BACKGROUND & AIMS:
INTRODUCTION:Adolescent girls and young women (AGYW), including those who sell sex in sub-Saharan Africa, are especially vulnerable to HIV. Reaching them with effective prevention is a programmatic priority. The HIV prevention cascade can be used to track intervention coverage, and identify gaps and opportunities for programme strengthening. The aim of this study was to characterise gaps in condom use and identify reasons underlying these gaps among young women who sell sex (YWSS) in Zimbabwe using data from enrolment into an impact evaluation of the DREAMS programme. DREAMS provided a package of biomedical, social and economic interventions to AGYW aged 10 to 24 with the aim of reducing HIV incidence.
METHODS:In 2017, we recruited YWSS aged 18 to 24 using respondent-driven sampling in six sites across Zimbabwe. We measured knowledge about efficacy of, access to, and effective (consistent) use of condoms with the most recent three sexual partners, separately by whether YWSS self-identified as female sex workers (FSW) or not. Among YWSS without knowledge about efficacy of, not having access to, and not effectively using condoms, we described the potential reasons underlying the gaps in the condom cascade. To identify socio-demographic characteristics associated with effective condom use, we used logistic regression modelling. All analyses were RDS-II weighted and restricted to YWSS testing HIV-negative at enrolment.
RESULTS:We enrolled 2431 YWSS. Among 1842 (76%) YWSS testing HIV-negative, 66% (n = 1221) self-identified as FSW. 89% of HIV-negative YWSS demonstrated knowledge about efficacy of condoms, 80% reported access to condoms and 58% reported using condoms consistently with the three most recent sexual partners. Knowledge about efficacy of and effective use of condoms was similar regardless of whether or not YWSS self-identified as FSW, but YWSS self-identifying as FSW reported better access to condoms compared to those who did not (87% vs 68%; age- and site-adjusted (adjOR) = 2.69; 95% CI: 2.01 to 3.60; p < 0.001). Women who reported experiencing sexual violence in the past year and common mental disorder in the past week were less likely to use condoms consistently (43% vs. 60%; adjOR = 0.49; 95% CI: 0.35 to 0.68; p < 0.001) and (51% vs. 61%; adjOR = 0.76; 95% CI: 0.60 to 0.97; p = 0.029), respectively.
CONCLUSIONS:Despite high knowledge about efficacy of and access to condoms, there remain large gaps in self-reported consistent condom use among YWSS. Addressing the structural determinants of YWSS' inconsistent condom use, including violence, could reduce this gap. YWSS who do not self-identify as FSW have less access to condoms and may require additional programmatic intervention.
背景与目标:
简介:包括在撒哈拉以南非洲地区出售性行为的少女和青年妇女(AGYW)特别容易感染艾滋病毒。通过有效的预防措施达到这些目标是一项计划优先事项。艾滋病毒预防级联可用于跟踪干预措施的覆盖范围,并找出差距和加强计划的机会。这项研究的目的是使用从DREAMS计划的效果评估中纳入的数据,来描述津巴布韦使用安全套的空白,并找出导致这些空白的年轻女性(YWSS)造成这些空白的原因。 DREAMS为10至24岁的青年妇女提供了一揽子生物医学,社会和经济干预措施,目的是减少艾滋病毒的发病率。
方法:2017年,我们在津巴布韦的六个地点进行了由受访者驱动的18至24岁的YWSS。我们通过YWSS是否自我确定为女性性工作者(FSW)来分别评估与最近三个性伴侣的避孕套的功效,使用和有效(一致)使用的知识。在没有了解安全套功效,无法使用和无法有效使用安全套的YWSS中,我们描述了安全套级联中存在差距的潜在原因。为了确定与有效使用避孕套相关的社会人口统计学特征,我们使用了逻辑回归模型。所有分析均按RDS-II加权,并仅限于YWSS在入院时检测HIV阴性。
结果:我们注册了2431 YWSS。在1842年(76%)的YWSS测试呈阴性的YWSS中,有66%(n = 1221)自我确定为FSW。 89%的HIV阴性YWSS表现出对安全套功效的了解,80%的人报告使用安全套,58%的人报告与最近三个性伴侣保持一致使用安全套。不论YWSS是否自我识别为FSW,关于安全套功效和有效使用的知识都是相似的,但是YWSS自我识别为FSW的情况与不使用安全套的人相比,安全套的使用情况更好(87%vs 68%;年龄-且网站调整后(adjOR)= 2.69; 95%CI:2.01至3.60; p <0.001)。在过去一年中报告经历过性暴力和在过去一周中患有常见精神障碍的妇女较少持续使用避孕套的比例(43%vs. 60%; adjOR = 0.49; 95%CI:0.35至0.68; p <0.001)和分别为(51%vs.61%; adjOR = 0.76; 95%CI:0.60至0.97; p = 0.029)。
结论:尽管对避孕套的功效和使用有很高的了解,但在YWSS中,自我报告的一致使用避孕套仍存在很大差距。解决YWSS避孕套使用不一致(包括暴力)的结构性决定因素,可以缩小这一差距。没有自我认定为FSW的YWSS使用安全套的机会较少,可能需要其他程序干预。