PrEP and the syndemic of substance use, violence, and HIV among female and male sex workers: a qualitative study in Kisumu, Kenya
PrEP and the syndemic of substance use, violence, and HIV among female and male sex workers: a qualitative study in Kisumu, Kenya
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DOI：
10.1002/jia2.25266
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发表时间：
2019-04-01
影响因子：
6
通讯作者：
Syvertsen, Jennifer L.
中科院分区：
文献类型：
--
作者：
Bazzi, Angela R.;Yotebieng, Kelly;Syvertsen, Jennifer L.
简介：女性和男性性工作者更容易感染艾滋病毒和其他健康危害，而药物使用、身体暴力和性暴力以及获得保健服务的机会有限又加剧了这一问题。在肯尼亚的基苏穆，性工作很普遍，药物使用是一个日益严重的公共卫生问题，为预防艾滋病毒提供暴露前预防（PrEP）可能有助于遏制艾滋病毒的流行。我们的研究探讨了“syndemics”，或物质使用，暴力和艾滋病毒相互加强的流行病，在肯尼亚的女性和男性性工作者之间的PrEP接受性和可行性，这是第一个批准PrEP用于预防艾滋病毒的非洲国家之一。从2016年到2017年，基苏穆报告最近酗酒或吸毒和暴力经历的性工作者参加了关于艾滋病毒风险和对保健服务需求的看法的定性访谈，包括PrEP编程。内容分析确定的主题有关PrEP知识，可接受性，访问的挑战和交付preferences.Results：在45名女性和28名男性性工作者，年龄中位数分别为28和25。所有参与者都报告了上个月的饮酒情况，91%的女性和82%的男性报告了上个月的吸毒情况。暴力行为普遍存在，大多数妇女和男子报告去年遭受过身体暴力（96%妇女，86%男子）和性暴力（93%妇女，79%男子）。关于PrEP，访谈显示：（1）PrEP知识较低，尤其是女性;（2）PrEP可接受性和感知需求较高，尤其是在药物使用和暴力的流行病背景下;（3）偏好使用性工作者的投入设计的无障碍、非污名化的PrEP交付举措。通过一个综合性的透镜，物质使用和暴力相互作用，增加艾滋病毒的脆弱性和认识到需要在基苏穆的女性和男性性工作者之间的PrEP。虽然对PrEP的兴趣很高，但我们样本中的大多数性工作者，特别是女性，并没有从中受益。性工作者所经历的并发症药物使用和暴力对性工作者获得PrEP构成了重要障碍。增加性工作者获得PrEP的机会将需要通过综合规划解决药物使用和暴力问题。
Introduction: Female and male sex workers experience heightened vulnerability to HIV and other health harms that are compounded by substance use, physical and sexual violence, and limited access to health services. In Kisumu, Kenya, where sex work is widespread and substance use is a growing public health concern, offering pre-exposure prophylaxis (PrEP) for HIV prevention could help curtail the HIV epidemic. Our study examines "syndemics," or mutually reinforcing epidemics of substance use, violence and HIV, in relation to PrEP acceptability and feasibility among female and male sex workers in Kenya, one of the first African countries to approve PrEP for HIV prevention.Methods: From 2016 to 2017, sex workers in Kisumu reporting recent alcohol or drug use and experiences of violence participated in qualitative interviews on HIV risk and perspectives on health service needs, including PrEP programming. Content analysis identified themes relating to PrEP knowledge, acceptability, access challenges and delivery preferences.Results: Among 45 female and 28 male sex workers, median age was 28 and 25 respectively. All participants reported past-month alcohol use and 91% of women and 82% of men reported past-month drug use. Violence was pervasive, with most women and men reporting past-year physical (96% women, 86% men) and sexual (93% women, 79% men) violence. Concerning PrEP, interviews revealed: (1) low PrEP knowledge, especially among women; (2) high PrEP acceptability and perceived need, particularly within syndemic contexts of substance use and violence; and (3) preferences for accessible, non-stigmatizing PrEP delivery initiatives designed with input from sex workers.Conclusions: Through a syndemic lens, substance use and violence interact to increase HIV vulnerability and perceived need for PrEP among female and male sex workers in Kisumu. Although interest in PrEP was high, most sex workers in our sample, particularly women, were not benefiting from it. Syndemic substance use and violence experienced by sex workers posed important barriers to PrEP access for sex workers. Increasing PrEP access for sex workers will require addressing substance use and violence through integrated programming.