A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India.
A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India.
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DOI：
10.1186/1471-2458-11-s6-s8
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发表时间：
2011-12-29
影响因子：
4.5
通讯作者：
Alary M
中科院分区：
文献类型：
--
作者：
Deering KN;Boily MC;Lowndes CM;Shoveller J;Tyndall MW;Vickerman P;Bradley J;Gurav K;Pickles M;Moses S;Ramesh BM;Washington R;Rajaram S;Alary M
2003年，印度在包括卡纳塔克邦在内的六个高流行率邦发起了一项针对包括女性性工作者在内的高危人群的大规模艾滋病毒预防干预行动-Avahan倡议。本研究评估了干预暴露是否与FSW性伴侣使用避孕套相关，包括剂量反应关系。数据来自对卡纳塔克邦三个地区775名女性性工作者的横断面研究（2006- 2007年）。调查方法采用复杂的整群抽样设计。使用双变量和多变量logistic回归分别对5个干预暴露变量中的每一个与不同性伴侣（包括：所有客户、偶尔客户、最近的重复客户、最近的非付费伴侣以及丈夫或同居伴侣）一致使用避孕套的5种结局（CCU=总是与经常/有时/从不）之间的关系进行建模。对三个连续干预暴露变量进行了趋势线性检验。女性性工作者报告与所有客户的CCU最高（81.7%）;与女性性工作者的丈夫或同居伴侣的CCU最低（9.6%）。在多变量分析中，在干预人员接触的FSW中，所有客户和偶尔客户发生CCU的几率分别为6.3倍[95%置信区间，CI：2.8-14.5]和2.3倍[95% CI：1.4-4.1]，干预人员接触的FSW分别为4.9倍[95% CI：2.6-9.3]和2.3倍[95% CI：1.3-4.1]分别高于那些没有观察过工作人员展示安全套的人。一个显着的剂量-反应关系存在于每个CCU的结果和增加的时间，因为第一次接触的工作人员（P=0.001; P=0.006）和安全套演示目睹的数量（P=0.004; P=0.026）;剂量-反应关系也观察到安全套使用与所有客户和工作人员接触的次数（P=0.047）。干预暴露与最近的重复客户，最近的非付费伴侣或丈夫或同居伴侣的CCU几率较高无关。研究结果表明，暴露于大规模的艾滋病毒干预FSW与商业客户CCU增加。此外，CCU与客户之间存在剂量-反应关系，并且工作人员首次接触的时间，工作人员接触的次数和安全套演示次数增加。需要作出额外的方案努力，以增加与非商业性伙伴使用避孕套。
The Avahan Initiative, a large-scale HIV preventive intervention targeted to high-risk populations including female sex workers (FSWs), was initiated in 2003 in six high-prevalence states in India, including Karnataka. This study assessed if intervention exposure was associated with condom use with FSWs’ sexual partners, including a dose-response relationship. Data were from a cross-sectional study (2006-07) of 775 FSWs in three districts in Karnataka. Survey methods accounted for the complex cluster sampling design. Bivariate and multivariable logistic regression was used to separately model the relationships between each of five intervention exposure variables and five outcomes for consistent condom use (CCU= always versus frequently/sometimes/never) with different sex partners, including with: all clients; occasional clients; most recent repeat client; most recent non-paying partner; and the husband or cohabiting partner. Linear tests for trends were conducted for three continuous intervention exposure variables. FSWs reported highest CCU with all clients (81.7%); CCU was lowest with FSWs’ husband or cohabiting partner (9.6%). In multivariable analysis, the odds of CCU with all clients and with occasional clients were 6.3-fold [95% confidence intervals, CIs: 2.8-14.5] and 2.3-fold [95% CIs: 1.4-4.1] higher among FSWs contacted by intervention staff and 4.9-fold [95% CIs: 2.6-9.3] and 2.3-fold [95% CIs: 1.3-4.1] higher among those who ever observed a condom demonstration by staff, respectively, compared to those who had not. A significant dose-response relationship existed between each of these CCU outcomes and increased duration since first contacted by staff (P=0.001; P=0.006) and numbers of condom demonstrations witnessed (P=0.004; P=0.026); a dose-response relationship was also observed between condom use with all clients and number of times contacted by staff (P=0.047). Intervention exposure was not associated with higher odds of CCU with the most recent repeat client, most recent non-paying partner or with the husband or cohabiting partner. Study findings suggest that exposure to a large-scale HIV intervention for FSWs was associated with increased CCU with commercial clients. Moreover, there were dose-response relationships between CCU with clients and increased duration since first contacted by staff, times contacted by staff and number of condom demonstrations. Additional program effort is required to increase condom use with non-commercial partners.