余抗区女性性工作者艾滋病梅毒感染风险及社区综合干预研究

发布时间：2018-08-14 13:12

【摘要】：第一部分余杭区女性性工作者艾滋病梅毒感染风险 [目的]了解余杭区女性性工作者艾滋病梅毒相关高危行为及感染率,分析女性性工作者艾滋病梅毒感染影响因素。 [方法]2008年,对余杭区女性性工作者进行摸底调查后,在女性性工作者相对集中的乡镇街道,以场所为基础采用整群抽样方法选择研究对象。根据横断面调查设计,对愿意接受采血的FSW开展艾滋病性病防治问卷调查以及HIV、梅毒筛查。收取血样运用ELISA和WB进行HIV初筛和确证,运用TPPA和TRUST进行梅毒检测。应用Epidata3.1建立数据库并录入数据,用SPSS16.0进行统计分析,统计方法主要为Logistic回归分析。 [结果]共有836名研究对象纳入本次研究,平均年龄为22.97岁,籍贯以外地人为主,占93.7%,婚姻状况以未婚为主,占81.7%,文化程度以初中为主,占79.7%,有人流史者占54.5%。首次性生活年龄以15-19岁为主,占74.0%,首次性服务年龄以20-24岁为主,占58.6%。31.3%的FSW一年内患有泌尿生殖道感染,4.4%的FSW自述有吸毒史。最近一次商业性行为安全套使用率为83.5%,近一个月商业性行为时每次均使用安全套比例为39.0%。艾滋病感染率为0.1%,梅毒感染率为3.0%。多因素分析提示性服务价格≤50元、最近一次商业性行为不使用安全套、日均接客≥3人次、有吸毒史4个变量与艾滋病梅毒感染存在统计学关联。 [结论]余杭区女性性工作者文化程度偏低、首次性服务年龄偏小、防病意识不强、就诊不规范,坚持使用安全套比例较低。性服务价格低、安全套使用率低、日均接客人次数多、吸毒为余杭区FSW艾滋病梅毒感染的危险因素。第二部分余杭区女性性工作者艾滋病性病社区预防干预研究 [目的]探索以社区卫生服务中心为基础的女性性工作者艾滋病性病综合干预模式,并评估该模式的运行效果。 [方法]采用干预设计研究方法,设立2个干预组(分别以社区卫生服务中心和区疾控中心为基础)、1个对照组。2008年开展基线调查,并按照预先设计的干预模式进行持续两年时间的预防干预活动,2010年开展干预效果评估。采用定量研究方法,通过比较2008年和2010年安全套使用率、梅毒感染率和规范就诊率这三个指标来评估干预效果。 [结果]社区卫生服务中心(CHS)的干预对象主要为性服务价格较低的FSW,区疾控中心(CDC)的干预对象主要为性服务价格高的FSW。最近一次商业性行为安全套使用率在CHS干预组、CDC干预组中,分别从2008年的83.0%和81.5%提高到2010年的99.3%和92.7%,相反对照组从2008年的96.1%下降到2010年的80.2%,且差异具有统计学意义。最近一次非商业性行为安全套使用率在CHS干预组和CDC干预组中,从2008年的56.8%和35.7%分别提高到2010年的87.9%和59.7%,而对照组从2008年的46.6%下降到2010年的15.8%,差异也具有统计学意义。梅毒感染率2008年各组分别为1.1%、2.0%和10.7%,2010年分别为7.4%、1.7%和5.8%,各组自身前后对照均无统计学差异。规范就诊率在2008年分别为50.0%、34.7%和23.5%,各组间无统计学差异,2010年分别为73.3%、50.0%、38.1%,CHS干预组规范就诊率高于对照组。 [结论]依托社区卫生服务中心开展FSW艾滋病性病综合干预,在扩大中低性服务价格FSWs的干预覆盖范围、提高FSW安全套使用率、促进生殖道疾病规范就诊方面发挥了积极作用。CHS干预组的干预效果好于CDC干预组和对照组。
[Abstract]:Part one risk of AIDS syphilis infection among female sex workers in Yuhang District
[Objective] To understand the high-risk behavior and infection rate of HIV/AIDS syphilis among female sex workers in Yuhang District, and to analyze the influencing factors of HIV/AIDS syphilis infection among female sex workers.
[Methods] After a thorough survey of female sex workers in Yuhang District in 2008, a cluster sampling method was used to select the subjects based on the place. According to the cross-sectional survey design, a questionnaire survey on the prevention and treatment of AIDS and venereal diseases, as well as HIV and syphilis screening were conducted among the FSW willing to accept blood collection. Blood samples were collected for HIV screening and confirmation by ELISA and WB, and TPPA and TRUST were used for syphilis detection. Epidata 3.1 was used to establish database and input data. SPSS 16.0 was used for statistical analysis. Logistic regression analysis was the main statistical method.
[Results] A total of 836 subjects were included in the study. The average age was 22.97 years old, and the majority of them were foreigners, accounting for 93.7%. Their marital status was mainly unmarried, accounting for 81.7%. Their educational level was mainly junior high school, accounting for 79.7%. Those with abortion history accounted for 54.5%. The age of first sexual life was mainly 15-19 years old, accounting for 74.0%. The age of first sexual service was mainly 20-24 years old, accounting for 58.7%. 31.3% of FSW suffered from genitourinary tract infection within one year, and 4.4% of FSW reported drug abuse history. The latest commercial condom use rate was 83.5%. The proportion of condom use in commercial sexual intercourse was 39.0%. The HIV infection rate was 0.1% and the syphilis infection rate was 3.0%. Multivariate analysis indicated that the price of sexual service was less than 50 yuan. The latest commercial sexual intercourse did not use condoms, and the daily average number of visitors was more than 3.
[Conclusion] Female sex workers in Yuhang District have low educational level, low age of first sexual service, poor awareness of disease prevention, nonstandard treatment and low proportion of persistent condom use.
The second part is the prevention and intervention of AIDS and sexually transmitted diseases among female sex workers in Yuhang district.
[Objective] To explore a comprehensive intervention model of AIDS and STD among female sex workers based on community health service centers and evaluate its effect.
[Methods] Two intervention groups (based on the community health service center and the district CDC) and one control group were set up with intervention design method. The baseline survey was carried out in 2008. Pre-designed intervention model was used to carry out preventive intervention activities for two years and the intervention effect was evaluated in 2010. By comparing condom use rate, syphilis infection rate and standard visiting rate in 2008 and 2010, the intervention effect was evaluated.
[Results] The intervention target of community health service center (CHS) was mainly FSW with low price of sexual service, and the intervention target of district CDC was FSW with high price of sexual service. The last commercial condom use rate in CHS intervention group and CDC intervention group increased from 83.0% and 81.5% in 2008 to 99.3% and 92.7% in 2010, respectively. In contrast, the control group decreased from 96.1% in 2008 to 80.2% in 2010, and the difference was statistically significant. Syphilis infection rates were 1.1%, 2.0% and 10.7% in 2008, 7.4%, 1.7% and 5.8% in 2010, respectively. There was no significant difference between the two groups before and after treatment. The rate was higher than that of the control group.
[Conclusion] Comprehensive intervention based on community health service centers plays an active role in expanding the intervention coverage of FSWs with low and medium sexual service prices, increasing the condom use rate and promoting the standard treatment of reproductive tract diseases. The intervention effect of CHS intervention group is better than that of CDC intervention group and control group.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R759.1;R512.91

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