基于暗娼收集性伴精液检测HIV的可行性及相关因素分析

Study on the feasibility and related factors on semen samples from condoms, collected from sexual partners of and by the female sex workers for HIV-antibody testing

目的探讨通过女性性工作者（FSWs）的男性伴安全套中的精液（套存精液）进行HIV检测的可行性及相关影响因素。方法通过外展人员招募FSWs，对与之发生性行为的男性伴（嫖客或固定性伴）的套存精液进行HIV检测，然后对FSWs及其男性伴进行问卷调查，并对FSWs及其男性伴的静脉血进行HIV检测。结果共招募了54名FSWs、57名嫖客和43名固定性伴，FSWs、嫖客及固定性伴血清学HIV阳性率分别为33．33％、29．82％和23．26％；嫖客和固定性伴精液HIV阳性率分别为40．35％和30．23％，这两类精液的HIV抗体检测灵敏度均为100％，特异度分别为85．00％和90．91％。单因素分析显示，FSWs自我报告共用注射器吸毒行为及男性伴有子女这两个因素与血液和精液HIV抗体检测不一致有关。结论套存精液HIV抗体检测特异度较低，其原因可能为套存精液标本受到HIV阳性FSWs的污染，所以基于FSWs收集男性伴套存精液进行HIV检测可能高估这两类人群的HIV感染率。

Objective To explore the feasibility and related factors of using semen samples from condoms collected by their female sex workers （FSWs） for HIV-antibody testing. Methods FSWs were recruited by outreach workers. Semen samples from condoms of their sexual partners （paid or regular） were collected by FSWs themselves after intercourse and for HIV testing. Male partners were asked to participate in the study. Questionnaires were administered for both FSWs and their male sexual partners. Blood samples were also collected for HIV testing. Results In total, 54 FSWs with 43 of their regular sexual partners and 57 casual clients were recruited. HIV prevalence, determined from serum samples, were 33.33% among FSWs, 29.82% and 23.26% among their clients and regular sexual partners. 40.35% and 30.23% of the semen samples from the condoms they used, were tested positive for HIV among clients and regular sexual partners of the FSWs. The sensitivity of semen samples from condoms for HIV-antibodies was 100% among both clients and regular sexual partners of the FSWs, while the rates of specificity were 85.00% and 90.91% respectively. Data from Univariate analysis indicated that among FSWs, factors as the characteristics of self-reported needle sharing and the male sexual partners who had one child, were associated with the disparity between serum and condom semen sample for HIV-antibody testing. Conclusion HIV prevalence in male clients and regular sexual partners of the FSWs might be overestimated according to the HIV-antibody testing results of semen samples from condoms collected by FSWs themselves. Lower specificity indicated that FSWs with positive HIV might have contaminated the semen samples from the condom used by their HIV negative sexual partners.