Ipapashwe: NgoJanuwari 25, 2016
Abstract
iinjongo
Sivavanye umyinge wezinto kunye nentlalo-ntle yezinto ezinxulumene nokulala ngesini nabathengisi bezesondo ababhinqileyo. Sikwachaze neempawu zolutsha oluxele ukusetyenziswa ngokungachani kokusetyenziswa kweekhondomu ngee-FSW.
tindlela
Olu lophononongo olunqamlezayo (inqanaba lokuphendula: I-73%) ye-300 heterosexually esebenzayo eyishumi elivisayo yabasetyhini be-16 ukuya kwi-19 iminyaka yokuya kwikliniki kazwelonke ye-STI eSingapore phakathi kwe2009 kunye ne-2014. Sivavanye iimeko zokuphilisana kwendalo (umntu, umzali, intanga, isikolo kunye nefuthe lokuziphatha) kunye nokuziphatha okusemngciphekweni ngokwesini kusetyenziswa iphepha lemibuzo elizixelileyo. Ukubuyiselwa kwe-poisson kwasetyenziselwa ukufumana umda wokukhula kobunzima (aPR) kunye namanqanaba okuzithemba (CI).
iziphumo
Umyinge wabantu abafikisayo abesilisa abangatshatanga abake baba neentlobano zesini nee-FSW yi-39%. Uhlalutyo lwezinto ezininzi lubonisa ukuba izinto ezibalulekileyo ezinxulumene nokulala ngesondo kunye ne-FSWs yayikukuqalisa kwesondo ngaphambi kweminyaka eyi-16 (aPR 1.79 CI: 1.30-2.46), akazange abe nentombazana eyabelana ngesondo (aPR 1.75 CI 1.28-2.38), ixele ukuzithoba- amanqaku e-honor (aPR 0.96 CI: 0.93-0.98), amanqaku aphezulu okuvukelwa (aPR 1.03 CI: 1.00-1.07) kunye nokujonga rhoqo iphonografi (aPR 1.47 CI: 1.04-2.09). Ixesha lokusetyenziswa kweekhondomu ngokungahambelani kunye nee-FSWs yayiyi-30%.
izigqibo
Ipesenti enkulu yabasetyhini abangatshatanga abesilisa abatshatileyo ababeya kwiklinikhi yoluntu ye-STI bakhe babelana ngesondo nee-FSW. Ungenelelo ekujoliswe kulo olujongana namanqanaba ahlukeneyo empembelelo kule ndlela yokuziphatha uyadingeka. Oku kunjalo nangakumbi kuba umlinganiso othile wolutsha olukwishumi elivisayo uxela ukusetyenziswa gwenxa kwekhondomu nee-FSW, ezinokusebenza njengebhulorho yosulelo lwe-STI eluntwini. Uphononongo lukazwelonke kwimpilo yokufikisa lufanele ukubandakanya uvavanyo lokuya rhoqo kutyelelo lwezesondo kwezorhwebo kunye nokusetyenziswa kweekhondomu neeFSW zovavanyo lwexesha elide kunye nokubekwa esweni.
Amanani
Citation: Ng-JYS, uWong ML (2016) Ukuchonga kwabaFikisayo ukuba babe neentlobano zesini nabaseTyhini ababhinqileyo eSwitzerland. I-PloS ONE 11 (1): e0147110. doi: 10.1371 / ijenali.pone.0147110
umhleli: UJesse Lawton Clark, uDavid Geffen weSikolo seZamayeza e-UCLA, E-UNITED STATES
I funyenwe: Juni 26, 2015; Zamkelwa: Disemba 29, 2015; Yashicilelwe: January 25, 2016
Copyright: © 2016 Ng, Wong. Eli linqaku lokufikelela elivulekileyo elisasazwe phantsi kwemigaqo ye Ilayisenisi yeCreation Commons Licribution, evumela ukusetyenziswa, ukuhanjiswa, nokuvelisa okungahambisani naluphi na uhlobo, ukuba unobumba bokuqala kunye nomthombo baxelwe.
Ukufumaneka kwedatha: Ngenxa yeemfuno zesimilo malunga nokuthatha inxaxheba kwabucala, idatha esezantsi iya kufumaneka xa uceliwe. Izicelo zedatha zinokuthunyelwa kumbhali ohambelana ([imeyile ikhuselwe]).
Inkxaso: Olu fundo-mali luxhaswe liBhunga leSizwe loPhando lwezoNyango (i-NMRC), eSingapore. Akukho kungqubana komdla. I-NMRC ayibandakanyekanga kuyilo lwe-1); (2) ingqokelela, ucazululo, nokutolika idatha; (3) ukubhalwa kwengxelo; kunye (4) isigqibo sokungenisa iphepha ukuze lipapashwe.
Injongo yokunyanzela: Ababhali baye bavakalisa ukuba akukho mfuno ekhuphisanayo.
intshayelelo
Abathengi babasebenzi besondo ababhinqileyo (ii-FSWs) lelona qela likhulu lisasazekayo ekusasazeni isifo esosulela ngokwabelana ngesondo (STIs) kunye neentsholongwane zokugonywa kwabantu kwi-HIV. [1] E-China, abathengi be-FSW bafunyaniswa ukuba banamaxesha e-12 kunye namaxesha e-6 ukungangqinelani kosulelwa yi-HIV kunye ne-syphilis ngokulandelelana ngokuthelekiswa noluntu ngokubanzi. [2] Ngaphandle kwayo nayiphi na imingcipheko, ukubonwa ngokwesondo kwezorhwebo kujongwa njengenkqubo yezentlalo eAsia. [3, 4]
Uvavanyo lukazwelonke lwe-46,961 yamadoda asabelana ngesondo e-India anike ingxelo yokuba amadoda amancinci anamandla aphakamileyo okuthenga iinkonzo zesondo xa kuthelekiswa nabantu abadala. [5] Kolu phononongo, i-15 ukuya kwi-24 iminyaka yobudala yayiye iphindwe kabini kunale minyaka ingama-45 nangaphezulu ukuba babelane ngesondo nee-FSWs kunyaka odlulileyo. Kwabo phakathi kwe-15 ukuya kwi-24 iminyaka, i-41% ayisebenzisanga iikhondom ngokungaguqukiyo kunye nee-FSW. Nangona kunjalo, inani labakwishumi elivisayo, elichazwe njenge-10 ukuya kwi-19 yeminyaka ubudala nguMbutho wezeMpilo weHlabathi, owabelana ngesondo nee-FSW kunye nezinto ezinxulumene nokuziphatha azichazwanga kolu phando. Ngokolwazi lwethu, okwangoku akukho longenelelo lujolise ngqo kule ndlela yokuziphatha kulutsha lwaseAsia mhlawumbi ngenxa yokuba izibonelelo zoncedo zithunyelwa kumangenelelo okujolisa kumadoda amadala nakwii-FSW. Esinye isizathu sinokubakho ngenxa yokutsala kwedatha ngokobungakanani bokuziphatha kunye nezinto ezinxulumene nayo, ezinokuthi zichazwe kuthintelo olusemthethweni kunye nolokuziphatha olufana nemvume yomzali yokuqokelelwa kwale datha ibukhali. [6] Nangona kunjalo, ukujolisa kweli qela kubaluleke kakhulu kuba kunokuba nefuthe ekuziphatheni kwabo ngokwesini ngendlela entle xa sele bekhulile. [7] Ngapha koko, iAsia inenombolo yesibini yesibini yosulelo olutsha lwe-HIV kubantu abakwishumi elivisayo. [8] Nangona kunjalo, kukho ukunqongophala kwenkqubela phambili ukuthintela usulelo olutsha lwe-HIV leli qela ngenxa yedatha engonelanga. [6]
Ngelixa uninzi lwezifundo ezihambelana nokuthenga ngesondo kubandakanya izampulu zabantu abadala [2, 5, 9-11], bambalwa abajonge kunxibelelwano ngokukodwa phakathi kolutsha. [12, 13Iziphumo ezifunyenwe kwimpembelelo yokuxhatshazwa ngokwesondo kunye neendlela zokuziphatha eziyingozi ekuthengweni kwezesondo phakathi kwabakwishumi elivisayo nazo zixubekile. Uphononongo lukazwelonke e-United States lwavavanya izinto ezazifunyanwa kwishumi elivisayo (iminyaka eyi-12 ukuya kwi-17 iminyaka) eyayinxulunyaniswa nokuthenga ngesondo kwiminyaka kamva (iminyaka eyi-18 ukuya kwiminyaka ye-26). [13] Kwafunyaniswa ukuba imbali yokuxhatshazwa ngokwesondo, ukusetyenziswa kweziyobisi kunye nokubaleka ekhaya zizinto ezinobungozi. Ngokuchasene noko, kuvavanyo olwenziwe esikolweni eCanada, ukuxhatshazwa ngokwesondo kunye nokusetyenziswa kweziyobisi kwakunganxulunyaniswa nokuthenga iinkonzo zesondo. Kolu phononongo, i-3% yabo iphakathi kwe-15 ukuya kwi-18 yeminyaka ubudala bakhe bathenga isini kwaye kunokwenzeka ukuba babone imisebenzi yezesondo kwaye banesimo esivumayo sokuhenyuza. [12] Ngelixa lolu phando lujonge ukukhulisa ukuqonda malunga nezinto ezinxulumene nokuthenga iinkonzo zesondo phakathi kwabakwishumi elivisayo, singathanda nokuzalisa isithuba kulwazi malunga nokuziphatha okusemngciphekweni kwezesondo okunxulunyaniswa nokuba neentlobano zesini nee-FSW. Oku kukhokelela kwinjongo eziphambili zolu phononongo, elikukuchaza umlinganiso wolutsha olusebenza ngokwesondo olundwendwele kwiklinikhi yoluntu ye-STI e-Singapore owakhe walala ne-FSWs, kunye nemeko yezentlalo kunye neendlela zokuziphatha ngokwesondo ezihambelana noku. isimilo. Injongo yesibini kukuchaza iimpawu zolutsha olungakhange lusebenzise ikhondomu ngokungaguqukiyo kunye nee-FSW. Iziphumo zifanele zincedise ekwaziseni iinkqubo zokufikisa kwabasetyhini abakwishumi elivisayo, okwenziwa mandulo nangakumbi eSingapore njengoko ulutsha luyekiswa kwindlela yokuziphatha yesizwe kwizenzo zesondo.
Impahla nenkqubo
Abathathi-nxaxheba kunye nokugaywa
Idatha yolu hlalutyo ithathwe kwisiseko sovavanyo lweemfuno zongenelelo ngoncedo lwezempilo ngokwesondo (ibhalisiwe kunye neClinicalTrials.gov, inombolo yeNCT02461940) kulutsha oluya kwiKliniki ye-STI Control (DSC) ikliniki, ekuphela kweklinikhi ye-STI yelizwe e-Singapore. Idatha yaqokelelwa phakathi kukaNovemba 2009 kunye noDisemba 2014. Isizathu sokuqhuba isifundo kule klinikhi siphindwe kabini. Okokuqala, malunga ne-80% yabakwishumi elivisayo abanesifo esosulelayo esaziwa ngokuba yi-STIs eSwitzerland baya kule kliniki rhoqo ngonyaka. [14Okwesibini, aba bafundi bafikisayo bekwelona qondo liphambili lokusasazeka nge-STI phakathi kwabakwishumi elivisayo eSwitzerland. Iindlela zokubandakanywa kolu phononongo yayizizo: akuzange kutshatwe abantu ababhinqileyo abatshatileyo abaxela ukuba banobungqingili, ezichazwa njengokwabelana ngesondo nomntu obhinqileyo, kunye ne-16 emdala ukuya kwi-19 yokuya ekliniki okokuqala. Njengoko iminyaka esemthethweni yokwabelana ngesondo eSingapore ineminyaka eyi-16, asikhange sifumane abantu abafikisayo abakwiminyaka engaphantsi kwe-16, ekwakufuneka ukuba babekwe phantsi kophando lwamapolisa ngodlwengulo olusemthethweni.
Olu phando lwamkelwa yiBhodi yeSizwe yezeMpilo yoKhathalelo lweSizwe yezeMpilo. Abaselula abathathe inxaxheba kolu phando basayine ifom yokuvuma emva kokufumana isifundo, befunda iphepha lolwazi kwaye becacisa imibuzo nodliwanondlebe. Iifom zokutyikitya ezisayiniweyo zigcinwa kwikhabethe evaliweyo kwikliniki ye-DSC, kunokuba zibuyele kubathathi-nxaxheba. Kungenxa yokuba, ngenxa yobume bophando lwethu kunye nobudala babathathi-nxaxheba, bebengenakulindeleka ukuba beze neefom ezazibonakalisa ukutyelela kwabo kwikliniki ye-DSC. Endaweni yoko, banokulahla iifom ezisayiniweyo ezinamagama abo neenombolo zezazisi kwiindawo zikawonke-wonke. Ke ngoko, bekungacetyiswa ukuba zibuyisele iifom ezisayiniweyo kubathathi-nxaxheba. Nangona kunjalo, ifom yokuvuma esayiniweyo yenziwa yafumaneka kumthathi-nxaxheba kwikliniki ukuba uthatha inxaxheba uza kuyifumana. Njengenxalenye yesifundo, iindleko zovavanyo lwelabhoratri ye-STI (ukuya kuthi ga kwi-US $ 50) zaxuthwa kubathathi-nxaxheba ababhalisileyo.
Kwakukho amacandelo amabini kwiphepha lemibuzo. Inxalenye yokuqala kwiidemografiki kunye nokuba ngumzali yayilawulwa ngobuso ngabasebenzi bendawo kunye nabathathi-nxaxheba besifundo kwindawo yabucala yekliniki. Icandelo lesibini, elalilawulwa ngokwalo, lalinemibuzo yemozulu enobuthathaka enjengomngcipheko kunye nokuziphatha ngokwesondo kwaye yabekwa ekugqibeleni kophando. Ukunciphisa ukungabi namkhethe kwintlalontle, abathathi-nxaxheba baqinisekiswa ngemfihlo kunye nokungaziwa. Baxelelwa malunga nenjongo yokufunda, eyayikukuqonda ngcono indlela abaziphatha ngayo kunye nokusebenzisa iziphumo zokucwangcisela iinkqubo kubo.
Kolutsha olufanelekileyo lwe-409 lufikile ekliniki ngexesha lokufunda, i-300 (73%) yavuma kwaye yalugqiba uvavanyo olusisiseko. Esona sizathu siphambili sokungavumi yayikukungakwazi ukuzibophelela kwisifundo sempilo yezesondo. Akukho mahluko phakathi kwabaphenduli kunye nabangaphenduliyo ngokweminyaka yobudala (p = 0.320) kunye nobuhlanga (p = 0.704).
Amanyathelo
Iziphumo eziguquguqukayo.
Lo yayingumahluko oboniswe dichotomised wokuba wawukhe wabelana ngesondo nee-FSW, ezazisusela kumbuzo: "Zingaphi izinto owabelana ngazo nesondo ngunongogo ukususela oko wabelana ngesondo okokuqala?" Abo baphendule ngo- "1" okanye ngaphezulu badityaniswa kwathiwa " owakhe walala nawo ii-FSWs ngelixa abo babonisa i- "0" bahlelwa njenge- "zange babelane ngesondo ne-FSW".
Izinto ezinxulumene nokuzibandakanya kwisini kunye nee-FSW.
Silungelelanise imodeli yokuphilayo yendalo [15] Ukuvavanya izinto ezinxulumene nokusoloko unokwabelana ngesondo nee-FSW, ezibandakanya ukubala okulinganisa iimpembelelo zomntu, zabazali ,ontanga, zesikolo nakwezosasazo. Kwizakhi ezisekwe kumanqaku, into nganye yavavanywa kusetyenziswa isikali seLikert kwaye izinto zashwankathelwa ukwenza amanqaku.
Inqanaba lomntu ngamnye: Sivavanye iimpawu zentlalontle yoluntu (ubudala, uhlobo lwendawo yokuhlala, ubuzwe, inkolo, imeko yesikolo kunye nenqanaba lokusebenza kunye nenqanaba lezemfundo), isimilo esinobungozi, imbali yokuxhatshazwa ngokwesondo kunye neempawu zobuntu. Ukuziphatha okusemngciphekweni kubandakanya ukutshaya, ukusela utywala, ukulwa amaqela nokusebenzisa iziyobisi. Iimpawu zobuntu zibandakanya oku kulandelayo: Imvukelo yento ye-7 (i-Cronbach's alpha = 0.62) [16], Ukufuna kwe-6-into evakalayo yokufuna into (Cronbach's alpha = 0.78) [16], Into ye-4-into ethathwa njengolawulo lwangaphandle (i-Cronbach's alpha = 0.72) [17] kunye ne-10-into yeRosenberg isikali sokuzixabisa (Cronbach's alpha = 0.66) [18]. Into nganye ekwimo yomntu eyakhayo yavavanywa kusetyenziswa isikalo se-4-point Likert ye- "Not like me", "Aina of me", "Kunje ngam" kunye "Nje ngam".
Inqanaba lomzali: Impembelelo yabazali yavavanywa kusetyenziswa i-7-into efuna ukuba ngumzali (i-Cronbach's alpha = 0.79) kunye ne-8-into egunyazisiweyo yokuba ngumzali (eCronbach's alpha = 0.72) indices [19] ngeempendulo zento nganye ekalwe kwinqanaba le-4-point Likert, kunye nengxelo ethi "Ndiva ukuba ndingaya kubazali / imibuzo ngemibuzo ngesondo".
Inqanaba loontangaImpembelelo yoontanga yavavanywa ngokusekwe kumacandelo amabini: uxhulumaniso lwe-6-nto yoontanga kusetyenziswa isikali se4-point Likert wadogo (Cronbach's alpha = 0.74) [20] kunye umbuzo othi "Lungakanani uxinzelelo oluvela kubahlobo bakho lokuba ulale nabo?"
Inqanaba lesikolo: SUkuqhuba kweKwayala kwavavanywa ngemibuzo ethi "Ungazibeka phi wena ekusebenzeni kakuhle esikolweni?" kunye "Ungazibeka phi kwimicimbi yekharityhulamu esikolweni?"
Inqanaba leMidiya: Umxholo wezokwabelana ngesondo kwimithombo yeendaba enkulu yavavanywa ngokusekwe kwiintlobo ze-3 zokuveza ulwazi: I-1) imithombo yeendaba yokufikelela kuluntu, i-2) yathintelwa kwimithombo yeendaba eSwitzerland, oko kukuthi, imifanekiso engamanyala kunye ne-3) yemithombo yeendaba. Imithombo yeendaba yokufikelela kuluntu kubhekiselwa kwiinkqubo zeTV / iimovie / iividiyo / iingoma ezibonisa isondo okanye amabala ezesondo. Ukuvezwa rhoqo ukuvavanywa kusetyenziswa uphawu lwenqaku le-3-into eyinxalenye yosasazo lweendaba zesondo, [21] ngento nganye ekwisikali senqaku le-4 (inzima, kanye ngexesha, rhoqo, phantse lonke ixesha). Ukuveza imifanekiso engamanyala kugqitywe kukubuza, "Kukangaphi ufunda okanye ubukela imifanekiso engamanyala?" Ukuveza imithombo yeendaba kubhekiswa ekufundeni okanye ukubukela iinkqubo zeTV / iimovie ngomntu osulelwe yi-STIs / HIV / AIDS. Umzekelo we-Ewe / hayi ntetho ithi "Ndifundile kwiphephandaba okanye kwiphephandaba ngomntu osulelwe zizifo ezidluliselwa ngesondo."
Ukuziphatha ngokwesini.
Abathathi-nxaxheba baxela ubudala besini sokuqala (esachazwa njengesokwabelana ngomlomo, ubufazi okanye isondo) kwaye sachaza ukungxamiseka kwesondo njengelingezantsi kweminyaka ye-16. Ngalo lonke ixesha ukusetyenziswa kweekhondomu ngokwesondo lobufazi kunye nawo onke amaqabane kwakusekwe ku "Ngaba wakhe okanye iqabane lakho ukhe wasebenzisa ikhondomu ngokwesondo lobufazi?" Ngokukhetha u "Soloko", "Ngamanye amaxesha", "Akunjalo" kunye "Awunakukhumbula" . Kwa umbuzo ofanayo kunye nokhetho lwasetyenziswa ekusetyenzisweni kweekhondom kwisondo somlomo kunye nesondo. Ukongeza, bacelwe ukuba babonise amaqabane abo okwabelana ngesondo kunye nokukhetha "intombi, ihenyukazi, umxhasi, umntu athandana naye okanye abanye". Abathathi-nxaxheba bacelwa ukuba babonise inani lamaqabane ezesondo ebomini kwaye nenombolo yalolu hlobo lulandelayo lwamaqabane, “Intombazana (ama) ntombazana, amaQabane, abaThengi (abaThengi), abaDumileyo / abo baFanayo kunye nabanye.
Ii-STI ezichongiweyo zaqinisekiswa ngovavanyo lwelebhu ngexesha lokubhaliswa esifundweni. Oku kubandakanya isyphilis yosulelo, (isibeleko, urethral, pharyngeal, rectal) gonorrhea, chlamydia, non-gonococcal urethritis, herpes genital, warital warts, molluscum contagiosum, pubic lice kunye ne-HIV.
Ukujonga kunye nokuqonda.
Ukujonga kusetyenziso lwekhondom kwakusekwe kwinqanaba elishwankathelweyo leenkcazo ze-7. Isiteyitimenti ngasinye siye savavanywa ngenqanaba le-5-point Likert ye- "Andivumi kakhulu", "Andivumi", "Andicute", "Ndiyavuma" kunye "Ndiyavuma kakhulu". Oku kubandakanya: (1) ikhondomu yindlela efanelekileyo yokuzikhusela kwi-STIs. (2) Iikhondomu ziqhekeza ngokulula. (3) Ndiyifumanisa iyakhathaza / ngokungalunganga ukusebenzisa ikhondomu. (4) Iikhondomu zinciphisa ulonwabo ngokwesondo. (5) Iikhondomu zenza ukuba isondo lingcole. (6) Iikhondomu ziyabiza. (7) Kulula / kulula ukufumana ikhondom xa ndiyifuna. Izinto ze-2, i-3, i-4 kunye ne-6 zaphinda zakhowuda. Sisebenzise "Ucinga ukuba lithuba lakho lokufumana ii-STI?" Ukuvavanya amathuba abo okufumana ii-STIs. Abathathi-nxaxheba bacelwe ukuba bakhethe ingxelo echaza ngcono indlela abavakalelwa ngayo malunga nokwabelana ngesondo ngaphambi komtshato.
Ukundwendwela ngokwesondo kwezorhwebo kunye nokusetyenziswa kweekhondomu.
Abaphenduli abaye baxela ukuba babelane ngesondo nee-FSW babuzwa ukuba babonelele ngolwazi oluthe kratya malunga nale ndlela yokuziphatha. Ukusetyenziswa kweekhondomu okwenziwa rhoqo ngee-FSW kwavavanywa kusetyenziswa "Ngaba wakhe wacinga ukusebenzisa iikhondomu ngoonongogo kunyaka ophelileyo we-1?" Inketho "Ndisebenzisa iikhondomu ngalo lonke ixesha ngoonongogo" ithathwe njengokusetyenziswa rhoqo kweekhondomu kunye nezinye iindlela " Andikaze ndicinge ukuyisebenzisa "," Ndakhe ndacinga ngayo kodwa andikaqali ukuyisebenzisa "," Ndifuna ukusebenzisa iikhondomu kodwa andazi ukuba "," bendikhe ndisebenzisa iikhondom ngaphambili kodwa hayi ngoku "no" Bendikhe ndisebenzisa iikhondom ngamanye amaxesha ”zahlelwa njengezisebenzisa ikhondomu ngokungahambelani. Babuzwa kwakhona, benokhetho lokukhetha iimpendulo ezingaphezu kwelilodwa, ilizwe (oko kukuthi, iSingapore, iThailand, i-Indonesia, iCambodiya, iMalaysia, iChina, amanye amazwe ase-Asia okanye iNtshona) kunye nohlobo (Oko kukuthi, i-brothel, izitrato, I-massage parlors, imivalo / ii-pubs okanye iihotele) zokundwendwela ngokwesini kwezorhwebo. Sichaze izitrato, iiclass parlors, imivalo / ii-pubs kunye neehotele njengezicwangciso ezingasekelwanga kwindawo ye-brothel.
Ucatshulwa
Kuhlalutyo lwe-bivariate, ukwahluka ngokwamacandelo kwavavanywa kusetyenziswa i-chi-isikwere okanye uvavanyo lwendlela, ngelixa izinto eziqhubekayo zavavanywa kusetyenziswa uvavanyo lwe-sum-grade yeWilcoxon. Uhlalutyo lwe-multivariate, ukubuyela umva kwePoisson ngokwahluka okunamandla kwasetyenziswa endaweni yokuhlengahlengiswa kwezinto ngenxa yenxalenye ephezulu (> 10%) yabakwishumi elivisayo abanika ingxelo yokuba bakhe balala ne-FSWs. Sisebenzise indlela ehamba phambili yokwenza imodeli. Ulwahlulo ngalunye oluzimeleyo oluchazwe ngokuzimela kunye ne-p <0.1 kuhlalutyo lwe-bivariate lwalungeniswe kwimodeli, kusetyenziswa ukhetho lwangaphambili. Oku kubandakanya ukusela utywala, ukuvukela, ukuzithemba, ukulawulwa kwangaphandle, ukusebenza kwezifundo, imisebenzi yekharityhulam, ukujonga iphonografi, ubudala besini sokuqala ngaphambi kweminyaka eyi-16 ubudala kwaye babekhe baba neentlobano zesini. Umahluko wokuqala onike ingxelo yokwahluka okuphezulu kwimodeli ukhethiwe, kwaye okwahlukileyo okhethiweyo kukhethwe ngokufanayo. Izinto eziguqulweyo ezilandelayo zongezwa de kwakungekho mahluko ubalulekileyo kuqikelelo lwesiphumo esiguqukayo ukufumana eyona modeli iphambili. Imodeli yahlengahlengiswa kwiiyantlukwano zedemokhrasi (Oko kukuthi, ubudala, ubuhlanga, uhlobo lokuhlala, inqanaba lemfundo) kunye nonyaka wokuqeshwa. Ukulunga-kokulunga kwemodeli yokugqibela kubonise ukuba imodeli iyifakile kakuhle idatha (p = 1.00). Ubalo lweenkcukacha-manani lwacwangciswa p <0.05 kwaye kwahlengahlengiswa ubungakanani bokwanda (aPR). Sisebenzise iphakheji yesoftware iStata 14.0 (iStata Corp, iSitishi seKholeji, iTex) ukwenza uhlalutyo lweenkcukacha-manani.
iziphumo
Iimpawu ezibonakalayo kunye nokuziphatha ngokwesondo
Ngokubanzi, iminyaka ye-Median yabathathi-nxaxheba yayiyiminyaka ye-18 (udidi lwangaphakathi [IQR]: 18-19). Kancinci ngaphezulu kwesiqingatha (i-57%) yayingamaTshayina, i-33% yayingamaMalayali kwaye amanye ayengamaIndiya naseYurophu. Kwakungekho zibalo zibalulekileyo zentsebenzo phakathi kohlanga kunye neendlela ezizimeleyo zokwabelana ngesondo nee-FSWs. Amashumi amane anesixhenxe eepesenti abathathi-nxaxheba ayengafundanga. Malunga ne-40% yabakwishumi elivisayo babeneminyaka engama-≤10 yeminyaka yokufunda. Kwi-140 eyayingafundanga kwinqanaba lophando, i-66 (47%) yayiziikolo ezishiya isikolo. Iimpawu zentlalo-neendlela zokuziphatha zomngcipheko zishwankathelwe 1 Table. Isidala sokuqala sexesheni sasikwiminyaka ye-16 (IQR: 15-18) kunye nenani eliqhelekileyo labalingani bezesondo ebomini yayingu-3 (IQR: 2-6). Akukho namnye kwabathathi-nxaxheba owakhe wahlawulelwa isondo. Amashumi amane anesixhenxe eepesenti ayenee-STIs. Azange kubekho iimeko zokufumanisa ukuba une-HIV.
Inani labantwana abakwishumi elivisayo abathandanayo ababa neentlobano zesini kunye nee-FSW kunye nezinto ezinxulumene nokuhlala ulala ne-FSWs
Ikhulu elineshumi elinesibhozo (39%, 95% CI: 34% -45%) uxele ukuba walala ngesondo nee-FSWs, ngakumbi amaTshayina (44%) kunamaMalay (29%) (p = 0.02). Kuhlalutyo lwe-bivariate, abo baxela imvukelo ephezulu (p = 0.002), ukuzithemba okuphantsi (p = 0.02) kunye nolawulo oluphezulu lwangaphandle (p = 0.01) amanqaku, kwaye bakala intsebenzo yabo kwizifundo ngokomndilili okanye ngezantsi (p = 0.02) ) kunokwenzeka ukuba babelane ngesondo nee-FSWs. Ukuhamba rhoqo kokujonga iphonografi (p <0.001) yayixhaphake kakhulu phakathi kwabo bakhe balala ne-FSWs. Inqanaba lezemfundo (p = 0.62), impembelelo yabazali [Ukufuna isalathiso sobuzali: p = 0.20; Isalathiso sokugunyazisa: p = 0.49] kunye nefuthe loontanga [Uqhagamshelo lwabahlobo: p = 0.85] khange zinxulunyaniswe nokuziphatha.
Njengoko kuboniswe kuyo 2 Table, abesilisa abakhe babelana ngesondo kunye ne-FSWs babesengozini yokuba babelane ngesondo ngaphambi kweminyaka eyi-16 (p = 0.01) kwaye banamaqabane esini ngakumbi (p <0.001). Nangona kunjalo, babencinci amathuba okuba babenentombi eyabelana ngesondo (p <0.001) kwaye kunokwenzeka ukuba banike ingxelo ngokusetyenziswa kwekhondomu ngokusisigxina kunye nawo onke amaqabane esini sangasese (p <0.001), ngomlomo (p <0.001) kunye nesini sangasese ( p = 0.048) nazo zonke iintlobo zamaqabane.
Kuhlalutyo lwe-multivariate (3 Table), abakwishumi elivisayo abaqale isondo ngaphambi kweminyaka ye-16 (aPR 1.79 CI: 1.30-2.46), akazange abe nentombazana eyabelana ngesondo (aPR 1.75 CI 1.28-2.38), ingxelo engezantsi yokuzithemba (aPR 0.96 CI: 0.93-0.98) , amanqaku aphezulu okuvukela (aPR 1.03 CI: 1.00-1.07) kwaye abukele imifanekiso engamanyala rhoqo (aPR 1.47 CI: 1.04-2.09) ayesengozini yokuzibandakanya ngokwesondo nee-FSW.
Ukundwendwela ngokwesondo kwezorhwebo, ukusebenzisa ikhondomu kunye nee-STIs
Phakathi kwabo bake baba neentlobano zesini kunye nee-FSWs, i-38% yabika ukuba babelana ngesondo kunye ne-FSW, ngelixa abanye babezolana nentombazana (41%) okanye iqabane eliqhelekileyo (14%). Inani lexesha eliphakathi lokuhlangana kwezesondo kunye ne-FSW yayiyi-2 (IQR: 1-3). Eyona ndawo iqhelekileyo yokuthenga iinkonzo zesondo eSwitzerland (51%), yalandelwa yiThailand (40%) naseIndonesia (17%). Ngokubanzi, i-30% (n = 35) ayisebenzisanga iikhondom ngokungaguqukiyo kunye nee-FSW kunyaka ophelileyo. Isiqingatha sabaphenduli (i-51%) wayekhe wabelana ngesondo ngama-FSW asekwe kwi-brothel kunye ne-35% kunye nabasebenzi basesitalatweni.
Sifumanise ukuba ulutsha lwaseMalay lwalunqabile kakhulu ekusebenziseni iikhondom ngee-FSWs xa kuthelekiswa nabangengawo amaMalay (59% vs. 20%, p <0.001). Kwakungekho mahluko ubalulekileyo kwinani lokuhlangana ngokwesondo kunye nee-FSWs phakathi kwabo basebenzise iikhondom ngokungaguquguqukiyo nee-FSWs kunye nabo bangakhange (iMedian (IQR): 2 (1-3) vs 2 (2-3), p = 0.54 ). Abasebenzisi beekhondomu abangatshintshiyo nabo abahlukanga kubasebenzisi beekhondom abangahambelaniyo kwisimo sabo sokujonga ikhondom malunga nokusetyenziswa kwekhondom (iMedian (IQR): 23 (20-25) vs. 23 (21-25), p = 0.80).
Umyinge we-STIs efunyanisiweyo ekufuneni yafunyanwa ifana phakathi kwabo babelana ngesondo nee-FSWs kunye nabo bangenziyo (41.9% vs. 49.7%, p = 0.19). Nangona kunjalo, phakathi kwabakwishumi elivisayo abakhe balala ngesondo nee-FSWs, ii-STIs ezichongiweyo zaziphezulu kakhulu phakathi kwabo bangakhange basebenzise iikhondom ngokungaguquguqukiyo nee-FSWs nawo onke amanye amaqabane xa kuthelekiswa nabo basebenzisa iikhondom ngokungaguquguqukiyo (59% vs. 17%, p <0.001). I-STIs ezichongiweyo zaziphezulu, nangona zazingabalulekanga ngokwezibalo, phakathi kwabo bakhe balala ngesondo kunye ne-FSWs engeyiyo i-brothel kuphela xa kuthelekiswa nabo babekhe babelana ngesondo kunye ne-FSWs esekwe kwi-brothel kuphela (46% vs. 32%, p = 0.27). Amakhiwane 1 kwaye 2 ngokulandelanayo bonisa ipesenti yabo basebenzise iikhondomu ngokungalawulekiyo ilizwe kunye nohlobo lwee-FSW. Elona zinga liphezulu lokusetyenziswa kweekhondomu ngokungangqinelaniyo (i-53%) laxelwa phakathi kwabo bathenga iinkonzo zesondo e-Indonesia. Abathathi-nxaxheba ababesabelana ngesondo kunye nabasebenzi basesitalatweni baxela eyona pesenti ephezulu yokusetyenziswa kweekhondomu ngokungafanelekanga (i-39%) ngelixa abo babelana ngesondo nabathengisi ngesondo abasebenza ngezesondo baxela abaphantsi (23%).
* Yenza i-10 i-China, i-6 iMalaysia, i-2 Khambodiya, i-10 namanye amazwe ase-Asia kunye namazwe ase-2 aseNtshona.
ingxoxo
Umlinganiselo othile (i-39%) yamadoda akhulayo ngokwesini abangena kwikliniki yoluntu ye-STI kwisifundo sethu kuxelwe ukuba walala ngesondo nee-FSW. Oku kuphantsi kunoko kuxelwe kolunye uphononongo kwiikliniki ze-STI eVietnam, apho i-84% yabakwishumi elivisayo abaneminyaka eyi-14 ukuya kwiminyaka ye-19 babetyelele ii-FSWs kunyaka ophelileyo. [9] Siye safumana amanqanaba ahlukileyo empembelelo kule ndlela yokuziphatha. Kwimodeli yokulungelelanisa e-multivariate, safumanisa ukuba abantu abakwishumi elivisayo abaye baxela iminyaka yobudala bokuqalisa ngesondo, amanqaku okuzithemba aphantsi, amanqaku emvukelo aphakamileyo, akazange abe nentombazana eyabelana ngesondo, kwaye ukubukela rhoqo iphonografi kwakubeka ingxelo ngesondo nee-FSW.
Ngokwazi kwethu, sisifundo esinye kuphela esigxile kwindlela yokuziphatha ekuzibandakanya kwisini kunye nabathengisi bezesondo phakathi kolutsha kwaye oku kwenziwe phakathi kwabafundi bezikolo eziphakamileyo zaseCanada abaneminyaka eyi-16 ukuya kwi-18. [12] Olu phononongo lungamacandelo ajonge kwizinto ezinje ngokuziphatha gwenxa ngokwesondo (leyo yiminyaka ye-13 okanye ngezantsi), ukubanamaqabane angathandani naye, ukubukela iphonografi kwi-Intanethi kunye nokujonga izinto ezenziwa ngokwesondo njengezinto zokuhlanjwa. Emva kohlengahlengiso lwe-multivariate, kuphela ukujonga izinto ezenziwa ngesondo kuye kwaba yinto ebalulekileyo. Oku kwahlukile kufundo lwethu, mhlawumbi ngenxa yeendlela ezahlukeneyo zokusika kunye neendlela zovavanyo. Nangona kunjalo, iziphumo zethu ziyahambelana nezifundo kubantu abadala abesilisa ababandakanyeka kwezesondo. Uphononongo kwinani labesilisa baseSpain abaneminyaka eyi-18 ukuya kwi-49 bafumanisa ukuba abo babengatshatanga kwaye baqala ukwabelana ngesondo ngaphambi kweminyaka ye-16 banokuthenga isini. [11Ingxelo yaseOstreliya ichaze ukuba abantu abadala abangatshatanga abanakho ukunxibelelana nabanye kwiimeko zesondo kwaye babhenele kwii-FSW ukuze babe nobuhlobo. [22] Ukongeza, ukubukela iphonografi yinto ebalulekileyo ehambelana nokuthenga iinkonzo zesondo phakathi kwabasebenzi abafudukayo baseIndiya abaneminyaka eyi-27 yeminyaka, kwaye kwaqondwa ukuba iphonografi ibabenza babe nesimo sengqondo esifanelekileyo ngesondo elihlawulelwayo. [23]
Iziphumo zethu zikwabonakalise imiba eyahlukileyo kulutsha, ehambelana nengcinga kaJessor yeNgxaki yokuZiphethe. [24] Icacisa ukuba indlela yokuziphatha enengxaki (enjengokwabelana ngesondo nee-FSWs [5] ukubonakaliswa ngexesha lokufikisa njengesiphumo sokungalingani kulawulo lwenkqubo yobuntu (njengokuzithemba okuphantsi kunye nemvukelo), inkqubo eqondwayo yommandla (njengamajelo osasazo kunye ne-iphonografi) nenkqubo yokuziphatha (njengokuqala kobudala bokuya kwezesondo) . Qaphela, ukuzithemba bekungadibenanga nokuziphatha okuyingozi kwezesondo (ezinje ngetyala lesondo kunye nembali ye-STIs) phakathi kolutsha kuhlaziyo olucwangcisiweyo. [25] Nangona kunjalo, yayiyinto eyomeleleyo ehambelana nokulala ngesondo kunye nee-FSWs kwisifundo sethu. Oku kungachazwa ngabo bezabelana ngesondo nee-FSW njengendlela yokuphakamisa ukuzithemba kwabo okuphantsi, okubangelwa kukungakwazi ukufumana intombi. Oku kukwahambelana nokufunda okufunyenwe kulutsha lwaseAfrika lwaseMelika oluye lwafumanisa ukuba lwalusebenzisa isondo ukukhulisa ukuzithemba okanye izizathu eziqhayisayo. [26] Nangona kunjalo, siya kudinga ukwenza uphando olongezelelweyo ukuqonda ngcono ubudlelwane phakathi kokuzithemba okuphantsi kunye nokuthenga iinkonzo zesondo. Ungenelelo akufuneki lujolise kumanqanaba ahlukileyo empembelelo, kodwa kwakhona lujongane nokuziphatha kwengxaki njengenkqubo yeengxaki ezihlanganayo kunokuba zibhekise kubo njengabodwa.
Asifumenanga ii-STIs ezichongiweyo ukuba zidibene nokuba neentlobano zesini kunye nee-FSWs. Kukho iinkcazo ezinokwenzeka zoku. Kuqala, ii-STIs zichongiwe kwinqanaba lokubhaliswa esifundweni, ngelixa iziphumo zethu zezifundo beziphaya ubomi bokuzibandakanya kwezesondo nge-FSW. Ke ngoko, abathathi-nxaxheba abaye bathenga ngesondo ngaphambili banokuba banesifo i-STIs esibuhlungu kwaye bayanyangwa kwenye indawo ngaphambi kokuya kwikliniki. Okwesibini, umngcipheko wokufumana ii-STIs kwi-FSW kwakhona uxhomekeke kusetyenziso lwekhondomu nomntu owabelana naye ngesondo kunye nemeko yakhe ye-STI ngelo xesha lokunxibelelana ngesondo. Ngapha koko, sifumanisa ukuba ii-STIs ziphakame kakhulu phakathi kwabo bangakhange basebenzise iikhondomu ngokungangqinelaniyo neeFSW. Okokugqibela, malunga nesiqingatha sabathathi-nxaxheba bathenga ngesondo kwi-brothels eS Singapore. Zonke iibhulorho eSingapore zinelayisensi kwaye kusetyenziswe i-100% ukusetyenziswa kweekhondom. Ukongeza, abathengisi ngemizimba abasebenza ngesondo, phantsi kweNkqubo yoNyango lwezoNyango, kuye kufuneke ukuba bavavanywe i-gonorrhea kunye ne chlamydia, kwaye bavavanywe i-HIV kunye nesifo sesine inyanga nenyanga. Abantu abathengisa ngesondo abanesifo sikaGawulayo bayanyangwa eklinikhi kwaye kufuneka bayeke ukusebenza ngesondo ngexa lokunyanga.
Kukho ukusikelwa umda kolu phando oluthi luvuselele ekungagungqini kolunye uluntu. Okokuqala, nangona le kuphela kweklinikhi ye-STI ekwi-Singapore ethi ihambele ngaphezu kweekota ezintathu zezehlo ze-STI ezingaziwayo phakathi kwabakwishumi elivisayo, imele kuphela ulutsha olwabelana ngesondo oluye kule klinikhi okanye luye lwathunyelwa kuyo ukuba luhlolwe kwaye lunyangwe. Ii-STI. Qaphela, ayingabo bonke abakwishumi elivisayo ababelana ngesondo abaneempawu zesifo esingumvuka wokwabelana ngesondo kwaye ke, ulutsha oluya kwikliniki ye-STI alunako ukumela ulutsha olufikisayo ngokwesondo kuluntu ngokubanzi. Ukongeza, ulutsha oluzibandakanya ngesondo nee-FSWs lusenokungabi nazo ii-STIs kwaye ngenxa yoko, alunakho ukufuna unyango kwikliniki ye-STI. Njengoko idatha ibinomnqamlezo ngokwendalo, asikwazanga ukuseka ubudlelwane bexeshana phakathi kwezinto zomngcipheko kwaye nokuba besabelana ngesondo nee-FSWs. Endaweni yobomi bokusetyenziswa kweekhondomu nee-FSWs, sikuvavanye kuphela ukusetyenziswa kweekhondom kunyaka ophelileyo. Asikwazanga ukuzoba nakuphi na ukuthobela malunga nezizathu kunye nomxholo wokuthenga ngesondo phakathi kwabakwishumi elivisayo, oxhasa isidingo semfuno yophando. Isayizi yethu encinci yesampulu ikwanqumamisa amandla ethu eenkcukacha-manani zokuvavanya izinto ezizimeleyo ezinxulumene nokusetyenziswa kweekhondomu ngee-FSW. Okokugqibela, iziphumo zophando azinakuba ngokubanzi kubantwana abakwishumi elivisayo abaye baxela ukuba babelane ngesondo namaqabane angamadoda okanye abenzi bezesondo abangamadoda. Nangona kunjalo, isifundo sethu sinamazinga aphezulu okuthatha inxaxheba kunye nesampulu yeendlela ezahlukeneyo. Sikwasebenzise imodeli yendalo ukubona izinto ezinokubakho ngokuziphatha okuntsonkothileyo. Eyona nto ibaluleke kakhulu, iziphumo zethu zibonelela ngokuziphatha ngokuthenga ngokwesondo phakathi kwabakwishumi elivisayo kunye neziphumo zempilo yoluntu.
Ukufumana kwethu inani elithe kratya lokuthenga ngesondo phakathi kwabakwishumi elivisayo abakhuthele kwiklinikhi ye-STI yinto yezempilo yoluntu. Malunga nesinye kwisithathu sabakwishumi elivisayo nabo zange basebenzise iikhondom ngokungaguqukiyo kunye nee-FSW. Ngumthombo onokubakho wokufumana ikhontrakthi kwaye udlulisele ii-STIs kubantu ngokubanzi njengamaqabane abo aqhelekileyo okanye abathandana nabo, abathi banike ingxelo yokuba kusezantsi kokusebenzisa ikhondomu. [27] Ngapha koko, ulutsha oluye lwabelana ngesondo nabangekho-kulawulo lwezesondo njengabahambi ezitalatweni baxela inani eliphezulu lokusetyenziswa gwenxa kweekhondomu kuthelekiswa abo babelana ngesondo nabathengisi bezesondo base-Brothel e-Singapore, apho isungulwe inkqubo yokusebenzisa ikhondomu i-100%. [28] Kukwangumceli mngeni ukulandela ulutsha lwaseSwitzerland abathengi ababelana ngesondo kwii-FSWs ngokungekho mthethweni ezitratweni okanye phesheya. Imfundo yesondo yangoku kwizikolo zaseSingapore inokubangela ukuba iphinde ifundise ngokufundisa ulutsha malunga nokuthenga ngesondo kunye nokusetyenziswa kweekhondomu. Nangona kunjalo, abafundi abayekayo esikolweni basenokungabi nakho ukuxhamla kule nkqubo.
Ungenelelo olujolise kubathengi abakwishumi elivisayo abaya kwikliniki ye-STI yasesidlangalaleni eSwitzerland isebenza njengecebo elifanelekileyo nelinokwenzeka lokubonelela ngemfundo yokuthintela i-STI, ukukhangelwa kunye nonyango kubantu abakwishumi elivisayo abathenga ngesondo kwezi ndlela, nangona sivuma ukuba abafikisayo bangafuna ukhathalelo lwezempilo kolunye ulungiselelo. Esinye isizathu sokuba ungenelelo luqale ngexesha lokufikisa kukuba ulutsha lufikeleleka ngakumbi ekuguqukeni kokuziphatha kunabantu abadala. [29] Ungenelelo lokuziphatha olunjalo kufuneka lulungelelaniswe nolutsha oluzibandakanya kwisini kunye nee-FSW ngokulungisa amanqanaba ahlukeneyo eempembelelo ezinje ngezinto ezinxulumene nomntu ngamnye kunye neendaba. Kunikwe iziphumo zolu phando kwiklinikhi ye-STI, uphando lukazwelonke ngeendlela zokuziphatha ngokwesini kufuneka lubandakanye ulutsha kwaye lubandakanye imibuzo ekudibaneni ngesondo nee-FSWs ukuvumela ukubek'esweni nokujonga le ndlela. Izifundo ezizayo ezinenombolo enkulu yabaselula abazibandakanya nezesondo nge-FSWs zingabonelela ngakumbi ekuziphatheni kwabo kokusebenzisa ikhondomu.
izigqibo
Kukho inani elaziwayo labaselula abafikisayo abaya kwikliniki ye-STI abaye baxela ukuba babelane ngesondo nee-FSW. Njengenxalenye ebalulekileyo yabo abangazisebenzisanga iikhondomu, ziyibhlorho enokubakho yokuhanjiswa zizifo ezingumvuka wokwabelana ngesondo kwisininzi sabasetyhini ngokubanzi eSingapore nangaphaya. Ke ngoko, iinkqubo zokuthintela ezijolise kuzo kufuneka ziqale ngexesha lokufikisa ukuze zibeke iziseko zendlela yokuphila enempilo ngokwesondo.
Ukuxhasa ulwazi
Imibulelo
Sibulela abaphathi nabasebenzi beekliniki ze-DSC abathe basenza lula isifundo. Sibulela kwakhona kuDede Tham noRaymond Lim abathe bancedisa ukuqokelela idatha. Olu phononongo yayiyinxalenye yesifundo sokungenelela kokuziphatha kolutsha oluxhaswe ngemali liBhunga likaPhando lwezoNyango leLizwe.
Umbhali Wemivuzo
Yamkela kwaye yacwangcisa uvavanyo: I-WLM. Uvavanyo olwenziwe: JYSN. Uhlalutyo lwedatha: JYSN WLM. Bhala iphepha: JYSN WLM.
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