Heterosexual transmission has become the main route of HIV transmission in China. As the main body of commercial heterosexual transmission, female sex workers (FSW) have a high-risk behavior of inconsistent condom use that increase the risk of HIV infection and spread. This review summarizes associated factors of condom use among FSW such as demographic characteristics, condom negotiation, sexual partner type, sexual intercourse, violence and HIV testing, which can provide reference for the future prevention and research among the FSWs.
Adult ; China ; Coitus ; Condoms/statistics & numerical data* ; Female ; HIV Infections/prevention & control* ; Heterosexuality ; Humans ; Male ; Research/trends* ; Safe Sex ; Sex Work ; Sex Workers ; Sexual Partners

OBJECTIVETo explore the pattern of transmission of human immunodeficiency virus through risky sexual behaviors (RSB) in floating workers coming from the countryside to the cities.

METHODSData were collected anonymously through a structured questionnaire survey in 1595 men from Hangzhou and Guangzhou cities, using a multi-stage sampling method. Data from both preliminary analyses and multivariate regression analysis would show the cumulative adoption of RSB over time and the identification of factors associated with the adoption in this population from the two areas.

RESULTS57.9% - 88.1% of the study samples with the pre-stage RSB (receiving shampoo, massage or leisure-seeking activities from "sexual workers") and 79.9% of those with commercial RSB were initiated during the period when they were working away from their home-towns. The highest adoption rate (15.2% - 26.8%) was happened in the third month after moving to the urban areas for pre-stage RSB, while the highest rate (14.4%) was noticed in the sixth month for the commercial ones. The transition interval between the two behaviors was around 3 months. The cumulative rate was peaked from 57.3% to 70.4% for pre-stage RSB and 48.9% for commercial RSB. The cumulative adoption curves showed that the robust increment was more pronounced in the pre-stage than in the commercial RSB. Most of the early adopters were married and holding higher hedonistic beliefs for the commercial RSB. Communication of sex information and behavioral adoption of RSB was associated with the perceived stress and hedonistic beliefs.

CONCLUSIONRSB epidemics seemed to be social and group phenomena, suggesting that related social strategies should be developed in order to control the RSB in this population.

Adult ; China ; Employment ; HIV Infections ; transmission ; Humans ; Male ; Risk-Taking ; Rural Population ; Sex Work ; Sexual Behavior ; Social Behavior ; Urban Population

OBJECTIVETo provide the basis for AIDS intervention, the study on the relationship between AIDS related risk behaviors and the related factors was carried out among prostitutes, injection drug users and long-distance truck drivers.

METHODSQuestionnaire investigation and statistical analysis as chi(2) test, F test, logistic regression were adopted to analysis the relationship between AIDS related risk behaviors and the correlated factors.

RESULTSKnowledge about AIDS seemed to be related to their level of understanding the problem (in commercial sex workers r = 0.307, P = 0.000, in injection drug users F = 93.07, P = 0.000, in truck man F = 30.06, P = 0.000). Condom use when entertaining their clients last time was related to the knowledge of HIV transmission in commercial sex workers and truck drivers (OR = 1.171, 1.145) and knowledge of HIV prevention (OR = 1.081, 1.397), in drug users regarding gender difference (OR = 2.121).

CONCLUSIONThis study addressed that the effective means to reduce the rate of AIDS risk behaviors and to lessen the harm of AIDS are to improve the knowledge of AIDS and the effective methods to prevent AIDS in the high risk population.

Acquired Immunodeficiency Syndrome ; prevention & control ; Automobile Driving ; China ; Health Education ; Humans ; Risk-Taking ; Sex Work ; Substance-Related Disorders ; Surveys and Questionnaires

OBJECTIVETo determine the relationship between the rate of condom use and incidence of Chlamydia amongst commercial sex worker, using a mathematical model.

METHODSAssuming that p(%) is the rate of condom use by female sex workers, and r(%) is the incidence of Chlamydia. If the use of condom increases by delta p, then the incidence of Chlamydia will decrease by delta r. k is the relative rate of change. Then, the mathematical model established becomes dr/dp = -kr.

RESULTSThe solution of the differential equation is r (p) = r (P0) exp [-k (p - p0)]. Using the surveillance data gathered from 100% Condom Use Program in Wuhan City, the k value is calculated to be 4.36. If k indicates the contribution coefficient of reducing Chlamydia after condom use, when the rate of condom use increases by 16%, then the incidence of Chlamydia will decrease by 50%. The average difference between the actual incidence and the incidence calculated from the mathematical model is only 6.2%. This result demonstrates a good fit. The predicted result of using this mathematical model shows that at the time of lower levels of condom use, a small increment on the rate of condom use would considerably reduce the infection rate of Chlamydia.

CONCLUSIONWhen k remains constant, this mathematical model reflects the qualitative relationship between the rate of condom use and the incidence of Chlamydia.

China ; epidemiology ; Chlamydia Infections ; epidemiology ; prevention & control ; Condoms ; utilization ; Forecasting ; Humans ; Incidence ; Models, Theoretical ; Population Surveillance ; Sex Work

OBJECTIVETo perform cost-effectiveness analysis of interventions in female sex workers in Dehong prefecture in China, with an aim of providing evidence for rational resource allocation in female sex worker interventions in the future.

METHODSThe data of expenses for female sex worker interventions in Dehong from 2005 - 2007 were obtained through questionnaire survey. Meanwhile, the data from baseline survey in 2004, from surveillance of female sex workers from 2005 through 2007 as well as from the special survey on sexual transmission in 2007 were collected. Intervention effectiveness was estimated by using SEX 2.0 Tool recommended by UNAIDS. The cost-effectiveness ratio is calculated as the total cost divided by the number of estimated non-HIV patients due to these interventions.

RESULTSThe total cost for female sex worker interventions is 916 400 RMB from 2005 through 2007, and a total of 3297 female sex workers were effectively intervened in these three years. Thus, the actual intervention cost for each female sex worker (unit cost) is 277.9 RMB. If all the intervention work is performed as required, the predicted unit cost for female sex worker intervention would be 500.5 RMB. During the period of 2005 through 2007, 69 female sex workers had been successfully prevented from HIV infection; therefore, the cost-effectiveness ratio is 13 282 RMB.

CONCLUSIONIntervention among female sex workers is highly cost-effective.

China ; Cost-Benefit Analysis ; Female ; HIV Infections ; economics ; epidemiology ; prevention & control ; Humans ; Models, Statistical ; Primary Prevention ; economics ; Sex Work

OBJECTIVES: To explore the effect of HIV prevention information transmission model in the prevention of high-risk sexual behavior among men who have sex with men (MSM). METHODS: To establish the HIV "expert-key informant-MSM" preventive information transmission model and to intervene the MSM high-risk sexual behavior. Before and 3 months after the intervention, MSM was measured by general information questionnaire, AIDS knowledge and sexual behavior questionnaire, MSM Health Belief Scale for HIV Prevention, and Safe Sexual Self-efficacy Scale. RESULTS: AIDS knowledge and sexual behavior scores in MSM after the intervention were significantly higher than those before the intervention (=-13.047, <0.001); the scores of health belief before and after the intervention were significantly higher (=-3.272, =0.001); condom use in MSM after the intervention was more common than that before the intervention (<0.05), except for commercial sex. CONCLUSIONS The application of HIV prevention information transmission model can effectively improve AIDS-related knowledge, HIV prevention health beliefs, condom use rate of MSM population, and in turn promote the transformation of their high-risk sexual behavior.
Acquired Immunodeficiency Syndrome ; Condoms ; HIV Infections ; Homosexuality, Male ; Humans ; Male ; Risk-Taking ; Sex Work ; Sexual Behavior ; Sexual and Gender Minorities

OBJECTIVETo estimate the size of female sex workers and clients in Taizhou city.

METHODSA household survey using network scale-up method (NSUM) was conducted among the 3000 community residents in Taizhou city from August to October in 2011, which aimed to estimate the social network size (c value) of Taizhou residents, and the c value was adjusted by demographic characteristics, back estimation and outlier elimination. Using the adjusted c value, the number of acquaintance of female sex workers or clients and the respect level toward female sex workers or clients were used to estimate the size of female sex workers and clients.

RESULTSA total of 2783 valid questionnaires were collected, among which 1380 (49.6%) were collected from Taixing city, 1403 (50.4%) were collected from Jingjiang city. 1334 respondents were male (47.9%) and 1449 (47.9%) respondents were female. The mean age was (39.4 ± 10.7) years. The average personal social network size using original data for Taizhou residents was 525, which differed from place, sex, age, educational level and marriage status. Using the remaining known populations through back estimation, the social network size was 419 and became 424 after the elimination of outliers. The estimated population size for female sex worker was 6370 (95%CI: 5886 - 6853), which accounted for 0.52% (6370/1 229 980) of the total number of female aged from 15 to 49. The estimated population size for clients was 15 202 (95%CI: 14 560 - 15 847), which accounted for 1.28% (15 202/1 190 340) of the total number of males aged from 15 to 49 and the ration of clients to female sex worker was 2.39:1.

CONCLUSIONNSUM is an easy and quick way to estimate the size of female sex workers or clients, but the estimated sizes are subject to bias and error due to estimate effect and sample representativeness.

Adolescent ; Adult ; China ; Female ; Humans ; Male ; Middle Aged ; Sex Work ; statistics & numerical data ; Sex Workers ; statistics & numerical data ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo study the loss to follow-up (LTF) rate, HIV emerging incidence and influencing factors in the longitudinal study of female sex workers (FSWs) in Kaiyuan, Yunnan, and their influence on HIV emerging incidence estimate.

METHODSThe open cohort study on FSWs was launched in March 2006 and ended in June 2013 in Kaiyuan, Yunnan. Investigations were made every six months and lasted for 7 years. 661 FSWs found as HIV negative in the baseline study in March 2006 were chosen to study their LTF in the 7 year follow-up investigation. The Cox regression model was used to explore risk factors for HIV emerging infection and those for LTF. In June 2013, a survey was also conducted to explore the detailed reasons for loss to follow-up by contacting FSWs themselves.

RESULTSDuring 1 238.5 person-years of follow-up among 661 HIV negative FSWs, the HIV incidence rate was 1.29 (95% CI: 0.74-2.10)/100 person-year, and the LFT incidence rate was 48.68 (95% CI: 44.88-52.73) /100 person-year. The multivariate analysis showed drug abuse as an independent risk factor for FSWs' infection of HIV (adjusted risk ratio = 4.15, 95% CI: 1.43-12.02); FSWs over 25 years old (adjusted risk ratio = 0.68, 95% CI: 0.57-0.81), and drug abuse (adjusted risk ratio = 0.52, 95% CI: 0.35-0.79) were found with lower LFT rate to remain in the cohort.

CONCLUSIONHigh LFT rate was found in FSW cohort study in Kaiyuan, Yunnan, while the HIV infection risk exposure of the LFT group was lower than the groups of HIV follow-up. HIV prevalence of FSWs in the city might be overestimated. Causes of LFT of FSWs group required further study in the future, and the cohort follow-up retention strategy for FSWs needs to be developed.

Adult ; China ; epidemiology ; Cohort Studies ; Female ; Follow-Up Studies ; HIV Infections ; epidemiology ; Humans ; Incidence ; Longitudinal Studies ; Prevalence ; Risk Factors ; Sex Work ; Sex Workers ; Substance-Related Disorders ; Young Adult

OBJECTIVETo study the socio-demographic characteristics, acquired immune deficiency syndrome (AIDS) related behaviors of male clients of female sex workers and their determinants.

METHODSContacting subjects through 5 ways including volunteers of female sex workers (FSWs), sexually transmitted disease (STD) clinics, long-distance bus stations, long-distance cargo station while adopting methods as snowballing, employing an anonymous questionnaire. Data was analyzed by logistic regression analysis.

RESULTS(1) The majority of clients were 25-45 years old, married and of junior high school or above educational levels; (2) Among male clients of FSWs, numbers of having had commercial sexual intercourse was between 1 to 240, averaged 24 in the previous year. It significantly related to their occupation and the experience of their friends or colleagues who ever visited female sex workers; (3) 27.98% of them used condom every time during commercial sexual intercourse, which significantly related to the score of knowledge on AIDS, concourse of sex intercourse and inhabitation; (4) 28.36% of them had ever contracted STD, which significantly related to the frequency of commercial sexual intercourse in the previous year, risk awareness of being infected with human immunodeficiency virus, and frequency of condom use during commercial sexual intercourse.

CONCLUSIONThe proportion of always using condom was low among male clients of FSWs, and had had STDs. And it's necessary for active and specific intervention programs to them.

Acquired Immunodeficiency Syndrome ; prevention & control ; Adult ; China ; Condoms ; Humans ; Male ; Middle Aged ; Risk-Taking ; Sex Work ; Sexual Behavior ; Unsafe Sex ; statistics & numerical data

OBJECTIVETo monitor the time trend of behaviors change related to HIV/AIDS epidemic and HIV prevalence, and to provide information and basis for comprehensive HIV prevention responses and evaluation of intervention effectiveness among female sex workers in China.

METHODSDuring the year of 2004 to 2008, a series of cross-sectional surveys were conducted among female sex workers in community recruited in both entertainment places and in street, during the defined timeframe, a face-to-face interview was conducted with uniformed questionnaire; while, the venous blood specimen was collected. The sample size was 400 per site per survey.

RESULTSIn 15 continuous national HIV comprehensive surveillance sites among female sex workers from 2004 to 2008, the median of HIV prevalence was 0.0%; Prevalence (median) of syphilis respectively: 0.5%, 1.8%, 1.6%, 1.8% and 1.0%. The median of target subjects who used condom in the last commercial sex was: 81.8%, 80.5%, 84.6%, 87.0% and 88.9% respectively; the median of always used condom in commercial sex during the last month: 65.8%, 59.6%, 60.3%, 59.8% and 73.7%. The median of awareness rate on HIV/AIDS transmission of female sex workers was: 74.3%, 84.1%, 65.2%, 66.0% and 74.3%. The median of target subjects who attended HIV VCT services were: 12.4%, 20.4%, 25.8%, 25.3% and 31.7%. The median of the proportion of female sex workers who reached intervention in last year respectively: 46.4%, 76.1%, 72.1%, 95.0% and 90.8%.

CONCLUSIONCondom use and HIV awareness rate need to enhance further among female sex workers. The proportion of female sex workers who attended VCT and knew their HIV testing result and the proportion of female sex workers who reached intervention in last year both increase. HIV prevalence rate among female sex workers is generally low, but high risk behaviors are still alarming. It is necessary to take more comprehensive and effective prevention measures and intervention.

Adult ; China ; epidemiology ; Cross-Sectional Studies ; Female ; HIV Infections ; epidemiology ; prevention & control ; Humans ; Sentinel Surveillance ; Sex Work ; Unsafe Sex ; Young Adult