■加纳的艾滋病毒流行的特征是低水平的广泛性流行病,女性性工作者(FSW)及其客户之间的传播做出了重大贡献。本研究旨在确定和描述FSW的主要特征和性行为,并估计HIV的患病率,梅毒,淋病,衣原体,和乙型肝炎病毒(HBV)在加纳的FSW。
■使用时间定位采样(TLS)方法共招募了7,000名FSW用于研究,其中5,990名(85.6%)参与者完成了研究的生物学和行为方面。对受访者进行了结构化问卷,以评估几个因素,如背景特征,性危险行为,避孕套的使用,艾滋病毒/艾滋病知识,意见,和态度。经过培训的工作人员在提供用于艾滋病毒和性传播感染检测的样本后,使用移动数据收集软件(REDCap)进行了面对面的访谈。描述性统计,如中位数,范围,图表,和百分比进行和呈现。还包括,是双变量分析,以建立FSW类型与研究其他相关特征之间的关系。
■在从所有地区采样的7,000(100%)FSW中,6,773人参加了行为学,6,217人参加了生物学。有783名(11.2%)受访者仅参与行为,而227名(3.2%)仅参与生物行为。大多数都很年轻,平均年龄为26岁,大多数人从未结婚或丧偶/离婚,四分之一人没有受过教育或只受过小学教育。大多数(74.8%)的FSW在25岁或以下年龄首次出售性行为,中位年龄为20岁。大多数(84.8%)的FSW表示他们是为了钱而从事性工作,无论是自我还是家庭,平均每周有十一(11)个性伴侣。超过一半(55.2%)的FSW是在研究之前从事性工作不到5年的新进入者。与付费客户一致使用避孕套的情况通常不令人满意(71%),然而,非常低(24%)与他们的亲密伴侣或男朋友。在调查前的最后三个月中,只有大约一半(54.6%)的FSW接受过艾滋病毒预防服务,这在不同地区有所不同。总的来说,艾滋病的综合知识水平较低。只有35%的FSW具有全面的知识。HIV的患病率为4.6%,在从事性工作时间较长的座位(以妓院为基础)和年龄较大的FSW中,HIV的患病率更高。2015年和2011年的生物行为调查(BBS)中的HIV患病率估计为6.9%和11.1%。分别。
■与以前的研究结果相比,研究结果表明,加纳在减少FSW中的艾滋病毒负担方面取得了重大进展。然而,危险行为,如低持续使用避孕套,各地区艾滋病毒服务覆盖率低,低综合知识可能会逆转迄今为止取得的成果。应立即采取行动,将艾滋病毒服务的覆盖面扩大到所有地点。必须努力接触新进入者,同时解决对艾滋病毒的强烈误解。
The HIV epidemic in Ghana is characterized as a mix of a low-level generalized epidemic with significant contributions from transmission among female sex workers (FSW) and their clients. This study seeks to identify and describe key characteristics and sexual behaviors of FSW and estimate the prevalence of HIV, syphilis, gonorrhea, chlamydia, and hepatitis B virus (HBV) among FSW in Ghana.
A total of 7,000 FSW were recruited for the study using Time Location Sampling (TLS) approach with 5,990 (85.6%) participants completing both biological and the behavioral aspects of the study. A structured questionnaire was administered to respondents to assess several factors, such as background characteristics, sexual risk behaviors, condom usage, HIV/AIDS knowledge, opinions, and attitudes. Trained staff conducted face-to-face interviews using mobile data collection software (REDCap) after provision of specimens for HIV and STI testing. Descriptive statistics such as medians, ranges, charts, and percentages are performed and presented. Also included, are bivariate analyses to establish relationships between FSW type and other relevant characteristics of the study.
Among the 7,000 (100%) FSW sampled from all regions, 6,773 took part in the behavioral and 6,217 the biological. There were 783 (11.2%) respondents who took part only in the behavioral and 227 (3.2%) only in the biological. Most were young, with a median age of 26 years, majority had never been married or were widowed/divorced and a quarter had no education or had only primary education. Majority (74.8%) of FSW first sold sex at age 25 years or less with a median age of 20 years. Most (84.8%) of the FSW indicated that they entered sex work for money, either for self or family and had an average of eleven (11) sexual partners per week. More than half (55.2%) of the FSW were new entrants who had been in sex work for less than 5 years before the study. Consistent condom use with paying clients was generally unsatisfactory (71%), and was however, very low (24%) with their intimate partners or boyfriends. Only about half (54.6%) of FSW have been exposed to HIV prevention services in the last three months preceding the survey, and this varies across regions. Overall, comprehensive knowledge about HIV and AIDS was low. Only 35% of FSW had comprehensive knowledge. HIV prevalence was 4.6% and was higher among seaters (brothel-based) and older FSW who had been sex work for a longer period. The HIV prevalence from the previous bio-behavioral survey (BBS) in 2015 and 2011 were estimated to be 6.9 and 11.1%, respectively.
Compared to the results from the previous studies, the findings give an indication that Ghana is making significant progress in reducing the burden of HIV among FSW in the country. However, risky behaviors such as low consistent condom use, low coverage of HIV services across the regions, and low comprehensive knowledge could reverse the gains made so far. Immediate actions should be taken to expand coverage of HIV services to all locations. Efforts must be made to reach out to the new entrants while also addressing strongly held myths and misconceptions about HIV.