HIV阳性暗娼行为学特征及干预管理初探

Analysis on behavioral characteristics and intervention management of HIV positive illicit prostitution

[目的]了解HIV抗体阳性暗娼人口社会学、行为学特征、感染后治疗关怀管理,为阳性暗娼管理探索有针对性的措施。[方法]对大理州2015-2020年暗娼哨点监测发现的阳性暗娼进行问卷调查,对高中档暗娼组和低档暗娼组的艾滋病知识知晓情况和相关危险行为特征进行分析。[结果]大理州2015-2020年共监测发现HIV阳性暗娼106例,HIV抗体阳性检出率0.56%。其中新发阳性44例(占41.51%),既往阳性62例(占58.49%)。高中档场所占20.76%,低档场所占79.24%。平均年龄(36.62±9.18)岁,小学及以下占79.25%,大理本地户籍47.17%,64.15%来源疾控动员自主检测,公安抓获检测阳性检出率(3.34%)高于疾控自主检测阳性检出率(0.38%)(χ^(2)=256.93,P<0.001)。高中档暗娼最近1个月安全套使用率高于低档暗娼(χ^(2)=5.34,P<0.025)。106例阳性暗娼中,接受干预服务的比例为91.51%。58.49%阳性暗娼继续从事卖淫活动,20.75%仍然在本地继续卖淫。感染后从事性服务时间在5年及以上的占58.06%。公安机关对25.80%继续卖淫活动的阳性暗娼给予拘留或罚金或接受刑事处罚(判刑)。阳性暗娼接受抗病毒治疗比例91.51%,94.35%阳性暗娼没有享受生活关怀救助或劳动技能培训。[结论]大理发现阳性暗娼以低档暗娼为主,年龄偏大、文化程度低、公安抓获暗娼阳性比例较高,继续卖淫占一定比例。公安机关对继续卖淫者的处罚力度弱,艾滋病传播危险因素依然存在。建议加大暗娼干预检测力度,多渠道发现阳性暗娼;将阳性暗娼纳入流动感染者管理体系,进行动态管理追踪;强化阳性预防宣传教育,强化其权利、责任告知;劝离活动场所,提供必要的救助、关怀、再就业培训支持;转介抗病毒治疗,发现地与户籍地做好无缝对接,减少脱失,降低传播的风险;公安与卫生部门密切配合,加大对阳性暗娼的法律惩处的力度。

Objective To understand the demographic sociological, behavioral characteristics and post-infection treatment, care and management for HIV-positive illicit prostitution so as to explore targeted measures for the management of HIV positive illicit prostitution. Methods A questionnaire survey was conducted for HIV positive illicit prostitution in sentinel surveillance stations in Dali Prefecture from the year 2015 to 2020. It analyzed AIDS knowledge awareness and relevant risk behavior characteristics for low, medium and high-grade illicit prostitution groups. Results A total of 106 cases of HIV positive illicit prostitution were detected and found in Dali Prefecture from 2015 to 2020,relevance ratio of HIV positive was 0.56%,and 44(41.51%)cases were newly HIV positive of them, previous HIV positive were 62(58.49%)cases. There were 20.76% in medium and high-grade places, and 79.24% were in low-grade places. Their average age was(36.62±9.18)years old, 79.25% were primary school or below education background, 47.17% were Dali locality census register, 64.15% were autonomous detection by the mobilization of disease prevention and control center. Positive rate from the arrest of public security(3.34%)was higher than that from the autonomous detection by the mobilization of disease prevention and control center(0.38%)(χ^(2)=256.93,P<0.001). The condom use rate of medium and high-grade illicit prostitution in the last month was higher than that of low-grade(χ^(2)=5.34,P<0.025). Among 106 cases of HIV positive illicit prostitution, the proportion of accepting intervention services was 91.51%. 58.49% positive illicit prostitution continued to engage in whoredom and 20.75% still continued to engage in whoredom locally. 58.06% had engaged in sexual services for 5 years or more after infection. Public security organs had arrested, fined or given criminal punishment(sentence)to 25.80% of positive illicit prostitutionWho continued to engage in whoredom activities. The proportion of positive illicit prostitution receiving antiviral treatment was 91.51%. 94.35% positive illicit prostitution did not recieved life care or labor skills training. Conclusions The positive illicit prostitutions in Dali were mainly low-grade sex workers, older age, lower education level, higher proportion of positive illicit prostitutions who were caught by police, and a certain proportion of continuing to engage in whoredom. The punishment of public security organs for those who continue to engage in prostitution is weak, and the risk factors for the spread of AIDS still exist. It is suggested to strengthen the intervention and detection of illicit prostitution and find positive illicit prostitution through multiple channels. The positive illicit prostitution will be included in the management system of floating infected persons and conduct dynamic management and tracking. Strengthen the publicity and education of positive prevention, and strengthen the notification of its rights and responsibilities;Persuade them to leave the activity site and provide necessary assistance, care and reemployment training support;Refer to antiviral treatment, and make seamless connection between the place of discovery and the domicile to reduce loss and the risk of transmission;Public security and health departments should closely cooperate to increase the strength of the legal punishment for positive illicit prostitution.