娱乐休闲场所女性性服务者医学外展服务研究

Study on medical outreach services in female sex workers of a sauna bath place in Shanghai city

目的 评价医务人员多次系统定期地连续对目标人群提供常规性传播疾病筛查、及时规范的治疗和医疗咨询等医学外展工作对预防控制性传播疾病和艾滋病（STDs／AIDS）的意义与作用。方法 选择上海市区1所综合性娱乐休闲场所，以其中从事女性性服务的人员为研究对象，于2003年4月和9月、2004年3月和10月，分4次进行性卫生与性传播疾病流行病学调查，同时提供医学外展服务。结果 4次共调查女性性服务者205人，获得有效资料191人，平均年龄为24．39～25．03岁。工作经历以娱乐休闲场所为主；对常见的STDs知晓率较低，5种疾病（艾滋病、淋病、尖锐湿疣和梅毒等4种性传播疾病＋肝炎）全部知晓率51．8％；从第1次调查到第4次调查，预防用药率、就医率和安全套使用率均呈上升趋势，但仅预防用药率第4次和前3次相比，差异有统计学意义（P〈0．001）；各次调查的阴道冲洗率均在70％以上，各次的疾病检出率差异无统计学意义（P=0．394）。第1次调查时，细菌性阴道炎、霉菌和滴虫的检出率（34．0％）高于以后3次调查的检出率（分别为18．2％，14．9％和12．8％；x^2=7．688，P=0．006）；未检出淋病奈瑟球菌（GN）和人类免疫缺陷病毒（HIV）抗体阳性者。结论 医学外展服务可及时发现治疗病人，减少传染源，切断传播链，可提高医学服务的可及性，对改善特定人群的高危行为有一定促进作用。

Objective To evaluate the performance in which systemic continuous medical outreach services and surveillance of sexually transmitted disease（STDs） were provided to the sauna female workers; to explore better ways to control the STDs epidemic. Methods In April 2003, September 2003, March 2004 and October 2004, systemic periodic medical services and surveillance were provided to the sauna female workers and collected their characteristics possibly associated with STDs. Results Among the four surveys, the average ages were fiom 24.39 to 25.03. Their prior experiences all were in the recreation location（bar, sauna, KTV and so on）. The rates of knowing the names of common STDs all were low, and the rate of knowing the names of four kinds STDs and hepatitis was 51.8 % ;the rates in the forth smurvey were different from the former surveys significantly（ P 〈 0. 001 ）. The rates of douching keep in high level（all up to 70 % ）. The differences of the incidences of STDs were not statistically significant（ P = 0. 394）, the rate of the abnormal results in the leucorrhea routine examining（including bacteria vaginitis, mycosis and trichomoniasis）in the first survey（34.0 % ）was higher than those in the other surveys（ 18.2 %, 14.9 % and 12.8 %, P = 0. 006）. No HTV infection and gonorrhea were detected. Conclusion Though the performance, the STDs could be detected and rational therapies could be provided timely to cut down the chain of transmitting STDs; to enhance the female sauna workers＇ ability; to access to the medical services, and to promote their behaviors on their own lmtlatlves.