暗娼与性伴之间安全套协商使用情况分析

Analysis on condom use negotiation with sex partners and condom use in female sex workers

目的了解暗娼与嫖客或固定性伴之间安全套协商和使用情况,为暗娼的艾滋病综合干预措施的制定提供参考依据。方法采用横断面调查,于2018年4-6月在云南省红河哈尼族彝族自治州蒙自市、建水县,依托娱乐服务场所招募≥16岁暗娼,估算样本量需476人,问卷调查收集其人口学特征、安全套协商及使用情况信息。采用logistic回归模型分析暗娼与不愿使用安全套的嫖客协商后安全套使用的影响因素。结果共调查暗娼852人,年龄(24.29±8.44)岁。最近1个月性行为,有58.6%(499/852)的暗娼每次都要求嫖客使用安全套但嫖客不愿使用,协商后有88.4%(441/499)的暗娼每次与嫖客都使用安全套。有14.4%(99/687)的暗娼每次都要求固定性伴使用安全套,但固定性伴不愿使用,经协商后,54.5%(54/99)暗娼与固定性伴每次都使用安全套。最近1个月,暗娼说服不愿使用安全套的嫖客时,53.3%(266/499)的采用“强制要求”策略,19.4%(97/499)的采用“风险说服”策略,23.1%(115/499)的采用“强制要求及风险说服”策略,4.2%(21/499)的采用其他策略协商。4.4%(22/499)的暗娼感觉说服嫖客使用安全套困难。多因素logistic回归分析结果显示,和感觉说服嫖客使用安全套困难的暗娼相比,难度适中(OR=4.00,95% CI:1.55~10.32)、容易(OR=30.17,95% CI:3.22~282.44)的暗娼更容易成功协商嫖客每次都使用安全套。和采用其他策略与嫖客协商使用安全套的暗娼相比,采用“强制要求”策略者(OR=4.44,95% CI:1.41~14.01)、采用“强制要求及风险说服”策略者(OR=5.52,95% CI:1.55~19.73)更容易成功协商嫖客每次都使用安全套。结论通过安全套协商策略,可促使不愿使用安全套的嫖客使用安全套。采用“强制要求”策略更容易成功协商嫖客每次都使用安全套,结合“风险说服”策略更有利于成功协商。

Objective To know condom use negotiation with clients and regular sex partners and condom use in female sex workers (FSWs), and provide reference for the development of comprehensive HIV/AIDS intervention for FSWs. Methods The cross sectional survey was conducted in Jianshui county and Mengzi county in Honghe Hani and Yi autonomous prefecture. A total of 476 FSWs aged 16 years and above were recruited from entertainment venues, and the information about their demographic characteristics, condom use negotiation and condom use were collected by using questionnaires. Logistic regression model was used to analyze related factors of condom use after negotiation between FSWs and clients unwilling use condom. Results A total of 852 FSWs who aged (24.29±8.44) years old participated in the survey. In past month, 499 FSWs had negotiation for condom use with unwilling clients (58.6%, 499/852), after negotiation, 441 FSWs (88.4%, 441/499) had consistent condom use in each sex with the clients. In the past one month, 99 FSWs had negotiation for unwilling use condom with regular sex partners (14.4%, 99/687), after negotiation, 54 FSWs (54.5%, 54/99) had consistent condom use in each sex with regular sex partners. Among the FSWs, 266 (53.3%, 266/499) reported that they could say "It is a mandatory requirement" to persuade clients who were unwilling to use condom. 97(19.4%, 97/499) reported that they could say "There is risk for infection" to persuade clients who were unwilling to use condoms. 115 (23.1%, 115/499) reported that they could say "It is a mandatory requirement" and "there is risk for infection" to persuade their unwilling clients to use condoms. 21 (4.2%, 21/499) reported that they used other strategies. 22 (4.4%, 22/499) felt that it was difficult to persuade clients to use condoms. Multivariate logistic regression analysis showed that compared with FSWs who felt difficult in persuading clients to use condoms, FSWs who felt moderate difficulty were more likely to have consistent condom use after negotiation (OR=4.00, 95%CI:1.55-10.32) and FSWs who felt easy in persuading clients to use condoms were also more likely to have consistent condom use (OR=30.17, 95%CI:3.22-282.44). Compared with FSWs used other strategies to persuade their clients to use condoms, FSWs who said it was a mandatory requirement were more likely to have consistent condom use after negotiation (OR=4.44, 95%CI:1.41-14.01) and FSWs who said it was a mandatory requirement and there was risk for infection were also more likely to have consistent condom use (OR=5.52, 95%CI:1.55-19.73). Conclusions Negotiation for condom use increased the rate of condom use in FSWs in sex with clients who were unwilling to use condom. The negotiation strategy of "It is a mandatory requirement" would promote condom use in FSWs in sex with clients who were unwilling to use condom. Besides, the negotiation strategy of saying "there is risk for infection" had additional effects.