【摘要】：第一部分余杭區(qū)女性性工作者艾滋病梅毒感染風險 [目的]了解余杭區(qū)女性性工作者艾滋病梅毒相關高危行為及感染率,分析女性性工作者艾滋病梅毒感染影響因素。 [方法]2008年,對余杭區(qū)女性性工作者進行摸底調查后,在女性性工作者相對集中的鄉(xiāng)鎮(zhèn)街道,以場所為基礎采用整群抽樣方法選擇研究對象。根據橫斷面調查設計,對愿意接受采血的FSW開展艾滋病性病防治問卷調查以及HIV、梅毒篩查。收取血樣運用ELISA和WB進行HIV初篩和確證,運用TPPA和TRUST進行梅毒檢測。應用Epidata3.1建立數據庫并錄入數據,用SPSS16.0進行統(tǒng)計分析,統(tǒng)計方法主要為Logistic回歸分析。 [結果]共有836名研究對象納入本次研究,平均年齡為22.97歲,籍貫以外地人為主,占93.7%,婚姻狀況以未婚為主,占81.7%,文化程度以初中為主,占79.7%,有人流史者占54.5%。首次性生活年齡以15-19歲為主,占74.0%,首次性服務年齡以20-24歲為主,占58.6%。31.3%的FSW一年內患有泌尿生殖道感染,4.4%的FSW自述有吸毒史。最近一次商業(yè)性行為安全套使用率為83.5%,近一個月商業(yè)性行為時每次均使用安全套比例為39.0%。艾滋病感染率為0.1%,梅毒感染率為3.0%。多因素分析提示性服務價格≤50元、最近一次商業(yè)性行為不使用安全套、日均接客≥3人次、有吸毒史4個變量與艾滋病梅毒感染存在統(tǒng)計學關聯。 [結論]余杭區(qū)女性性工作者文化程度偏低、首次性服務年齡偏小、防病意識不強、就診不規(guī)范,堅持使用安全套比例較低。性服務價格低、安全套使用率低、日均接客人次數多、吸毒為余杭區(qū)FSW艾滋病梅毒感染的危險因素。 第二部分余杭區(qū)女性性工作者艾滋病性病社區(qū)預防干預研究 [目的]探索以社區(qū)衛(wèi)生服務中心為基礎的女性性工作者艾滋病性病綜合干預模式,并評估該模式的運行效果。 [方法]采用干預設計研究方法,設立2個干預組(分別以社區(qū)衛(wèi)生服務中心和區(qū)疾控中心為基礎)、1個對照組。2008年開展基線調查,并按照預先設計的干預模式進行持續(xù)兩年時間的預防干預活動,2010年開展干預效果評估。采用定量研究方法,通過比較2008年和2010年安全套使用率、梅毒感染率和規(guī)范就診率這三個指標來評估干預效果。 [結果]社區(qū)衛(wèi)生服務中心(CHS)的干預對象主要為性服務價格較低的FSW,區(qū)疾控中心(CDC)的干預對象主要為性服務價格高的FSW。最近一次商業(yè)性行為安全套使用率在CHS干預組、CDC干預組中,分別從2008年的83.0%和81.5%提高到2010年的99.3%和92.7%,相反對照組從2008年的96.1%下降到2010年的80.2%,且差異具有統(tǒng)計學意義。最近一次非商業(yè)性行為安全套使用率在CHS干預組和CDC干預組中,從2008年的56.8%和35.7%分別提高到2010年的87.9%和59.7%,而對照組從2008年的46.6%下降到2010年的15.8%,差異也具有統(tǒng)計學意義。梅毒感染率2008年各組分別為1.1%、2.0%和10.7%,2010年分別為7.4%、1.7%和5.8%,各組自身前后對照均無統(tǒng)計學差異。規(guī)范就診率在2008年分別為50.0%、34.7%和23.5%,各組間無統(tǒng)計學差異,2010年分別為73.3%、50.0%、38.1%,CHS干預組規(guī)范就診率高于對照組。 [結論]依托社區(qū)衛(wèi)生服務中心開展FSW艾滋病性病綜合干預,在擴大中低性服務價格FSWs的干預覆蓋范圍、提高FSW安全套使用率、促進生殖道疾病規(guī)范就診方面發(fā)揮了積極作用。CHS干預組的干預效果好于CDC干預組和對照組。
[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.
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R759.1;R512.91

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