2014年-世界发展银行全球_Middle_East_and_North_Africa___Epidemiology_and_Economics_Intelligence_to_Inform_Policy_Decisions_on_Resource_Allocation_for_HIVAIDS_Programs_73页_1mb

Summary of the 2014 Integrated Biological and Behavioral Surveillance Survey (IBBSS) in Djibouti

Core Content

The 2014 Integrated Biological and Behavioral Surveillance Survey (IBBSS) in Djibouti was the first of its kind to examine the prevalence and risk factors of HIV and syphilis among Female Sex Workers (FSWs) and Long-Distance Truck Drivers (LDTDs). Conducted by the Executive Secretariat for Tuberculosis, HIV/AIDS and Malaria (ES) in collaboration with FHI 360 through the ROADs II project, the survey aimed to provide evidence-based data to inform policy decisions on resource allocation for HIV/AIDS programs.

The survey was funded by the World Bank and USAID/PEPFAR and involved a two-stage time-location cluster (TLC) sampling approach for LDTDs and a "take all" approach for FSWs. Data was collected through structured individual interviews and biological testing using electronic tablets and kits such as Determine and Immunocomb for HIV, and Treponema Pallidum Hemoagglutination Assay for syphilis.

Main Objectives

1. Identify and validate locations where FSWs and LDTDs operate or are accessible in Djibouti Ville.
2. Assess baseline behaviors related to HIV/AIDS, STIs, reproductive health, and family planning.
3. Measure the prevalence of HIV and syphilis among both groups.
4. Evaluate health service access and needs.
5. Provide recommendations for targeted interventions.

Key Findings

Female Sex Workers (FSWs)

• HIV Prevalence: 13%, six times higher than the general population (2.5%).
• Syphilis Prevalence: 5%, five times higher than the national estimate (1%).
• Age Distribution: 68% were under 30, with a mean age of 27.1 years.
• Work Locations: 52.5% operated from service bars, 22% from homes, and 25.5% from streets or brothels.
• Condom Use: 57% used condoms when working elsewhere, but only 47% in brothels. 38% used condoms regularly in brothels, compared to 48% elsewhere.
• Unprotected Sex: 29–40% of sexual encounters were unprotected with occasional and regular clients, respectively.
• Condom Breaks: 14% experienced condom breaks within a month before the survey, and 9% during the last sexual encounter.
• Sexual History: 69% had their first sexual encounter before 18 years of age; 72% began commercial sex after 18.
• Regular and Occasional Clients: 63% had regular clients, 82% had occasional clients.
• Family Planning: 72% used contraceptives at the time of recruitment; 44% preferred private pharmacies for purchasing medicine.
• Knowledge of STIs: 45% had heard of STIs; 69% of those in public places had heard of STIs.
• Health Seeking Behavior: 50% sought assistance from public health clinics, 23% from private pharmacies, 19% from home remedies.
• Gender-Based Violence (GBV): 74% of FSWs reported GBV, with 28% of cases being sexual. 10% of those who experienced GBV were HIV positive.

Long-Distance Truck Drivers (LDTDs)

• HIV Prevalence: 1% among 526 tested.
• Syphilis Prevalence: 1.5% among LDTDs.
• Demographics: 50% were under 30, mean age 31; 64% were literate; 45% were married.
• Sexual Behavior: 77% had their first sexual encounter between 16 and 20 years of age; 77% first sex with non-paid female partners.
• Condom Use: 72% used condoms consistently with both occasional and regular partners; 90% used condoms with paid partners, 76% with non-paid partners.
• Knowledge of STIs and HIV: Only 6.5% were aware of STIs; 75% had been tested for HIV, with most tests being voluntary.
• Risk Perception: 18% felt at risk of HIV, but 57% did not. Only a small percentage (less than 10%) considered anal sex, multiple partners, or condom breaks as risk factors.
• Migration and Mobility: Most LDTDs were from Ethiopia. Their mobility and isolation increased vulnerability to HIV and STIs.
• Sexual Risk: 40% of LDTDs and dock workers engaged in unprotected sex while experiencing STI-like symptoms.

Limitations and Recommendations

Limitations

• Limited data on STI spread and risk factors among FSWs.
• Only active syphilis was tested, while self-reported STIs were also included.
• No data on children under 18 who may be involved in sex work or trucking.

Recommendations

1. Increase testing demand for HIV and syphilis among FSWs and LDTDs.
2. Improve knowledge on sexual health, STI symptoms, and the link between untreated STIs and HIV.
3. Promote consistent condom use with both paying and non-paying partners.
4. Design FSW-friendly interventions, including mobile outreach, counseling, and testing services.
5. Investigate language and cultural barriers for LDTDs, especially those from Ethiopia.
6. Enhance risk awareness among LDTDs, particularly on anal sex, multiple partners, and condom breaks.
7. Develop cross-border programs targeting highly mobile and vulnerable groups.
8. Expand health service coverage along the Addis Ababa-Djibouti transport corridor.
9. Conduct further qualitative research to understand emerging issues and behaviors.
10. Focus on younger populations (under 25) and consider media-based strategies to reach them.

Conclusion

The survey highlights the high prevalence of HIV and syphilis among FSWs and LDTDs, emphasizing the need for targeted interventions. It also underscores the importance of addressing individual, social, and programmatic vulnerabilities to effectively curb the spread of HIV and STIs in Djibouti. The findings provide a baseline for future studies and will inform the development of more effective HIV/AIDS and STI prevention strategies.