High HIV Prevalence and Low HIV-Service Engagement Among Young Women Who Sell Sex: A Pooled Analysis Across 9 Sub-Saharan African Countries
High HIV Prevalence and Low HIV-Service Engagement Among Young Women Who Sell Sex: A Pooled Analysis Across 9 Sub-Saharan African Countries
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DOI：
10.1097/qai.0000000000002432
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发表时间：
2020-10-01
影响因子：
3.6
通讯作者：
Baral, Stefan D.
中科院分区：
文献类型：
--
作者：
Rucinski, Katherine B.;Schwartz, Sheree R.;Baral, Stefan D.
背景资料：需要流行病学数据来说明撒哈拉以南非洲处于社会边缘地位的年轻妇女的特定年龄艾滋病毒负担和参与艾滋病毒服务的情况。设定：通过受访者驱动抽样（N = 6592），在南部、中部和西部非洲的9个国家招募了年龄≥ 18岁的报告卖淫的妇女。研究方法：汇总了个人层面的数据，并使用广义线性混合模型估计了每个地区特定年龄的艾滋病毒流行率和抗逆转录病毒治疗（ART）覆盖率。使用广义估计方程比较了不同年龄层（18-19岁、20-24岁和≥ 25岁）的艾滋病毒感染妇女的艾滋病毒服务参与结果（既往艾滋病毒检测、艾滋病毒状况意识和ART使用情况）。结果如下：在南部非洲、中部非洲和西部非洲，按年龄划分，18%-19%，45.4% [95%置信区间（CI）：37.9 - 53.0]、5.8%（95% CI：4.3 - 7.8）和4.0%（95% CI：2.9 - 5.4）的卖淫女青年感染艾滋病毒。在所有区域，艾滋病流行率在成年早期急剧上升，但抗逆转录病毒疗法在各年龄组的覆盖率都不理想。与≥ 25岁的成年女性相比，18-19岁的年轻女性以前接受过艾滋病毒检测的可能性较小[患病率（PR）为0.76; 95% CI：0.72 - 0.80]，（PR 0.48; 95% CI：0.35至0.64），不太可能接受ART（PR 0.67; 95% CI：0.59至0.75）。结论：在这一汇总分析中，18-19岁的艾滋病毒流行率已经很高，这表明有必要开展预防工作，使那些在青春期早期就从事性交易的妇女受益。抗逆转录病毒治疗的覆盖率仍然很低，最年轻年龄组的妇女最少参与艾滋病毒相关服务。消除向卖淫女青年提供艾滋病毒服务的障碍，是全面防治艾滋病毒的核心。
Background: Epidemiological data are needed to characterize the age-specific HIV burden and engagement in HIV services among young, marginalized women in sub-Saharan Africa. Setting: Women aged >= 18 years who reported selling sex were recruited across 9 countries in Southern, Central, and West Africa through respondent driven sampling (N = 6592). Methods: Individual-level data were pooled and age-specific HIV prevalence and antiretroviral therapy (ART) coverage were estimated for each region using generalized linear mixed models. HIV-service engagement outcomes (prior HIV testing, HIV status awareness, and ART use) were compared among women living with HIV across age strata (18-19, 20-24, and >= 25 years) using generalized estimating equations. Results: By age 18%-19%, 45.4% [95% confidence interval (CI): 37.9 to 53.0], 5.8% (95% CI: 4.3 to 7.8), and 4.0% (95% CI: 2.9 to 5.4) of young women who sell sex were living with HIV in Southern, Central, and West Africa respectively. Prevalence sharply increased during early adulthood in all regions, but ART coverage was suboptimal across age groups. Compared with adult women >= 25, young women aged 18-19 were less likely to have previously tested for HIV [prevalence ratio (PR) 0.76; 95% CI: 0.72 to 0.80], less likely to already be aware of their HIV status (PR 0.48; 95% CI: 0.35 to 0.64), and less likely to be taking ART (PR 0.67; 95% CI: 0.59 to 0.75). Conclusions: HIV prevalence was already high by age 18-19 in this pooled analysis, demonstrating the need for prevention efforts that reach women who sell sex early in their adolescence. ART coverage remained low, with women in the youngest age group the least engaged in HIV-related services. Addressing barriers to HIV service delivery among young women who sell sex is central to a comprehensive HIV response.