山东省女性性工作者安全套使用情况及影响因素分析

Analysis of condom use and its factors on female sex workers in Shandong province

目的 了解山东省女性性工作者人群安全套的使用情况及其影响因素.方法 根据山东省各市AIDS疫情、地理位置、经济状况等分布状况选取11个地市,2009年4-7月份对选取地区的4732名女性性工作者进行匿名问卷调查,采集血清样本4641人份,采用血清ELISA法和胶体金法进行相关的抗体检测.结果 共调查女性性工作者4732名,年龄范围在15～58岁,以低年龄组（≤24岁）为主,占61.5%（2912/4732）;婚姻状况以未婚、离异或丧偶者为主,占72.8%（3441/4725）;文化程度以初中及以下为主,占72.0%（3403/4726）;外省户籍的占42.3%（1994/4719）.根据不同类别场所来源可将样本分为高档场所组和低档场所组.对AIDS知识回答全部正确者占45.7%（2164/4732）,最近一次商业性行为时使用安全套者占80.6%（3416/4236）,最近1个月商业性行为每次都使用安全套者占58.4%（2467/4221）,在调查对象中有7.3%（337/4637）的人承认曾被诊断患性病,30.7%（1449/4726）的人承认曾做过HIV抗体检测,70.4%（3323/4732）的人曾接受过AIDS性病的干预服务,3.6%（167/4668）的人承认有吸毒史.经多因素logistic回归分析结果显示：高文化程度（初中及以下对高中及以上,调整的OR=0.77,95%CI：0.67～0.90）、接受过AIDS干预（接受对未接受,调整的OR=1.36,95%CI：1.17～1.58）及抗体检测（做过对未做过,调整的OR=1.33,95%CI：1.15～1.55）、AIDS知识了解较好（低分组对高分组,调整的OR=0.37,95%CI：0.32～0.44）等因素是增加安全性行为的独立影响因素,而吸毒行为（吸毒对不吸毒,调整的OR=0.22,95%CI：0.15～0.31）则是增加不安全性行为的独立影响因素.结论 目前山东省女性性工作者人群HIV感染率总体上仍处于较低水平,但安全套的低使用率和性病的高流行现象提示需关注影响该人群高危行为的因素,采取更加有针对性的干预措施.

Objective This study was to investigate the condom use and its factors on sex workers in Shandong province, and to provide effective suggestions for AIDS prevention strategies and interventions. Methods From April to July in 2009,4732 female sex workers were investigated through anonymous questionnaires from 11 cities which were selected based on the AIDS epidemic, geographic location, economic conditions in Shandong province. Serum samples were collected and antibodies were tested by ELISA and TPPA from 4641 people. Results 4732 female sex workers who were 15 -58 years old were investigated and the majority belonged to the low age group （ ≤24 years old） which accounted for 61.5%（2912/4732）. Among the 4732 female sex workers, the unmarried, the divorced,or the widowed females accounted for 72. 8% （ 3441/4725 ） and 72.0% （ 3403/4726 ） of them were poorly educated. 42. 3%（1994/4719） of them were found from other provinces. The right answers for knowledge of AIDS accounted for 45.7% （2164/4732）. 80. 6% （3416/4236） of these females were found to used condoms in the most recent commercial sex activity. The rate of consistently using condoms in sex activity during the last month was 58.4% （2467/4221）. In this survey ,7.3% （337/4637） of investigated females had been diagnosed with sexually transmitted diseases, 30. 7% （ 1449/4726 ） of them had received HIV antibody test, 70. 4%（3323/4732） of these people had received the AIDS intervention services, and 3.6% （ 167/4668 ） of them had ever used drug. Multivariate logistic regression analysis showed that high education level （junior high school or lower vs senior high school or higher, adjusted OR= 0. 77,95% CI：0. 67 - 0. 90 ） , having received the HIV intervention （ received vs unreceived,adjusted OR= 1. 36,95% CI： 1.17 - 1.58 ） ,antibody detection （done vs not done,adjusted OR = 1.33,95% CI： 1.15 - 1.55） ,and good knowledge about AIDS （ low score group vs high score group, adjusted OR = 0. 37, 95% CI： 0. 32 - 0. 44 ） were independent factors that increased safe sex behavior; while using drug （ drug vs not drug,adjusted OR =0. 22,95% CI：0. 15 -0. 31 ）was a negative factor. Conclusion The prevalence rate of HIV infection among female sex workers was low in Shandong province. However, the low rate of condom use and the high prevalence of self-reported STD-related symptoms suggested that more attentions should be paid to the factors of risk behaviors, and more targeted interventions are critically needed.