云南两地街头暗娼高危行为干预工作覆盖面及影响因素研究
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摘要
背景
异性性传播已成为我国艾滋病新发感染的主要途径,暗娼是其中重要的桥梁人群,街头暗娼是该人群中最易感染的群体。我国对该人群干预工作尚处于起步阶段,覆盖面有限,亟待发现工作中的问题,形成有效防治策略。
目的
1了解街头暗娼艾滋病/性病感染危险性及干预工作开展现况;
2估计街头暗娼规模和干预工作覆盖面;
3分析街头暗娼干预工作覆盖面的影响因素。
方法
选择云南省临沧市临翔区和德宏州潞西市为研究现场,采用定性和定量研究相结合的方式开展调查。定性研究采用参与式观察了解街头暗娼生活、性交易特点和分布情况以及干预工作流程,通过对CDC工作人员、街头暗娼、关键知情人等45名被访者进行深入访谈了解街头暗娼规模、干预工作开展情况及其相关看法:定量研究采用普查法估计街头暗娼规模,问卷调查收集街头暗娼活动特点、艾滋病/性病相关危险行为特征及其接受干预情况。根据定量研究结果估计干预覆盖面,综合定性研究结果分析干预覆盖面影响因素。
定性资料使用Nvivo 7.0软件进行存储、编码和管理,在描叙性分析基础上进行推断性分析;定量资料采用Epidata 3.0建立数据库,SPSS13.0进行分析。
结果
1两地街头暗娼的特征为:年龄跨度大、受教育程度低、流动性高、性交易无组织、频率高而价格低、安全套使用率低、部分存在吸毒行为、性病感染情况严重、嫖客以中青年和农民工居多;临翔区和潞西市该人群HIV阳性检出率分别为3.3%和20.93%;两地不同程度开展了针对街头暗娼人群的外展服务、同伴教育、艾滋病/性病检测、性病诊疗、健康知识培训班和姐妹联谊会等干预工作。
2普查法估计临翔区街头暗娼规模为108人,潞西市为155人;临翔区干预工作覆盖3处站桩点中的2处,居住地和人群覆盖率分别为83.33%和65.74%;潞西市干预工作覆盖最集中的1处站桩点,居住地和人群覆盖率分别31.81%为28.39%。
3街头暗娼高危行为干预工作覆盖面主要受街头暗娼活动特殊性、同伴宣传员作用、卫生部门开展的工作以及多部门合作四方面因素影响。其中卫生部门重视街头暗娼干预工作、掌握街头暗娼活动地点、同伴宣传员联络和号召作用以及加强与公安部门联系配合能够提高干预工作覆盖面;而该人群活动无组织性、戒备心强、对CDC和同伴宣传员的误解等,以及同伴宣传员欠缺沟通能力等,限制了干预覆盖面的提高。
结论
1两地街头暗娼人群艾滋病高危行为干预工作覆盖面不足,未能起到有效遏制艾滋病传播的作用。
2亟需提高街头暗娼干预工作覆盖面,采取针对该人群特点的干预措施,强化同伴宣传员作用,发展性病门诊为依托的外展服务模式,建立起街头暗娼人群的干预工作考核体制,以保证其长期效果。
Background
Heterosexual transmission has become one of the driving forces of the spread of HIV/AIDS in China. Commercial sex workers are the major bridging population for transmission, among whom street-based sex workers (SSWs) are the most vulnerable to HIV/AIDS. However, there is limited literature on the characteristics of interventions targeting SSWs and the extent of intervention coverage. Evidence-based research is therefore needed to better understand ongoing interventions, so as to ensure effective implementation.
Objective
1. To understand the HIV/AIDS risks SSWs are exposed to, and the interventions targeted at them.
2. To estimate the number of SSWs, and then evaluate the extent of intervention coverage.
3. To identify the associated factors influencing intervention coverage.
Methods
Two counties are selected in Yunnan province as study sites. Both qualitative and quantitative methodologies were employed in the field investigation. Qualitative methodologies used included participant observation and in-depth interviews to understand the sex trade environment and up to 45 participants (SSWs, peer-educators, clients, CDC staff, local citizens and policemen) were surveyed. Quantitative methodologies used included a census to estimate the number of local SSWs. Meanwhile a structured questionnaire was designed for SSWs in order to obtain information on their HIV/AIDS related risk behaviors and the intervention services they received. Through qualitative methodologies, the extent of intervention coverage was evaluated. Through quantitative methodologies, the associated factors influencing intervention coverage were identified.
All qualitative data were coded, sorted and conceptualized by Nvivo 7. 0 software. Deductive analysis was then applied based on the descriptive analysis. The quantitative data were inputted into a database established using Epidata 3.0 software, and analyzed using SPSS 13. 0 software.
Results
1. Local SSWs have a wide range of ages, are poorly educated and are highly mobile. Their sexual transactions are free of external control, resulting in dramatic high frequencies and low transaction prices. Condom use and its importance are not properly understood and drug abuse was sometimes reported. HIV positive rates among participants were 3.3% and 20.93% in Linxiang and Luxi respectively. The majority of clients were migrant labors. The interventions and health services SSWs received included out-reach services, peer-education, AIDS/STD testing and STD treatment, etc, which were primarily implemented by the local CDC,
2. It was estimated there were 108 and 155 street-based sex workers in Linxiang and Luxi respectively. In Linxiang, the intervention covered 2/3 of localities where SSWs found clients, 83. 33% of temporary rental accommodation, and 65.74% of the target population. In Luxi, the intervention covered the only location where SSWs found clients, 28.39% of temporary rental accommodation, and 25.81% of the target-population.
3. The major factors associated with influencing the intervention coverage included: the intervention capacity of local agencies, peer-education, the characteristics of SSWs and cross-sector government cooperation. Properly identifying the distribution and size of the local SSWs population, emphasizing on the intervention of the targeted population, supporting peer educators and strengthening communication with the local PSB (Public Security Bureau) were positive factors for good intervention coverage. Neglecting the importance of interventions among the target population by local agencies, the lack of capacity of peer educators, free control of sex transaction and misunderstanding of intervention services among SSWs were negative factors affecting intervention coverage.
Conclusions
1. Intervention coverage of SSWs is too low to effectively prevent HIV/AIDS transmission.
2. Immediate efforts should be made to; improve coverage of interventions targeted at SSWs; develop out-reach services based from STD clinics; and establish an intervention evaluation system in order to guarantee long term effectiveness.
异性性传播已成为我国艾滋病新发感染的主要途径,暗娼是其中重要的桥梁人群,街头暗娼是该人群中最易感染的群体。我国对该人群干预工作尚处于起步阶段,覆盖面有限,亟待发现工作中的问题,形成有效防治策略。
目的
1了解街头暗娼艾滋病/性病感染危险性及干预工作开展现况;
2估计街头暗娼规模和干预工作覆盖面;
3分析街头暗娼干预工作覆盖面的影响因素。
方法
选择云南省临沧市临翔区和德宏州潞西市为研究现场,采用定性和定量研究相结合的方式开展调查。定性研究采用参与式观察了解街头暗娼生活、性交易特点和分布情况以及干预工作流程,通过对CDC工作人员、街头暗娼、关键知情人等45名被访者进行深入访谈了解街头暗娼规模、干预工作开展情况及其相关看法:定量研究采用普查法估计街头暗娼规模,问卷调查收集街头暗娼活动特点、艾滋病/性病相关危险行为特征及其接受干预情况。根据定量研究结果估计干预覆盖面,综合定性研究结果分析干预覆盖面影响因素。
定性资料使用Nvivo 7.0软件进行存储、编码和管理,在描叙性分析基础上进行推断性分析;定量资料采用Epidata 3.0建立数据库,SPSS13.0进行分析。
结果
1两地街头暗娼的特征为:年龄跨度大、受教育程度低、流动性高、性交易无组织、频率高而价格低、安全套使用率低、部分存在吸毒行为、性病感染情况严重、嫖客以中青年和农民工居多;临翔区和潞西市该人群HIV阳性检出率分别为3.3%和20.93%;两地不同程度开展了针对街头暗娼人群的外展服务、同伴教育、艾滋病/性病检测、性病诊疗、健康知识培训班和姐妹联谊会等干预工作。
2普查法估计临翔区街头暗娼规模为108人,潞西市为155人;临翔区干预工作覆盖3处站桩点中的2处,居住地和人群覆盖率分别为83.33%和65.74%;潞西市干预工作覆盖最集中的1处站桩点,居住地和人群覆盖率分别31.81%为28.39%。
3街头暗娼高危行为干预工作覆盖面主要受街头暗娼活动特殊性、同伴宣传员作用、卫生部门开展的工作以及多部门合作四方面因素影响。其中卫生部门重视街头暗娼干预工作、掌握街头暗娼活动地点、同伴宣传员联络和号召作用以及加强与公安部门联系配合能够提高干预工作覆盖面;而该人群活动无组织性、戒备心强、对CDC和同伴宣传员的误解等,以及同伴宣传员欠缺沟通能力等,限制了干预覆盖面的提高。
结论
1两地街头暗娼人群艾滋病高危行为干预工作覆盖面不足,未能起到有效遏制艾滋病传播的作用。
2亟需提高街头暗娼干预工作覆盖面,采取针对该人群特点的干预措施,强化同伴宣传员作用,发展性病门诊为依托的外展服务模式,建立起街头暗娼人群的干预工作考核体制,以保证其长期效果。
Background
Heterosexual transmission has become one of the driving forces of the spread of HIV/AIDS in China. Commercial sex workers are the major bridging population for transmission, among whom street-based sex workers (SSWs) are the most vulnerable to HIV/AIDS. However, there is limited literature on the characteristics of interventions targeting SSWs and the extent of intervention coverage. Evidence-based research is therefore needed to better understand ongoing interventions, so as to ensure effective implementation.
Objective
1. To understand the HIV/AIDS risks SSWs are exposed to, and the interventions targeted at them.
2. To estimate the number of SSWs, and then evaluate the extent of intervention coverage.
3. To identify the associated factors influencing intervention coverage.
Methods
Two counties are selected in Yunnan province as study sites. Both qualitative and quantitative methodologies were employed in the field investigation. Qualitative methodologies used included participant observation and in-depth interviews to understand the sex trade environment and up to 45 participants (SSWs, peer-educators, clients, CDC staff, local citizens and policemen) were surveyed. Quantitative methodologies used included a census to estimate the number of local SSWs. Meanwhile a structured questionnaire was designed for SSWs in order to obtain information on their HIV/AIDS related risk behaviors and the intervention services they received. Through qualitative methodologies, the extent of intervention coverage was evaluated. Through quantitative methodologies, the associated factors influencing intervention coverage were identified.
All qualitative data were coded, sorted and conceptualized by Nvivo 7. 0 software. Deductive analysis was then applied based on the descriptive analysis. The quantitative data were inputted into a database established using Epidata 3.0 software, and analyzed using SPSS 13. 0 software.
Results
1. Local SSWs have a wide range of ages, are poorly educated and are highly mobile. Their sexual transactions are free of external control, resulting in dramatic high frequencies and low transaction prices. Condom use and its importance are not properly understood and drug abuse was sometimes reported. HIV positive rates among participants were 3.3% and 20.93% in Linxiang and Luxi respectively. The majority of clients were migrant labors. The interventions and health services SSWs received included out-reach services, peer-education, AIDS/STD testing and STD treatment, etc, which were primarily implemented by the local CDC,
2. It was estimated there were 108 and 155 street-based sex workers in Linxiang and Luxi respectively. In Linxiang, the intervention covered 2/3 of localities where SSWs found clients, 83. 33% of temporary rental accommodation, and 65.74% of the target population. In Luxi, the intervention covered the only location where SSWs found clients, 28.39% of temporary rental accommodation, and 25.81% of the target-population.
3. The major factors associated with influencing the intervention coverage included: the intervention capacity of local agencies, peer-education, the characteristics of SSWs and cross-sector government cooperation. Properly identifying the distribution and size of the local SSWs population, emphasizing on the intervention of the targeted population, supporting peer educators and strengthening communication with the local PSB (Public Security Bureau) were positive factors for good intervention coverage. Neglecting the importance of interventions among the target population by local agencies, the lack of capacity of peer educators, free control of sex transaction and misunderstanding of intervention services among SSWs were negative factors affecting intervention coverage.
Conclusions
1. Intervention coverage of SSWs is too low to effectively prevent HIV/AIDS transmission.
2. Immediate efforts should be made to; improve coverage of interventions targeted at SSWs; develop out-reach services based from STD clinics; and establish an intervention evaluation system in order to guarantee long term effectiveness.
引文
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[1]中英性病艾滋病防治合作项目.艾滋病高危人群规模的估计方法.2002:3-9.
[2]吕繁,张大鹏,贺雄,等.艾滋病高危人群基数估计及其方法.中华流行病学杂志[J].2003,24(n):987-990.
[3]张大鹏,王丽艳,孙良先,等.普查法与乘数法估计暗娼人群基数方法学的试点研究.中国艾滋病性病[J],2005,11(4):282-284.
[4]赵金扣,马小燕,王丽艳,等.用于难以接近人群的一种新的抽样方法:同伴推动抽样法(RDS).疾病控制杂志,2005,9(6):634-636.