Combination HIV prevention for female sex workers: what is the evidence?
Combination HIV prevention for female sex workers: what is the evidence?
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DOI：
10.1016/s0140-6736(14)60974-0
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发表时间：
2015-01-03
期刊：
影响因子：
168.9
通讯作者：
Cates, Willard, Jr.
中科院分区：
文献类型：
--
作者：
Bekker, Linda-Gail;Johnson, Leigh;Cates, Willard, Jr.
性工作有多种形式，全世界所有性别的性工作者都受到艾滋病毒流行的影响。与性工作有关的艾滋病毒风险的决定因素发生在几个层面上，包括个人生物和行为、二元和网络以及社区和社会环境层面。有证据表明，为性工作者提供有效的艾滋病毒预防一揽子计划应包括针对当地情况量身定做的生物医学、行为和结构性干预措施的组合，并由性工作者社区领导和实施。一个基于南非异性恋流行的模型模拟表明，南非的避孕套推广和分发计划已经将性工作者及其客户的艾滋病毒发病率降低了70%以上。在乐观的模型假设下，暴露前口服预防以及检测和治疗方案可以在10年内将南非性工作者及其客户的艾滋病毒发病率进一步降低40%。将这些生物医学方法与包括行为和结构组成部分在内的一揽子预防措施结合起来，作为社区驱动方法的一部分，将有助于减少世界各地不同环境中性工作者的艾滋病毒感染。
Sex work occurs in many forms and sex workers of all genders have been affected by HIV epidemics worldwide. The determinants of HIV risk associated with sex work occur at several levels, including individual biological and behavioural, dyadic and network, and community and social environmental levels. Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. A model simulation based on the South African heterosexual epidemic suggests that condom promotion and distribution programmes in South Africa have already reduced HIV incidence in sex workers and their clients by more than 70%. Under optimistic model assumptions, oral pre-exposure prophylaxis together with test and treat programmes could further reduce HIV incidence in South African sex workers and their clients by up to 40% over a 10-year period. Combining these biomedical approaches with a prevention package, including behavioural and structural components as part of a community-driven approach, will help to reduce HIV infection in sex workers in different settings worldwide.