HIV抗体阳性和阴性暗娼的行为学差异分析

Study on Behavioral Change between HIV Positive and HIV Negative Female Sex Workers

目的分析艾滋病病毒（HIV）抗体阳性与阴性暗娼的高危行为,为开展针对性的干预工作提供科学的依据。方法以2012-2013年暗娼哨点监测中发现的既往已报告的HIV感染者作为HIV抗体阳性组,按1∶2配比选择HIV抗体阴性者作为阴性组。比较两组间在人口学特征、高危行为、安全套使用率及接受干预服务等差异。结果 2012-2013年暗娼哨点共发现既往HIV感染者224例,共匹配205对。HIV抗体阳性组最近一个月与客人性行为时坚持使用安全套的比例为88.8%,HIV抗体阴性组为80.7%,粗比值比（OR）值为2.273,95%可信区间（CI）：1.271～4.066,调整后OR值为2.178,95%CI：1.053～4.505;既往HIV阳性暗娼亚组分析中,除艾滋病知识知晓率（报告年限1年以上组高于1年以内组,P=0.036）,其余各因素在是否接受抗病毒治疗和报告年限亚组中差异均无统计学意义。结论 HIV阳性暗娼在知晓阳性结果后,高危行为有所改进,但仍存在感染嫖客的危险,且干预效果不受报告年限影响。常规干预措施对该人群效果不明显,应积极探索早期抗病毒治疗等有效干预手段,借助社区组织等感染者小组干预模式,进一步加强对阳性暗娼的管理。

Objective To analyze the behavior change before and after human immunodeficiency virus（HIV）infection of female sex workers（FSW）,and evaluate the effectiveness of FSW behavior intervention.Methods FSW infected with HIV were designed as a case group based on 2012-2013 sentinel surveillance database,and HIV negative group of FSW set-up as a control group at the ratio of 1∶2.FSW of the control group came from the same sentinel surveillance areas,with the age difference not more than 5years old and no drug-use.The demographic,behavioral and intervention information were analyzed to compare the difference between the case and control groups.Openepi 3.02 was used for sample size calculation and SPSS 18 used for data analysis.P value not more than0.05 was considered statistically significant.Results A number of 224 FSW infected with HIV was detected via FSW sentinel surveillance during 2012-2013.The proportion of always using condom with clients in the last month showed statistical significance between case and control groups,with crude OR2.273（95% CI：1.271～4.066）and adjusted OR2.178（95%CI：1.053～4.505）;no statistical significance was found among the subgroups of ART and years of HIV diagnosis except for awareness of HIV related knowledge（P=0.036）.Conclusion After FSW are aware of their HIV infection status,the proportion of the high risk behavior declined.However,the danger of HIV infection still exists,and the effect of behavior intervention appeared unobvious in the follow-up of the FSW infected with HIV.It is necessary to conduct the targeted intervention for FSW infected with HIV and explore the behavior intervention model in cooperation with CBO.