Muc dfch nghien ciiu nham danh gia kien thiic phdng tranh lay nhiem HIV va hanh vi sii dung bao cao su trong quan he tinh due ciia nhdm GMD sau 5 nam can thiep 2003-2008.. Y HOC VIET
Trang 1DANH GIA KIEN THUfC VA HANH VI SlTDUNG BAO CAO SU
CUA NHOM PHU NUf MAI DAM TAI MOT SO T I N H THANH PHO NAM 2009
-rmm lidi!'; qi:.''l
'iCl.^ V f l nci
ii'j Oi: Nguyen Thanh Long*
TOM TAT
Dieu tra ve kien thiic, thai dp va hanh vl sii" dung
bao cao su trong nhdm gai mai dam (GMD) dypc tien
hanh tai 7 tinh, thanh phd thupc dy an Phdng lay
nhilm HIV/AIDS d Viet Nam trong nam 2009 Muc
dfch nghien ciiu nham danh gia kien thiic phdng tranh
lay nhiem HIV va hanh vi sii dung bao cao su trong
quan he tinh due ciia nhdm GMD sau 5 nam can thiep
(2003-2008) Phypng phap dieu tra m6 ta cat ngang,
chi so dieu tra dypc xay dyng dya tren bp chi sd theo
doi va danh gia chypng trinh quoc gia Cd 644 gai mai
dam dypc dieu tra Ket qua cho thay ty le thu'dng
xuyen sii dung bao cao su (BCS) ciia GMD trong 6
thang qua, 1 thang qua va trong lan quan he tinh due
gan day nhat lan lu-pt la 95.80%, 91.31%, va 88.83%
Tuy nhien, nhiing hanh vi tinh due khong an toan ciia
GMD van cdn ton tai nhy viec thydng xuyen sii dung
BCS vdi ban tinh thydng xuyen (khach quen, chdng,
ngydi yeu) chiem ty le thap (35% - 45%), khdng cai
thien nhieu so vdi so lieu ban dau (31,58% - 48,6%)
91% GMD cd y thiic ty bao ve minh bang each thuyet
phuc khach hang sii dung BCS Cac sd lieu thu dypc
trong dieu tra nay se giiip cho viec lap ke hoach can
thiep va xay dyng cac mo hinh phii hpp dam bao tfnh
ben vUng
SUMMARY
EVALUATE KNOWLEDGE AND BEHAVIOR IN
CONDOM USE AMONG FEMALE SEX WORKERS
AT SOME PROVINCES IN 2009
A survey on knowledge, attitudes and behavior in
condom use among female sex workers (FSWs) was
conducted at 7 provinces/cities funded by the
HIV/AIDS Prevention and Control in Vietnam Project in
2009 The purpose of the study is to evaluate
knowledge on HIM/MDS prevention and behavior on
cPndom use during sexual intercourses among FSW after 5-year intervention (2003-2008) This is a cross sectional study and its indicators are based on the National M&E data set The survey was conducted among 644 FSWs The findings showed that the rates
of regular condom use in the past 6 months, 1 month and latest sex are 95,80%, 91,31% and 88,83% successively However, there exists unsafe sexual behavior among FSWs The rate of condom use in sex with regular sexual partners (frequent clients, husbands and lovers) is low (35%-45%), which does not much improve in comparison with the initial data (31,58% - 48,6%) 9 1 % of FSWs have a sense of self-protection by persuading their clients to use condoms The results found in this survey can help to develop intervention plans as well as build appropriate and sustainable models
I OAT VAN OE - " ^ S ' - V O ^ - ; ^ '''':"[.' ''^ "" ' Dich HIV d' Viet Nam van dang a trong giai
doan dich tap trung voi ty Ie nhiem HIV cao trong nhdm nghien chich ma tiiy (23,2%), phu nir mai dam (4%) va ty le hien mSc trong quSn the dan cu ndi chung vao khoang 0,27% Tinh ddn het 2008 tren toan quoc da co 138.191 nguai nhiem HIV va 41.544 benh nhan da tu vong do AIDS, so truong hpp benh nhan AIDS va tu vong tang deu theo cac nam Cac ca nhilm HIV xuit hien 6' 63 tinb/thanh, 96% s6 huyen va bon 66%
so xa/phu6ng Trong tong s6 nhQng ca nhilm HIV dup-c bao cao, 78,9% dang trong dp tu6i
20-39, nam giai nhiem HIV chiem 85,2% S6 nguoi nhiem HIV a lua tuoi ngay cang tre va thong qua con duong quan he tinh due dang ngay cang tra nen pho bien Co sy kbac nbau ve hinh thai lay nhilm HIV cila cac dia phuong, cac tinh thanh
* Cue Phong chong HIV/AIDS Bo Y ti Wof
Trang 2Y HOC VIET NAM THANG 12 - SO 1/2009
pho phia BSc, hinh thai nhiem chu ylu qua tiem
chich ma tiiy, cac tinh mien Trung va mot s6 tinh
mien tay Nam bp, nhiem HIV chii ylu qua quan
he tinh due khong dupc bao ve
Cac phan tfch dich te hpc gSn day cho thiy
CO hien tupng dan xen ve hinh thai lay truyen, ty
le su dung ma tiiy trong nhom gai mai dam c6 xu
hudng gia tang nhat la a cac tinh, thanh pho trpng
diem Trong boi canh nhu vay viec tien hanh
nghien ciiu ve kien thiic, hanh vi trong nhdm gai
mai dam la het siic can thiet de dinh hudng cho
cac hoat dpng can thiep dy phong lay nhiem HIV
cho cac tinh thanh pho Du an Phong lay nhiem
HIV a Viet Nam do Cue Phdng chong
HIV/AIDS Bp Y te lam chii dy an tap trung vao
hoat dpng can thiep giam tac bai va phong lay
nhiem HIV trong nhom nguy ca cao a 21 tinh
Viet Nam [2] De danh gia hieu qua cua du an,
nghien ciiu ve kien thiic, thai dp hanh vi su dung
bao cao su dupc tien hanh tren 7 tinh, thanh pho
II MUC Tiiu NGHIEN CCfU
1 Danh gia ket qua cua hoat dpng can thiep
cho nhdm GMD thong qua khao sat kien thiic,
thai dp va hanh vi su dung bao cao su
2 Danh gia kha nang tiep can bao cao su va
hanh vi quan he tinh due an toan cua nhom GMD
IV KET QUA NGHIEN CQU
1 Dac diem chung cua nhom GMD:
III PHUONG PHAP NGHIEN COU
1 Thiet ki dieu tra: Dieu tra mo ta cat
ngang kit hpp phucmg phap dinh tinh va phuong phap djnh lupng phong van doi tupng dieu tra theo bp cau hoi in san
2 Bia diem dieu tra: 7 tinh co tinh hinh lay
nhiem HIV cao cu the la Ha Npi, Quang Ninh, Hai Phdng, TP Ho Chi Minh, Cin Tha, An Giang va Da Nang
3 Thdi gian dieu tra: Tir thang 2 den thang
6 nam 2009
4 Bdi twffng dieu tra: Nhdm gai mai dam
dang song tai dia ban cac tinh noi tren
5 Cdc chi so dieu tra: Chi so dieu tra dupc
xay dung dya tren bp chi so theo doi va danh gia chuang trinh quoc gia cho nhom GMD
6 C& mdu dieu tra: l/ac tinh ty le dii
tu'png GMD CO kien thiic va hanh vi su dung BCS la 80%, sai s6 cho phep 10%, hieu lyc thilt
kl 1,5 Ca mlu n = 92 GMD/tinh T6ng s6 ciia 7 tinh la 644 GMD
7 Chon mdu: Lap danh sach cac quan
huyen cd nhieu boat dpng gai mai dam (diim nong), tai moi tinh chpn 3 huyen Phuang phap chpn mau chum hay chpn mau toan bp dupc ap dung tiiy theo so lupng gai mai dam hoat dpng tai moi diem nong
jm UiB u§il c:: .238 snub i'.z
Thdng tin
n
Tuoi
<20
20-24
25-29
>=30
Ha Npi
92
0,0 12,0 35,9 52,2
Trinh do van hoa
MiJ chii'
Tieu hoc
Trung hpc ui sd
3,3 9,8 47,8
Hai Phong
92
1,1 15,2 28,3 55,4
1,1 14,1 54,3
Quang Ninh
92
5,4
27,2
26,1 41,3
0,0 6,5 46,7
Oa nang
92
2,2 33,7
30,4
33,7
0,0 5,4
63
TP
HCM
92
1,1
33,7 28,3 37,0
3,3
25 53,3
Can thd
92
10,9 25,0 27,2 37,0
5,4 43,5
44,6
An Giang
92
10,9 37,0 32,6 19,6
12,0 58,7 27,2
Tong
644
4,5
26,2 29,8 39,4
3,6 23,3 48,1
Trang 3Pho thong trung
hoc
THCN, CO, DH
37 2,2
Tinh trang hon nhan
Chu'a ket hon
Oang co chong
Oa ly dj
Oa ly than
Goa chong
32,6 34,8 20,7 8,7 3,3
28,3 2,2
30,4 31,5 27,2 2,2 8,7
44,6 2,2
43,5 19,6 26,1 4,3 6,5
28,3 3,3
64,1 8,7
25 1,1 1,1
18,5 0,0
52,2 18,5 23,9 2,2 3,3
6,5 0,0
42,4 16,3 39,1 0,0 2,2
2,2 0,0
51,1 19,6 27,2 1,1 1,1
23,6 1,4
45,2 21,3
27 2,8 3,7
Da s6 GMD a dp tuoi <30 (60,5%) Co 4,5% so GMD duoi 20 tu6i, tap frung chii ylu a An
Giang (10,9%) va Cin Tha (10,9%) Phin lon GMD co trinh dp tu trung hpc ca sa tra xudng (75%)
Ty le nay rat cao tai Can Tha (93,5%) va An Giang (97,9%) Khoang 1/5 so GMD hien dang co gia dinh, 1/3 s6 GMD dang o'trong tinh trang ly dj, ly than hay goa chong ;; , , ^^
2 Hanh vi sif dung bao cao su: it ij;; v • ' , ; ? : ! ; ^niij
Hanh vi tinh due an toan trong nhom GMD duac cai thien ro ret va kha deu a 7 dia phuong (Bieu
d6 1) Ket qua nay the hien qua ty le tang len ciia chi so thuang xuyen su dung BCS ciia GMD trong 6
thang qua, 1 thang qua va trong lin QHTD gin day nhit, lin lugt la 88,83%, 91,31% va 95,80%
Bieu do 1: Ty le sii' dung bao cao su trong lan QHTD gan day nhat, trong mpt thang qua
va trong 6 thang qua ciia GMD
%
120-I Gan day nhat m 1 thang 6 thang qua
100-1-90 2
79-378 3
BUO
95,7 97.8 85.9 82,6 |84.(
^97i7.89^7„gg^^,7 _ 3.^i57g5^_9Jj9_4A94,6 9i4.,^.,„_
_88.83
O i l
1891
»!«(
Ha Noi Hai Phong Quang Ninh Da Ning TPHCM CSnTho' An Giang Chung
So sanh vai ket qua dieu tra ket hpp hanh vi va cac chi s6 sinh hpc HIV/STI 2006 (IBBS), hanh vi sii' dung BCS ciia GMD khi QHTD voi khach hang trong lan QHTD gan day nhit a nghien ciiu nay (DG 2008) da tang len ro ret Ty le GMD tra loi co sti dung BCS trong lin QHTD gin day nhit voi khach hang a dilu tra IBBS 2006 (88%) thap hon (p<0,001) so voi kit qua dilu tra nay (95,8%) [1] Trong 7 tinh dilu tra, chenh lech giua hai lin dilu tra nhilu nhit la a Quang Ninh (p<0,001) Ci Ha Npi, Da Ning va Cin Tha la su chenh lech giua hai cupc dilu tra chua ro rang (P>0,05) [1]
Trang 4- %
120
IBBS 2006 DG 2009
97,8 95.7 gg95,7 94,6
HJNoi Hai Quang BaNang Tp.HCM Can Thd An Giang Chung
— Phong Ninh
Dja phirong
•' Bieu do 2: Ty le GMD co sii dung BCS trong tat ca cac lan QHTD vai khach trong 1 thang qua
Ty le GMD tra lai co su dung BCS trong tat
ca nhiing lan QHTD vai khach hang trong 1
thang qua a dilu tra IBBS 2006 (67,9%) thip hon
(p<0,001) so vai kit qua dieu tra nay (91,3%)
Trong 7 tinh dilu tra, chenh lech giua hai lan
dilu tra rit ro a 6 tinh (p<0,001), chi co a Can
Tha la sy chenh lech giQa hai cupc dieu tra chua
ro rang (p>0,05) Tuy nhien, ty le GMD tra lai sir
dung BCS dii voi nguai yeu, ban tinh van thap
diu a cac tinh, tir 35-45% So vai so lieu ban dau
cua du an la 31,58%-48,62%, ty le nay khong
cho thiy co sy thay doi dang ke nao Trong khi
do, ty le sii dung BCS doi voi ban tinh bat chpt
cung chua cai thien nhieu a mpt so tinh, la trung
binh 70% Qua phong van sau, nhirng ly do ciia
viec GMD khong thuang xuyen dung/chua bao
gia diing BCS la:
• Su dung BCS co thi lam mat di sy tin cay
doi vai ban tinh
• Khong cin thilt lim (thuong a GMD tre,
mai hanh nghe)
• GMD thieu kinh nghiem trong thuyet phuc khach hang va chap nhan khi thuyet phuc that bai
• GMD da nhiem HIV "Khong con gi dl mat" nen khong can phong tranh gi cho ban than
• Doi vai khach hang ciia GMD, viec su dung BCS lam mat cam hiing
3 Thay doi kien thirc va thai do cua nhom GMD
99% GMD da timg nghe noi v l BLTQDTD bao gom HIV/AIDS Hiu hit GMD dupc phong van cho thay hp nam duac nguon lay, duong lay benh va each phat hien benh Tuy nhien, ciing c6 tai 11,5% GMD dupc phong vin cho la mpt nguai CO the lay nhiem HIV neu dung chung nha
ve sinh, 19,6% cho rang muoi dot co the lay truyin HIV Kien thiic trong phong chong HIV/AIDS/STI ciia GMD trong dilu tra nay da dupc cai thien hon so voi ket qua dieu tra ket hpp hanh vi va cac chi so sinh hpc HTV/STI 2006 (IBBS 2006) [1]
27,2
PNMD dirdng pho PNMD nha hang DJa phuong Bieu do 4: Ty le GMD tra lai diing cac bien phap du phong lay nhiem HIV
Trang 5i Ty le GMD duang pb6 cung nhu nha hang
tra lai diing cac bien phap dy phong lay nhiem
HIV trong dilu tra nay lin lupt la 27,2% va
22,6%, cao hon (p<0,001) so voi kit qua dilu tra
IBBS (11,5% va 13,7%) Da phin GMD cho ring
minh khong phai d6i tupng nguy ca cao lay
nhilm HIV/AIDS (59,3%) Ty le nay cao nhit a
cin Tha (79,3%), An Giang (76,1%) va thip nhit
a Ha Npi Chi co 36,7% so GMD duac phong
vin thira nhan minh thupc doi tupng nguy ca cao
lay nhiim HIV (cao nhat la a Ha Npi vai 62% va
thip nhit a An Giang voi 18,5% GMD nhan
thiic tit vl tac dung cua viec su dung BCS trong
do 93,5 - 100% cho ring BCS dung dl phong
ching cac benh vl LTQDTD, 62-89,1% gin BCS
vai tac dung tranh thai Trong so nhung GMD co
su dung BCS, ty le cao (95,7%-100%) hiiu ring
cin sir dung BCS ngay tu dau de tranh cac benh
lay truyin qua duong tinh due Ty le cao GMD
(97,8 - 100%) hieu biet ve tam quan trpng cua
viec su dung BCS doi vai quan he tinh due qua
duang am dao Trong khi do, ty le thap (khoang
30%) hiiu biit vl sy can thiet dung BCS doi voi
quan he tinh due duang mieng va duong hau
mon Nguyen nhan la do cac GMD cho rang
dung BCS qua duong mieng va hau mon de
phong benh lay truyen la khong can thiet Them
nua, mui ciia BCS co the tao cam giac kho chju
CO khi gay ngiia mieng, hpng
Co den 91% GMD luon luon thuyet phuc
khach hang su dung BCS trong quan he tinh due,
chi CO 5,9% thinh thoang va 2,6%o khong thuyet
phuc Theo GMD, 72% luon thuyet phuc thanh
cong de khach hang su dung BCS, 26,9% thinh
thoang thuyet phuc thanh cong va chi co gin 1 %
la thuyet phuc khong thanh cong Trong s6 GMD
thuylt phuc khach hang sir dung BCS khong
thanh cong co 53% luon luon kien quylt tir chii
khong quan he, 24,8% thinh thoang tii' choi va
khoang 20% chip nhan van quan he Ty le phu
nG mai dam biit nai kham chua benh LTQDTD
miin phi dao dpng trong khoang 65-93% Ty le
da tiing nhan djch vu mien phi tai cac phong kham do trong 12 thang qua la 37-75%
4 Tinh sdn co vd khd ndng tiep can
Miic dp bao phii va sy san co cua BCS a tai kenh truyen thong dat muc cao Tuy nhien, tinh trang het hang luon xay ra anh huong lan den tiep can ciia GMD khi can va day cQng la mpt van de can quan tam trong cac chuong trinh tiep thi xa hpi [3,4] Ben canh d6, ty le ban hang thong qua kenh khong truyen thong dat mpt ket qua rat khiem ton chiem trung binh 21% Tinh san CO, dac biet tai kenh khong truyen thong, co vai tro quan trpng trong viec thiic day hanh vi sir dung BCS cua GMD va khach hang ciia GMD[5,6] GMD chua tim kilm san phim BCS tai kenh khong truyen thong: 93,5% GMD biet den nha thuoc la nai co the den mua BCS, va da
CO 79,2% noi da mua tai nha thuoc Trong khi chi
CO 20% - 25% biet thong qua dong ding vien, ca
so y te, nha nghi de co BCS Mpt ty le rit khiem tin, duoi 15% GMD da thyc hien mua BCS tai kenh khong truyen thong BCS can dupc dam bao san co a cac kenh khong truyen thong, bao gom quan nuoc via he, quay thuoc la Tuy nhien, khong tim duac quan nuac via he hay quay ban thuoc la nao san co BCS Dieu nay cho thay, viec tiep can kenh khong truyen thong khong don gian, cho dii kenh nay dugc xem la quan trpng dl tiep can doi tupng co hanh vi nguy ca cao Tuy nhien, tinh san co BCS tai nai GMD tilp khach rit cao, dac biet la BCS OK (67,4% din 85,9%) Cac loai BCS khae chiem ty le khiem ton hon nhieu (thip nhit la 1,4% tai TPHCM va cao nhit
la 30,8% tai Quang Ninh) Dieu nay cho thay cac
ca sa nha hang, khach san co y thuc cao trong viec dam bao tinh san co BCS cho GMD sir khi can Ti le nhiem HIV a GMD co chilu huong
giam ro ret tir 5,15% nam 2006 xuing con 3,5%
nam 2008
Trang 6Y HOC VIET NAM THANG 12 - SO 1/2009
V KET LUAN
1 Co sy cai thien ro rang ve hanh vi tinh
due an toan thong qua thoi quen sir dung BCS
diing each trong nhom gai mai dam sau giai doan
5 nam trien khai cac bien phap can thiep Ty le
GMD tra lai c6 sir dung BCS trong tit ca nhung
lan QHTD vai khach hang trong 1 thang qua la
91,3% cao ban a dilu tra IBBS 2006 (67,9%)
(p<0,001) • •'-•: ,: v: :ni; r i - ; •' ;^ :•'
2 Gai mai dam co hieu biet tot ve eac benh
lay truyen qua duong tinh dye va HIV va c6 y
thiic tot trong viec tu bao ve minh bing each
thuyet phuc khach hang sir dung BCS trong quan
he tinh due 99% GMD da tirng nghe noi vl
BLTQDTD bao gim HIV/AIDS Hiu hit GMD
duac phong van cho thay hp biet duac nguon lay,
duong lay benh va each phat hien benh
3 Miic dp bao phu va sy san co cua BCS a
tai kenh truyen thong dat muc cao hon kenh
khong truyen thong, ty le ban hang thong qua
kenh khong truyen thong dat mpt kit qua rit
khiem ton chiem trung binh 21% trong khi do
93,5% GMD noi rang co the mua bao cao su tai
cacnhathuoc ' i.' n-i^ !':'-• ^ - - o '_ ; K,; OK
VI KHUYEN NGH!
1 Tiep tuc day manh viec cung cap bao cao
su qua kenh khong truyen thong, tang cuong tinh
san CO va kha nang tiep can vai bao cao su qua
kenh khong truyen thong la het sire quan trpng
trong chuong trinh can thiep du phong lay nhiem
HIV/AIDS;
2 Tang cuong cac chuong trinh giao due
truyen thong dac biet cho lap tre vi nhilu gai mai dam hanh ngbl con kha tre va kiln thiic hiiu biit
ve HIV con a miic rit thip;
3 Diy manh cac dich vu tu vin xet nghiem HIV ty nguyen, cac chuang trinh vl dilu trj cac nhiem khuin lay truyin qua duong tinh due cin dugc quan tam va tap trung chuang trinh nay cho nhom gai mai dam
.qi! 4 Can CO he thong giam sat va danh gia cap nhat nhirng thay doi ve kien thirc, thai dp va hanh
vi cua nhom GMD nham dieu chinh, dua ra cac giai phap thich hpp, trong do cac chi so vl thay doi hieu biet va hanh vi dugc theo doi danh gia
dinh ky ^VMb
:'"::K-TAI LIEU THAM KHAO
1 Bo Y tl 2005-06, Kit qua Chuang trinh giam sat
kk hpp hanh vi va cac chi s6 sinh hpc HIV/STI
(IBBS) tai Viet Nam
2 B6 Y te, 2009, Cue Phong ching HIV/AIDS, Bao
cao danh gia kit thiic dy an "Phong lay nhilm HIV a Viet Nam"
3 Donovan, R and Henely, N (2003) Social
Marketing: Principles and Practice (2003), IP
Communications
4 Jude Varcoe, 2004, Assessing the effectiveness of
social marketing Esomar Publiccation
5 Kotler, P., Roberto, N and Lee, N (2002)
Social Marketing: Improving the Quality of Life
Second Edition, Sage Publications
6 Ralf Matthaes v^ cpng sn, 2004: Condom Usage
& Behaviour Study Prepared for DKT
Intemational
/ • ' • : ' ' J
• l i r :•! '
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