HIV infection risk and condom use among sex workers in Senegal: evidence from the list experiment method
HIV infection risk and condom use among sex workers in Senegal: evidence from the list experiment method
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DOI：
10.1093/heapol/czz155
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发表时间：
2020-05-01
影响因子：
3.2
通讯作者：
Vickerman, Peter
中科院分区：
文献类型：
--
作者：
Lepine, Aurelia;Treibich, Carole;Vickerman, Peter
社会期望偏差，这是一种倾向，低估了社会不良的健康行为，显着扭曲的信息，从自我报告中获得的敏感行为。因此，高危人群自我报告的避孕套使用情况被认为是系统性的过度报告，而且不可能确定避孕套使用的决定因素。本文的主要目的是获得公正的信息，女性性工作者（FSWs）使用安全套使用的双重列表实验方法来分析的作用，艾滋病病毒感染和暴露于艾滋病病毒的预防方法。更具体地说，估计艾滋病毒阳性和艾滋病毒阴性的FSW之间的避孕套使用水平的差异。此外，FSW的登记和参与暴露前预防（PrEP）示范项目在安全套使用的作用。一项列表实验旨在从2015年和2017年接受调查的塞内加尔786名FSW中获取安全套使用信息。使用列表实验方法，参与者被随机分配到两组（治疗组或对照组）中的一组，并被要求报告他们同意的陈述的数量。被分配到对照组的受访者被呈现三个非敏感项目，而被分配到治疗组的受访者被呈现相同的三个陈述加上敏感项目（例如，“我在与客户的最后一次性交中使用了避孕套”）。比较两组同意的平均句子数量，可以估计治疗组的避孕套使用率，估计几个亚组的流行率，可以确定艾滋病毒感染风险在避孕套使用中的作用。在2015年和2017年，女性性工作者在与客户的最后一次性交中使用安全套的比例分别为80%和78%，这明显低于两波面对面调查中获得的97%。在使用列表实验法估计各亚组的安全套使用情况时，我们发现HIV阳性FSW中的安全套使用率仅为34%，比HIV阴性FSW中的安全套使用率低47个百分点。我们还发现，注册的FSW比秘密的FSW更有可能使用避孕套。然而，我们没有发现参加PrEP示范项目的FSW和未参加的FSW之间的安全套使用有任何差异。因此，卫生政策的目标应该是增加艾滋病毒阳性的FSW中安全套的使用。
Social desirability bias, which is the tendency to under-report socially undesirable health behaviours, significantly distorts information on sensitive behaviours that is gained from self-reports. As a result, self-reported condom use among high-risk populations is thought to be systematically over-reported, and it is impossible to identify the determinants of condom use. The main objective of the article is to elicit unbiased information on condom use among female sex workers (FSWs) using the double list experiment method to analyse the role of HIV infection and exposure to HIV prevention methods in condom use. More specifically, the difference in levels of condom use between HIV-positive and HIV-negative FSWs is estimated. In addition, the role of FSWs' registration and participation in a pre-exposure prophylaxis (PrEP) demonstration project in condom use is considered. A list experiment was designed to elicit condom use information from 786 FSWs in Senegal who were surveyed in 2015 and 2017. Using the list experiment method, participants were randomly assigned to one of two groups (treatment or control) and were asked to report the number of statements they agreed with. Respondents assigned to the control group were presented with three non-sensitive items, whereas those allocated to the treatment group were presented with the same three statements plus the sensitive item (e.g. 'I used a condom during my last intercourse with a client'). Comparing the average number of sentences that were agreed with in both groups provides an estimation of the condom use rate in the treatment group and estimating such prevalence for several sub-groups allows the role of HIV infection risk in condom use to be identified. The percentage of FSWs using condoms in their last sexual intercourse with a client was 80% in 2015 and 78% in 2017, which was significantly lower than the 97% obtained in the face-to-face surveys in both waves. When estimating condom use among sub-groups with the list experiment method, we found that condom use among HIV-positive FSWs was only 34%, which was 47 percentage points lower than condom use among HIV-negative FSWs. We also found that registered FSWs are more likely to use condoms than clandestine FSWs. However, we did not find any difference in condom use between FSWs who were enrolled in the PrEP demonstration project and those who were not enrolled. Health policies should therefore aim to increase condom use among HIV-positive FSWs.