Abstract：
OBJECTIVE: The burden of HIV and other sexually transmitted infections (STIs) remains high in sex workers globally, calling for strengthening targeted prevention strategies, including HIV pre-exposure prophylaxis (PrEP). The study\'s objective was to assess HIV and STI burden among female, male and transgender sex workers in Flanders, Belgium, to guide targeting of PrEP strategies for sex workers.
METHODS: We conducted a retrospective analysis of routine data collected between January 2016 and December 2019 by community-based organisations providing sexual healthcare services for sex workers in Flanders. HIV prevalence stratified by gender was assessed and associations with sociodemographic characteristics were explored using bivariable and multivariable logistic regression. Positivity rates of chlamydia, gonorrhoea and syphilis tests were used as proxy indicators for STI burden.
RESULTS: The study included a total of 6028 sex workers, comprising 5617 (93.2%) female, 218 (3.6%) male and 193 (3.2%) transgender sex workers. The HIV prevalence was 0.3% among female, 8.9% among male and 12.3% among transgender sex workers. Engaging in escort sex work and originating from South America or Sub-Saharan Africa were associated with a higher likelihood of having acquired HIV. The positivity rate for gonorrhoea was higher among male sex workers (5.2% vs 2.2%) and syphilis was more frequently detected among male and transgender sex workers (3.0% and 6.1% vs 0.5%), all compared with female sex workers.
CONCLUSIONS: HIV combination prevention, including improved access to PrEP, should be strengthened among sex workers in Flanders, with particular attention to male and transgender sex workers.
METHODS: We conducted a retrospective analysis of routine data collected between January 2016 and December 2019 by community-based organisations providing sexual healthcare services for sex workers in Flanders. HIV prevalence stratified by gender was assessed and associations with sociodemographic characteristics were explored using bivariable and multivariable logistic regression. Positivity rates of chlamydia, gonorrhoea and syphilis tests were used as proxy indicators for STI burden.
RESULTS: The study included a total of 6028 sex workers, comprising 5617 (93.2%) female, 218 (3.6%) male and 193 (3.2%) transgender sex workers. The HIV prevalence was 0.3% among female, 8.9% among male and 12.3% among transgender sex workers. Engaging in escort sex work and originating from South America or Sub-Saharan Africa were associated with a higher likelihood of having acquired HIV. The positivity rate for gonorrhoea was higher among male sex workers (5.2% vs 2.2%) and syphilis was more frequently detected among male and transgender sex workers (3.0% and 6.1% vs 0.5%), all compared with female sex workers.
CONCLUSIONS: HIV combination prevention, including improved access to PrEP, should be strengthened among sex workers in Flanders, with particular attention to male and transgender sex workers.
摘要：
目标：全球性工作者的艾滋病毒和其他性传播感染（STIs）负担仍然很高，呼吁加强有针对性的预防战略，包括HIV暴露前预防（PrEP）。这项研究的目的是评估女性的艾滋病毒和性传播感染负担，佛兰德斯的男性和变性性工作者，比利时,指导针对性工作者的PrEP策略。
方法：我们对2016年1月至2019年12月期间为佛兰德性工作者提供性保健服务的社区组织收集的常规数据进行了回顾性分析。评估按性别分层的HIV患病率，并使用双变量和多变量逻辑回归研究与社会人口统计学特征的关联。衣原体阳性率，淋病和梅毒试验被用作性传播感染负担的替代指标。
结果：该研究共包括6028名性工作者，由5617名(93.2%)女性组成，218名（3.6%）男性和193名（3.2%）跨性别性工作者。女性艾滋病毒感染率为0.3%，男性为8.9%，变性人为12.3%。从事护送性工作并来自南美或撒哈拉以南非洲与感染艾滋病毒的可能性更高。男性性工作者淋病阳性率较高（5.2％vs2.2％），男性和变性性工作者中梅毒更常见（3.0％和6.1％vs0.5％），与女性性工作者相比。
结论：HIV联合预防，包括改善对PrEP的访问，应该在法兰德斯的性工作者中加强，特别关注男性和变性性工作者。
方法：我们对2016年1月至2019年12月期间为佛兰德性工作者提供性保健服务的社区组织收集的常规数据进行了回顾性分析。评估按性别分层的HIV患病率，并使用双变量和多变量逻辑回归研究与社会人口统计学特征的关联。衣原体阳性率，淋病和梅毒试验被用作性传播感染负担的替代指标。
结果：该研究共包括6028名性工作者，由5617名(93.2%)女性组成，218名（3.6%）男性和193名（3.2%）跨性别性工作者。女性艾滋病毒感染率为0.3%，男性为8.9%，变性人为12.3%。从事护送性工作并来自南美或撒哈拉以南非洲与感染艾滋病毒的可能性更高。男性性工作者淋病阳性率较高（5.2％vs2.2％），男性和变性性工作者中梅毒更常见（3.0％和6.1％vs0.5％），与女性性工作者相比。
结论：HIV联合预防，包括改善对PrEP的访问，应该在法兰德斯的性工作者中加强，特别关注男性和变性性工作者。
