“我经期使用草莓味避孕套”:乌干达古卢市女性性工作者的安全性行为和STI筛查行为

F. Bongomin, Winnie Kibone, Pebalo Francis Pebolo, Fiona Gladys Laker, J. Okot, F. Kaducu, Grace Madraa, C. Loum, S. Awor, Agnes Napyo, D. Musoke, S. Ouma
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引用次数: 0

摘要

背景:女性性工作者(FSWs)感染和传播艾滋病毒和其他性传播感染(STIs)的风险较高。我们旨在探讨性行为、性传播感染的知识和态度、性传播感染筛查的障碍、支持和干预措施。方法:在这项以社区为基础,同时进行定量-定性、探索性混合方法研究中,我们进行了87次半结构化定量访谈和6次深度访谈,目的是在乌干达古卢市选择fsw。定性方法以描述现象学为基础。结果:定量研究纳入FSWs 87例,中位年龄28岁。总体而言,87.4% (n = 76)的参与者报告在他们的最后一次性接触中使用了安全套。83名(95.4%)参与者知道自己的艾滋病毒状况,其中6% (n = 5)报告为艾滋病毒阳性。76名(87.4%)参与者报告在性工作期间至少感染了一种性传播感染。此外,66.7% (n = 58)的参与者报告在过去三个月内接受过性传播感染筛查,其中外阴阴道念珠菌病(55.3%,n = 42)和梅毒(32.9%,n = 25)是最常见的性传播感染。然而,只有2.3% (n = 2)的参与者报告了目前的性传播感染症状。在定性研究中,主要主题包括性行为,包括使用避孕套的谈判策略和挑战,以及筛选促进因素和障碍。使用避孕套的谈判策略包括利用健康风险信息,提高无保护性行为的费用,以及直接拒绝。复杂的挑战包括,由于经济依赖、易受暴力侵害以及难以控制性环境,在促进安全性行为方面的作用有限。定期筛查的促进因素包括社会影响、情绪缓解、既定的检测习惯和可访问的诊所,而障碍包括成本、耻辱、对检测准确性的怀疑和不方便的门诊时间。结论:在乌干达古卢市,妇女在性传播感染方面面临严重脆弱性。虽然观察到诸如提高艾滋病毒意识和使用避孕套等令人鼓舞的趋势,但在性传播感染筛查、安全性行为的谈判以及获得预防和治疗方面仍然存在明显的挑战。为了解决这些问题,应制定有针对性的干预措施,以提高性传播感染筛查的可及性,使性工作者具备有效的谈判技能,并为性传播感染预防和治疗提供全面支持,从而有助于改善这一边缘化人群的整体性健康和福祉。
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“I Use Strawberry Flavoured Condoms during My Periods”: Safe Sex Practices and STI Screening Behaviours among Female Sex Workers in Gulu City, Uganda
Background: Female sex workers (FSWs) are at a higher risk of contracting and transmitting HIV and other sexually transmitted infections (STIs). We aimed to explore the sexual behaviour, knowledge and attitudes towards STIs, barriers, support and intervention for STI screening. Methods: In this community-based, concurrent quantitative–qualitative, exploratory mixed-methods study, we administered 87 semi-structured quantitative and six in-depth interviews to purposively select FSWs in Gulu City, Uganda. The qualitative methodology was based on descriptive phenomenology. Results: The quantitative study included 87 FSWs, with a median age of 28 years. Overall, 87.4% (n = 76) participants reported condom use during their last sexual encounter. Eighty-three (95.4%) participants were aware of their HIV status, with 6% (n = 5) reporting being HIV-positive. Seventy-six (87.4%) participants reported contracting at least one STI during sex work. In addition, 66.7% (n = 58) of the participants reported being screened for STIs in the past three months, with vulvovaginal candidiasis (55.3%, n = 42) and syphilis (32.9%, n = 25) being the most common STIs. However, only 2.3% (n = 2) of the participants reported current STIs symptoms. In the qualitative study, the main themes encompassed sexual behaviour, including condom-use negotiation strategies and challenges, as well as screening facilitators and barriers. Condom-use negotiation tactics involved leveraging health-risk information, increased charges for unprotected sex, and outright refusal. Complex challenges included limited agency in promoting safe sex due to economic reliance, vulnerability to violence, and difficulties in controlling the sexual environment. Facilitators for regular screening included social influences, emotional relief, established testing habits, and accessible clinics, while barriers encompassed cost, stigma, doubts about test accuracy, and inconvenient clinic hours. Conclusions: FSWs face significant vulnerabilities in Gulu City, Uganda, regarding STIs. While encouraging trends such as high HIV awareness and condom usage were observed, persistent challenges in STI screening, negotiation of safe sex practices, and access to prevention and treatment remain evident. To address these concerns, targeted interventions should be developed to enhance STI screening accessibility, empower sex workers with effective negotiation skills, and provide comprehensive support for STI prevention and treatment, thereby contributing to improved overall sexual health and well-being among this marginalized population.
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