greener R;Roy A;Greener L;Ombidi W;Lessitala F;Haghparast-Bidgoli H;Beksinska M;Gichangi P;Reza-Paul S;Smit JA;Chersich M;Delva W
在一个旨在改善女性性工作者获得艾滋病毒以及性健康和生殖健康服务的实施研究项目的背景下，在四个城市对女性性工作者进行了基线横断面调查。该调查衡量了性工作者在哪里寻求艾滋病毒/性健康和生殖健康护理，以及是什么促使他们做出选择。采用应答者驱动抽样（RDS），在南非德班（n = 400）、莫桑比克太特（n = 308）、肯尼亚蒙巴萨（n = 400）和印度迈索尔（n = 458）招募FWS并进行访谈。通过非参数自举法估计RDS调整比例，并使用事后成对比较检验在城市间进行比较。在各个城市，女性性工作者最常在公共卫生设施寻求大部分艾滋病毒/性健康和生殖健康服务，特别是在德班（从65%的避孕套到97%的艾滋病毒护理）。在迈索尔，专门针对FSW的服务仅在性传播感染护理（89%）和艾滋病毒检测（79%）方面覆盖率较高。私营营利诊所是蒙巴萨的重要提供者（从性传播感染护理和艾滋病毒检测的17%到艾滋病毒护理的43%不等），但在其他城市并非如此。在德班和蒙巴萨选择护理提供者的最重要原因是距离近，在太特是“他们经常去的地方”，在迈索尔是护理费用高。在可能的情况下，更经常选择专门针对FSW的诊所，因为等待时间较短，认为护理质量更高，更隐私和更友好的人员。各城市寻求艾滋病毒/性健康和生殖健康服务的地点差别很大。与迈索尔相比，有针对性的服务在非洲城市的覆盖面有限。在选择护理地点时，便利性似乎比护理质量更重要。将有针对性的干预措施与一般保健服务联系起来，以改善获得服务的最佳模式，需要根据每个城市的具体情况加以调整。
A baseline cross-sectional survey among female sex workers (FSWs) was conducted in four cities within the context of an implementation research project aiming to improve FSWs’ access to HIV, and sexual and reproductive health (SRH) services. The survey measured where FSWs seek HIV/SRH care and what motivates their choice. Using respondent-driven sampling (RDS), FWSs were recruited in Durban, South Africa (n = 400), Tete, Mozambique (n = 308), Mombasa, Kenya (n = 400) and Mysore, India (n = 458) and interviewed. RDS-adjusted proportions were estimated by non-parametric bootstrapping, and compared across cities using post-hoc pairwise comparison tests. Across cities, FSWs most commonly sought care for the majority of HIV/SRH services at public health facilities, most especially in Durban (ranging from 65% for condoms to 97% for HIV care). Services specifically targeting FSWs only had a high coverage in Mysore for STI care (89%) and HIV testing (79%). Private-for-profit clinics were important providers in Mombasa (ranging from 17% for STI care and HIV testing to 43% for HIV care), but not in the other cities. The most important reason for the choice of care provider in Durban and Mombasa was proximity, in Tete ‘where they always go’, and in Mysore cost of care. Where available, clinics specifically targeting FSWs were more often chosen because of shorter waiting times, perceived higher quality of care, more privacy and friendlier personnel. The place where care is sought for HIV/SRH services differs substantially between cities. Targeted services have limited coverage in the African cities compared to Mysore. Convenience appears more important for choosing the place of care than aspects of quality of care. The best model to improve access, linking targeted interventions with general health services, will need to be tailored to the specific context of each city.