撒哈拉以南非洲地区(2000-2020年)嫖娼男性的人口规模、艾滋病毒流行率和艾滋病毒预防:一项基于87项人口调查的荟萃分析。

IF 10.5 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

PLoS Medicine Pub Date : 2022-01-25 eCollection Date: 2022-01-01 DOI:10.1371/journal.pmed.1003861

Caroline Hodgins, James Stannah, Salome Kuchukhidze, Lycias Zembe, Jeffrey W Eaton, Marie-Claude Boily, Mathieu Maheu-Giroux

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引用次数: 5

摘要

背景:包括性工作者在内的重点人群是艾滋病毒感染和传播的高危人群。付钱进行性行为的男性可能通过与性工作者及其其他伴侣发生性关系而导致艾滋病毒传播。为了描述撒哈拉以南非洲(SSA)男性性交易人群的特征，我们分析了人口规模、艾滋病毒流行情况以及艾滋病毒预防和治疗的使用情况。方法和发现:我们对2000年至2020年在SSA进行的基于人口的调查进行了随机效应荟萃分析，其中包含了男性有偿性行为的信息。我们提取了性活跃男性的人口规模、终生性伴侣数量、安全套使用情况、HIV患病率、HIV检测、抗逆转录病毒(ARV)使用和病毒载量抑制(VLS)情况。我们按地区和时间段进行汇总，并使用元回归评估时间趋势。我们纳入了87项调查，总共超过36.8万名男性受访者(15-54岁)，来自35个国家，占SSA男性的95%。8% (95% CI 6%-10%;性活跃男性的调查数量[n] = 87)报告曾为性行为买单。最后一次有偿性行为中避孕套的使用随着时间的推移而增加，达到68%(95%可信区间64%-71%;Ns = 61)。支付性费用的男性艾滋病毒感染率较高(患病率[PR] = 1.50;95% ci 1.31-1.72;Ns = 52)，并且更有可能接受过艾滋病毒检测(PR = 1.14;95% ci 1.06-1.24;n = 81)比没有买春的男性要多。花钱进行性行为的男性艾滋病毒感染者终生艾滋病毒检测水平相似(PR = 0.96;95% ci 0.88-1.05;Ns = 18)， ARV使用(PR = 1.01;95% ci 0.86-1.18;Ns = 8)， VLS (PR = 1.00;95% ci 0.86-1.17;n = 9)与那些没有支付性交易费用的艾滋病毒感染者的比例相同。研究的局限性包括依赖于敏感行为的自我报告，以及对ARV使用和VLS信息的少量调查。结论:性交易很普遍，在这35个国家中，有过性交易的男性感染艾滋病毒的可能性比其他男性高50%。需要为这一弱势群体作出进一步的预防努力，包括改善获得艾滋病毒检测和安全套使用倡议。应将支付性费用的男性视为预防艾滋病毒的优先人群。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Population sizes, HIV prevalence, and HIV prevention among men who paid for sex in sub-Saharan Africa (2000-2020): A meta-analysis of 87 population-based surveys.

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Population sizes, HIV prevalence, and HIV prevention among men who paid for sex in sub-Saharan Africa (2000-2020): A meta-analysis of 87 population-based surveys.

Background: Key populations, including sex workers, are at high risk of HIV acquisition and transmission. Men who pay for sex can contribute to HIV transmission through sexual relationships with both sex workers and their other partners. To characterize the population of men who pay for sex in sub-Saharan Africa (SSA), we analyzed population size, HIV prevalence, and use of HIV prevention and treatment.

Methods and findings: We performed random-effects meta-analyses of population-based surveys conducted in SSA from 2000 to 2020 with information on paid sex by men. We extracted population size, lifetime number of sexual partners, condom use, HIV prevalence, HIV testing, antiretroviral (ARV) use, and viral load suppression (VLS) among sexually active men. We pooled by regions and time periods, and assessed time trends using meta-regressions. We included 87 surveys, totaling over 368,000 male respondents (15-54 years old), from 35 countries representing 95% of men in SSA. Eight percent (95% CI 6%-10%; number of surveys [Ns] = 87) of sexually active men reported ever paying for sex. Condom use at last paid sex increased over time and was 68% (95% CI 64%-71%; Ns = 61) in surveys conducted from 2010 onwards. Men who paid for sex had higher HIV prevalence (prevalence ratio [PR] = 1.50; 95% CI 1.31-1.72; Ns = 52) and were more likely to have ever tested for HIV (PR = 1.14; 95% CI 1.06-1.24; Ns = 81) than men who had not paid for sex. Men living with HIV who paid for sex had similar levels of lifetime HIV testing (PR = 0.96; 95% CI 0.88-1.05; Ns = 18), ARV use (PR = 1.01; 95% CI 0.86-1.18; Ns = 8), and VLS (PR = 1.00; 95% CI 0.86-1.17; Ns = 9) as those living with HIV who did not pay for sex. Study limitations include a reliance on self-report of sensitive behaviors and the small number of surveys with information on ARV use and VLS.

Conclusions: Paying for sex is prevalent, and men who ever paid for sex were 50% more likely to be living with HIV compared to other men in these 35 countries. Further prevention efforts are needed for this vulnerable population, including improved access to HIV testing and condom use initiatives. Men who pay for sex should be recognized as a priority population for HIV prevention.

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来源期刊

PLoS Medicine 医学-医学：内科

CiteScore

21.60

自引率

0.60%

发文量

227

审稿时长

3 months

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