High prevalence of HIV and syphilis and associated factors among low-fee female sex workers in mainland China: a cross-sectional study

BMC Infectious Diseases

Zunyou Wu²  Youfang Li³  Yanling Ma³  Jun Zheng⁴  Wei Liu¹  Manhong Jia³  Xi Chen⁴  Yuejiao Zhou¹  Wei Dong²  Yu Wang²  Willa M Dong²  Keming Rou²  Chu Zhou² 

[1] Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China;National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing, Changping District 102206, China;Yunnan Provincial Center for Disease Control and Prevention, Kunming, China;Hunan Provincial Center for Disease Control and Prevention, Changsha, China

关键词: China;    Low-fee sex workers;    Sexually transmitted infections;    Syphilis;    HIV;   

Others  :  1133978
DOI  :  10.1186/1471-2334-14-225

 received in 2013-12-11, accepted in 2014-03-19,  发布年份 2014

【 摘 要 】

Background

The prevalence of HIV and syphilis among middle and high-fee female sex workers (FSWs) has been widely reported but little is known among low-fee FSWs. This study aims to determine the prevalence and associated factors of HIV and syphilis among low-fee FSWs in China.

Methods

A cross-sectional study design was used. A convenience sample of low-fee FSWs was recruited from venues by outreach workers in 12 cities. Structured questionnaire interviews and blood sampling for HIV and syphilis were carried out. Univariate and multivariate logistic regression were used for assessing potential associated factors.

Results

This study enrolled 781 low-fee FSWs. There were 37 (4.7%) HIV positive participants and 117 (15.0%) participants were infected with syphilis. Final multivariate analysis identified five factors associated with HIV infection: older age (OR:2.6, 95% CI:1.1-6.1), local household registration (OR:3.3, 95% CI:1.5-6.9), employed in Yunnan province (OR:2.7, 95% CI:1.1-6.7), soliciting in self-rented rooms and “market day” buildings (OR:3.9, 95% CI:1.5-10.0), injection drug use in the past 6 months (OR:13.5, 95% CI:4.5-40.1); and four factors associated with syphilis infection: older age (OR:1.8, 95% CI:1.2-2.9), employed in Yunnan province (OR:2.1, 95% CI:1.2-3.6), soliciting in self-rented rooms and “market day” buildings (OR:2.3, 95% CI:1.4-3.7) , and no consistent condom use with clients in the past 30 days (OR:1.6, 95% CI:1.0-2.6).

Conclusions

A high prevalence of HIV and syphilis were found among low-fee FSWs. Those soliciting in self-rented rooms and “market day” buildings with the lowest income, and injection drug users (IDUs) in this population should take priority in further intervention strategies.

【 授权许可】

   
2014 Zhou et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Zhao R, Wang B, Fang X, Li X, Stanton B: Condom use and self-efficacy among female sex workers with steady partners in China. AIDS Care 2008, 20:782-790.
• [2]Poon AN, Li Z, Wang N, Hong Y: Review of HIV and other sexually transmitted infections among female sex workers in China. AIDS Care 2011, 23(Suppl 1):5-25.
• [3]Chen XS, Wang QQ, Yin YP, Liang GJ, Jiang N, Yang LG, Liu Q, Zhou YJ, Huan XP, Wei WH, Wang B: Prevalence of syphilis infection in different tiers of female sex workers in China: implications for surveillance and interventions. BMC Infect Dis 2012, 12:84. BioMed Central Full Text
• [4]Yang LG, Tucker JD, Yang B, Shen SY, Sun XF, Chen YF, Chen XS: Primary syphilis cases in Guangdong Province 1995–2008: opportunities for linking syphilis control and regional development. BMC Public Health 2010, 10:793. BioMed Central Full Text
• [5]Li J, Chen XS, Merli MG, Weir SS, Henderson GE: Systematic differences in risk behaviors and syphilis prevalence across types of female sex workers: a preliminary study in Liuzhou, China. Sex Transm Dis 2012, 39:195-200.
• [6]Chen XS, Liang GJ, Wang QQ, Yin YP, Jiang N, Zhou YJ, Yang LG, Liu Q, Wang HC, Wang B: HIV prevalence varies between female sex workers from different types of venues in Southern China. Sex Transm Dis 2012, 39:868-870.
• [7]Huang Y, Henderson GE, Pan S, Cohen MS: HIV/AIDS risk among brothel-based female sex workers in China: assessing the terms, content, and knowledge of sex work. Sex Transm Dis 2004, 31:695-700.
• [8]Guangting M: Going to fair: a local time reappeared in country life. J Guangxi Univ for Nationalities (philosophy and social science edition) 2007, 29:49-55. In Chinese
• [9]China Ministry of Health, UNAIDS, WHO: 2011 Estimates for the HIVAIDS Epidemic in China Report. 2011. Available at: http://www.unaids.org.cn/pics/20130521161757.pdf webcite
• [10]Wang L, Ding Z, Yan R, Li D, Guo W, Wang N: HIV prevalence among populations at risk, using sentinel surveillance data from 1995 to 2009 in China. Zhonghua Liu Xing Bing Xue Za Zhi 2011, 32:20-24.
• [11]Xu JJ, Smith MK, Chu J, Ding GW, Chang DF, Sharp GB, Qian HZ, Lu L, Bi AM, Wang N: Dynamics of the HIV epidemic in southern China: sexual and drug-using behaviours among female sex workers and male clients in Yunnan. Int J STD AIDS 2012, 23:670-675.
• [12]Wang L, Ding ZW, Ding GW, Guo W, Wang L, Qin QQ, Li DM, Wang LY, Yan RX, Hei FX: Data analysis of national HIV comprehensive surveillance sites among female sex workers from 2004 to 2008. Zhonghua Yu Fang Yi Xue Za Zhi 2009, 43:1009-1015.
• [13]Li Y, Detels R, Lin P, Fu X, Deng Z, Liu Y, Huang G, Li J, Tan Y: Difference in risk behaviors and STD prevalence between street-based and establishment-based FSWs in Guangdong Province, China. AIDS Behav 2012, 16:943-951.
• [14]Wang H, Chen RY, Ding G, Ma Y, Ma J, Jiao JH, Wu Z, Sharp GB, Wang N: Prevalence and predictors of HIV infection among female sex workers in Kaiyuan City, Yunnan Province, China. Int J Infect Dis 2009, 13:162-169.
• [15]Lu F, Jia Y, Sun X, Wang L, Liu W, Xiao Y, Zeng G, Li C, Liu J, Cassell H, Chen HT, Vermund SH: Prevalence of HIV infection and predictors for syphilis infection among female sex workers in Southern China. Southeast Asian J Trop Med Public Health 2009, 40:263-272.
• [16]Zhou Y, Li X, Zhang C, Tan G, Stanton B, Zhang X, Cui Y: Rates of HIV, syphilis, and HCV infections among different demographic groups of female sex workers in Guangxi China: Evidence from 2010 national sentinel surveillance data. AIDS Care 2013, 25(11):1433-1441.
• [17]Fang X, Li X, Yang H, Hong Y, Stanton B, Zhao R, Dong B, Liu W, Zhou Y, Liang S: Can variation in HIV/STD-related risk be explained by individual SES? Findings from female sex workers in a rural Chinese county. Health Care Women Int 2008, 29:316-335.
• [18]Hao C, Liu H, Sherman SG, Jiang B, Li X, Xu Y, Jiang Z, Zang C: Typology of older female sex workers and sexual risk for HIV infection in China: a qualitative study. Cult Health Sex 2014, 16:47-60.
• [19]Su S, Li X, Zhang L, Lin D, Zhang C, Zhou Y: Age group differences in HIV risk and mental health problems among female sex workers in Southwest China. AIDS Care 2014. Jan 13. [Epub ahead of print]
• [20]Wang H, Chen RY, Sharp GB, Brown K, Smith K, Ding G, Jin X, Xu J, Dong R, Wang N: Mobility, risk behavior and HIV/STI rates among female sex workers in Kaiyuan City, Yunnan Province China. BMC Infect Dis 2010, 10:198. BioMed Central Full Text
• [21]Wang JJ, Yang Q, Fan PY, Reilly KH, Ding GW, Wang N: Estimation of population-size changes and HIV prevalence among female sex workers from 2006 to 2009 in Kaiyuan, Yunnan, China. Biomed Environ Sci 2012, 25:489-494.
• [22]Wang H, Reilly KH, Brown K, Jin X, Xu J, Ding G, Zang C, Wang J, Wang N: HIV incidence and associated risk factors among female sex workers in a high HIV-prevalence area of China. Sex Transm Dis 2012, 39:835-841.
• [23]Lau JT, Tsui HY, Zhang Y, Cheng F, Zhang L, Zhang J, Wang N: Comparing HIV-related syringe-sharing behaviors among female IDU engaging versus not engaging in commercial sex. Drug Alcohol Depend 2008, 97:54-63.
• [24]Li Y, Detels R, Lin P, Fu X, Deng Z, Liu Y, Tan Y, Li J, Wu Z: Prevalence of HIV and STIs and associated risk factors among female sex workers in Guangdong Province, China. J Acquir Immune Defic Syndr 2010, 53(Suppl 1):S48-S53.
• [25]Xu J, Smith MK, Ding G, Chu J, Wang H, Li Q, Chang D, Wang G, Shang H, Jiang Y, Wang N: Drug use and sex work: competing risk factors for newly acquired HIV in Yunnan, China. PLoS One 2013, 8:e59050.
• [26]Li Q, Li X, Stanton B, Fang X, Zhao R: A multilevel analysis of gatekeeper characteristics and consistent condom use among establishment-based female sex workers in Guangxi, China. Sex Transm Dis 2010, 37:700-705.
• [27]Bhattacharjee P, Prakash R, Pillai P, Isac S, Haranahalli M, Blanchard A, Shahmanesh M, Blanchard J, Moses S: Understanding the role of peer group membership in reducing HIV-related risk and vulnerability among female sex workers in Karnataka, India. AIDS Care 2013, 25(Suppl 1):S46-S54.
• [28]Jin X, Chan S, Ding G, Wang H, Xu J, Wang G, Chang D, Reilly KH, Wang N: Prevalence and risk behaviours for Chlamydia trachomatis and Neisseria gonorrhoeae infection among female sex workers in an HIV/AIDS high-risk area. Int J STD AIDS 2011, 22:80-84.
• [29]Lowndes CM, Alary M, Verma S, Demers E, Bradley J, Jayachandran AA, Ramesh BM, Moses S, Adhikary R, Mainkar MK: Assessment of intervention outcome in the absence of baseline data: 'reconstruction' of condom use time trends using retrospective analysis of survey data. Sex Transm Infect 2010, 86(Suppl 1):i49-i55.
• [30]Celum CL: Sexually transmitted infections and HIV: epidemiology and interventions. Top HIV Med 2010, 18:138-142.
• [31]Zhou Y, Li X, Yang H, Hong Y, Fang X, Wang B, Stanton B: Effect of condom-use measures in predicting sexually transmitted diseases: variation by individual and contextual factors of sexual risk. Int J STD AIDS 2012, 23:e27-e34.
• [32]Jie W, Xiaolan Z, Ciyong L, Moyer E, Hui W, Lingyao H, Xueqing D: A qualitative exploration of barriers to condom use among female sex workers in China. PLoS One 2012, 7:e46786.
• [33]Hao C, Yan H, Yang H, Huan X, Guan W, Xu X, Zhang M, Tang W, Wang N, Gu J, Lau JT: The incidence of syphilis, HIV and HCV and associated factors in a cohort of men who have sex with men in Nanjing, China. Sex Transm Infect 2011, 87:199-201.
• [34]Lianne A, Urada DEM, Nymia P-S, Silverman JG, Strathdee SA: Condom negotiations among female sex workers in the Philippines: environmental influences. 2012, 7:e33282.
• [35]Mykletun A, Dahl AA, O'Leary MP, Fossa SD: Assessment of male sexual function by the brief sexual function inventory. BJU Int 2006, 97:316-323.
• [36]Lau JT, Wan SP, Yu XN, Cheng F, Zhang Y, Wang N, Zhang L, Zhang J: Changes in condom use behaviours among clients of female sex workers in China. Sex Transm Infect 2009, 85:376-382.
• [37]Huang Y, Maman S, Pan S: Understanding the diversity of male clients of sex workers in China and the implications for HIV prevention programmes. Glob Public Health 2012, 7:509-521.
• [38]Xiuxia Ye MS, Tian S, Bei P, Xueqin J, Yong C: Social, psychological, and environmental-structural factors determine consistent condom use among rural-to-urban migrant female sex workers in Shanghai China. BMC Public Health 2012, 12:599. BioMed Central Full Text
• [39]Bui TC, Markham CM, Tran LT, Beasley RP, Ross MW: Condom negotiation and use among female sex workers in Phnom Penh, Cambodia. AIDS Behav 2013, 17:612-622.
• [40]Maher L, Mooney-Somers J, Phlong P, Couture MC, Kien SP, Stein E, Bates AJ, Sansothy N, Page K, Young Women's Health Study Collaborative: Condom negotiation across different relationship types by young women engaged in sex work in Phnom Penh, Cambodia. Glob Public Health 2013, 8:270-283.
• [41]Zhongdan C, Schilling RF, Shanbo W, Caiyan C, Wang Z, Jianguo S: The 100% condom use program: a demonstration in Wuhan, China. Eval Program Plann 2008, 31:10-21.
• [42]Diabate S, Chamberland A, Zannou DM, Geraldo N, Azon-Kouanou A, Massinga-Loembe M, Ahomadégbé C, Labbé AC, Tremblay C, Alary M: Sexual behaviour after antiretroviral therapy initiation in female sex workers and HIV-positive patients from the general population, Cotonou, Benin. AIDS Care 2013, 25:1426-1432.
• [43]Chen XS, Yin YP, Shen C, Liu GG, Zhu ZJ, Wei WH, Wang HC, Huang SJ, Li J, Tucker JD, Mabey DC, Peeling RW: Rapid syphilis testing uptake for female sex workers at sex venues in Southern China: implications for expanding syphilis screening. PLoS One 2012, 7:e52579.
• [44]Kate M, Mitchell APC, Mabey D, Tucker JD, Peeling RW, Vickerman P: The impact of syphilis screening among female sex workers in China: A Modelling Study. PLoS One 2013, 8:e55622.
• [45]Lahuerta M, Sabido M, Giardina F, Hernandez G, Palacios JF, Ortiz R, Fernández VH, Casabona J, UALE projec: Comparison of users of an HIV/syphilis screening community-based mobile van and traditional voluntary counselling and testing sites in Guatemala. Sex Transm Infect 2011, 87:136-140.
• [46]Tucker J, Ren X, Sapio F: Incarcerated sex workers and HIV prevention in China: social suffering and social justice countermeasures. Soc Sci Med 2010, 70:121-129.