Alcohol use and associated risk factors among female sex workers in low- and middle-income countries: A systematic review and meta-analysis.
Alcohol use and associated risk factors among female sex workers in low- and middle-income countries: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pgph.0001216
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发表时间：
2023
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由于其在性工作行业的广泛使用，低收入和中等收入国家（LMIC）的女性性工作者（FSW）处于有害酒精使用和相关不良健康结果的高风险之中。与有害饮酒有关的因素包括暴力、心理健康问题、吸毒、危险性行为和艾滋病毒/性传播感染。据我们所知，迄今为止还没有定量合成FSW酒精使用数据。本系统性综述和荟萃分析旨在估计中低收入国家FSW中有害酒精使用的患病率，并研究与常见健康和社会问题的关联。审查方案已在PROSPERO注册，编号CRD 42021237438。我们检索了三个电子数据库，以获得从开始到2021年2月24日的同行评议定量研究。入选的研究报告了根据世界银行2019年收入组定义为LMIC的国家中18岁或以上的FSW饮酒的流行率或发生率。包括以下研究设计：横断面调查、病例对照研究、队列研究、病例系列分析或酒精使用基线测量的实验研究。使用循证管理中心（CEBMa）批判性评估工具评估研究质量。计算了以下方面的合并患病率估计值：（i）任何危险/有害/依赖性酒精使用，（ii）仅有害/依赖性酒精使用，包括总体和各地区，以及（iii）每日酒精使用。荟萃分析研究了有害的酒精使用与暴力、安全套使用、艾滋病毒/性传播感染、精神健康问题和其他毒品使用之间的关联。共检索到435篇论文。经过筛选，99篇论文报告了87项独特的研究，来自32个LMIC的51，904名参与者符合纳入标准。研究设计包括横断面（n = 89）、队列（n = 6）和实验（n = 4）。总体而言，5项研究被评为高质量，79项研究被评为中等质量，15项研究被评为低质量。29篇论文报告了22项独特的研究，使用了经过验证的酒精使用工具，包括AUDIT，CAGE和WHO CIDI。任何危险/有害/依赖性饮酒的合并患病率为41%（95% CI：31-51%），每日饮酒的患病率为26%（95% CI：17-36%）。全球各区域的有害酒精使用情况各不相同（撒哈拉以南非洲：38%;南亚/中亚/东亚和太平洋：47%;拉丁美洲和加勒比：44%）。有害酒精使用与不一致的避孕套使用（合并未校正的RR：1.65; 95% CI：1.01-2.67），性传播感染（合并未校正的OR：1.29; 95% CI 1.15-1.46）和其他药物使用（合并未校正的OR为2.44; 95% CI 1.24-4.80）显著相关，但与艾滋病毒，暴力或心理健康问题无关。我们发现，在中低收入国家的女性性工作者中，问题酒精使用和日常酒精使用的患病率很高。有害饮酒与重要的艾滋病毒风险因素有关，如不一致使用避孕套，性传播感染和其他药物使用。主要的局限性包括测量酒精使用和其他常见风险因素的工具和截止分数的异质性，以及缺乏纵向研究。迫切需要为中低收入国家的FSW提供量身定制的干预措施，以解决酒精使用以及相关的性工作风险环境。
Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. Factors associated with harmful alcohol use include violence, mental health problems, drug use, sexual risk behaviors and HIV/STIs. To our knowledge, there has been no quantitative synthesis of FSW alcohol use data to date. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns. The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021. Studies were selected for inclusion that reported any measure of prevalence or incidence of alcohol use among FSWs aged 18 or older from countries defined as LMIC in accordance with the World Bank income groups 2019. The following study designs were included: cross-sectional survey, case–control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use. Study quality was assessed with the Center for Evidence-Based Management (CEBMa) Critical Appraisal Tool. Pooled prevalence estimates were calculated for (i) any hazardous/harmful/dependent alcohol use, (ii) harmful/dependent alcohol use only, both overall and by region and (iii) daily alcohol use. Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use. In total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31–51%), and of daily alcohol use was 26% (95% CI: 17–36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01–2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15–1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24–4.80), but not with HIV, violence or mental health problems. We found a high prevalence of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with important HIV risk factors such as inconsistent condom use, STIs and other drug use. Major limitations included heterogeneity in tools and cut-off scores to measure alcohol use and other common risk factors, and a paucity of longitudinal studies. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment.