Workplace and HIV-related sexual behaviours and perceptions among female migrant workers

Assessing the drivers of sexual behavior among youth and its social determinants in Nepal

INTRODUCTION

Sexual behavior among youth is a public health concern, particularly in contexts where cultural norms, socio-economic factors, and access to comprehensive sexual education play pivotal roles. This paper aims to examine the determinants of sexual behavior among Nepali youths.

METHODS

This study analyzed data from 7,122 individuals aged 15-24 years from the Nepal Demographic and Health Survey (NDHS) 2022, focusing on a nationally representative sample. This study assessed the prevalence of sexual behaviors, including premarital sex, recent sexual activity, and multiple sexual partners. Determinants examined included socio-demographic characteristics, media use, smoking, and alcohol consumption. Bivariate and multivariate logistic regression analysis were conducted to determine the associations between social determinants and sexual behaviors.

RESULTS

The prevalence of premarital sex among the youth was 10.4%, with 15% of male youths reporting recent sexual activity and 2.8% having sexual intercourse with multiple partners. Variables significantly associated with premarital sex included older age groups (AOR = 2.81; 95% CI: 1.98-3.99), male (AOR = 7.87; 95% CI: 5.00-12.39), sales occupations (AOR = 2; 95% CI:1.12-3.57), smoking (AOR = 2.71; 95% CI:1.74-4.23), smokeless tobacco products (AOR = 1.94; 95% CI:1.12-3.34), and alcohol consumption (AOR = 2.97; 95% CI:2-4.41). Variables significantly associated with recent sexual activity included older age groups (AOR = 2.1; 95% CI:1.46, 3.03), being unmarried (AOR = 9.34; 95% CI:5.19-16.82), smoking (AOR = 2.01; 95% CI:1.33-3.05), use of smokeless products (AOR = 1.7; 95% CI:1.98-3.67), and alcohol consumption (AOR = 1.91; 95% CI:1.30-2.82). Youths using smokeless products had higher odds (AOR = 3.33; 95% CI:1.75-6.35) of having multiple sexual partners compared to those youths not using smokeless products.

CONCLUSION

Social determinants, along with smoking and alcohol consumption, were associated with sexual behaviors among youth. This study highlights the need for multicomponent health promotion (new public health) interventions which consider multi-level strategies, including culturally tailored sexual health programs, drug use behaviors, healthy lifestyle choices, comprehensive sexual health education for evidence-based interventions.

A Latent Class Analysis of Sexual Behavior and Associations with Sex Education, Smoking, Drinking, and Pornography Use Among Chinese Youth

The incidence of sexually transmitted diseases has alarmingly increased among Chinese youth in the past decade, and newly diagnosed cases of AIDS have almost doubled between 2010 and 2015. However, little is known about classes of sexual behavior among Chinese youth and associations with their other health behavior or experience of sex education. This study aimed to first identify classes of sexual behavior using latent class analysis and then to examine their associations with sex education, smoking, alcohol drinking, and pornography use. Data were from 13,865 unmarried youth aged 18-24 from the 2009 National Youth Reproductive Health Survey. Six indicators were used: timing of the first sexual intercourse, the number of past-year sexual partners, sex outside of a relationship, incidence of pregnancy, and contraceptive use at the latest and the first sexual intercourse. Four classes were identified: no sex (Class 1, 69%), safer sex (Class 2, 13%), early risk (Class 3, 13%), and multiple risk (Class 4, 5%). Smoking, drinking, and regular pornography use were associated with increased odds of being in the multiple risk class relative to the safer sex class. Sex education, smoking, and pornography use were associated with decreased odds of being in the no sex class relative to the safer sex class. The findings revealed qualitatively different classes of sexual behavior among Chinese youth and important roles of sex education, substance use, and pornography use. Reproductive health service providers can offer individually tailored services to serve youth with different profiles and needs.

Risky sexual behavior and associated factors among sexually-active unmarried young female internal migrants working in Burayu Town, Ethiopia

BACKGROUND

Young female internal migrants are highly vulnerable to risky sexual behaviors (RSB) which may result in serious health problems such as unintended pregnancy, abortion and sexually transmitted infections including HIV. RSB includes early sexual debut (before 18 years), having multiple sexual partners, sex without a condom or inconsistent use of condom and sex under the influence of substance use. This study aimed to assess the magnitude and the factors associated with RSB among sexually-active unmarried young female internal migrants in Burayu Town, Ethiopia.

METHODS

A cross sectional study design was used for the study. A total of 267 respondents was recruited into the study using a simple random sampling technique. A semi-structured interviews-administered questionnaire was used to obtain information from the study participants. The collected data were cleaned, coded and entered into Epi data version 3.1 and then exported to SPSS Ver.21 for analysis. Multiple logistic regression models were used to indicate the association between dependent and independent variables.

THE RESULTS

About 35% of the young female internal migrants had sexual debut before the age of 18 years; 64.4% had sex without condom or inconsistently used condom; nearly one quarter of the participants had multiple sexual partners, and 29.6% had sex under the influence of substance uses. The magnitude of RSB among the study participants was (79.1%). Sexting [AOR 3.47(95%; CI;1.10-11.94)], frequent engagement in social media [AOR 10.9(95%;CI;2.31-51.89)], feeling of embarrassment to buy condom [AOR 8.28(95%; CI; 2.10-32.62)], unfavorable attitude toward using condom for steady and loving relationship [AOR 5.72(95%; CI; 1.47-22.24)] were related with RSB while self-efficacy [AOR 0.15(95%: CI; 0.04-0.57)] to use condom and perceived risks of getting pregnant [AOR 0.05(95%; CI; 0.01-0.23)] were found to be protective factors.

CONCLUSION

The study found high levels of RSB among sexually-active unmarried young female internal migrants. This finding suggests an urgent need of intervention to promote safe sex among this group. Special attention and prompt interventions are needed to promote the use of condoms.

Characterizing Unsafe Sexual Behavior among Factory Workers in the Context of Rapid Industrialization in Northern Vietnam

Industrial workers or factory workers, especially migrant workers, have been found to be vulnerable populations at risk of sexually transmitted infections (STIs). However, there has been a gap in literature regarding health behaviors of migrant factory workers. We conducted a cross-sectional study among 230 factory workers in Hanoi and Bac Ninh cities in Northern Vietnam from July to September 2018 to identify sexual risk practices and related factors among migrant and nonmigrant factory workers. Information collected regarding sexual behavior included the number of sexual partners in the previous 12 months and whether they used condoms in their last sexual intercourse. Two-thirds of participants reported having no sexual activity in the last 12 months, and there was a low percentage of participants using condoms in their last sexual intercourse. Being female, living with spouses/partners, and being a nonimmigrant had a negative association with the lack of using condoms in the last sexual intercourse with casual partners/sex workers, as opposed to having mobility and self-care problems and identifying as a binge drinker. Therefore, workplace-based prevention programs focusing on providing tailored sexual health education and promoting condom use among industrial workers, especially those who are immigrant or migrant workers, in Vietnam should be emphasized.

Sex in the city

Purpose

The purpose of this paper is to determine the sexual risk behavior and sexual harassment among female beer promoters in Chiang Mai, Thailand and analyze the associations among demographic data, sexual activities, sexual orientation, attitudes and working conditions based on the level of sexual harassment.

Design/methodology/approach

This study is a cross-sectional study that approached 184 Thai female beer promoters in Chiang Mai by a snowball sampling technique. Data were collected through a self-administrative questionnaire to find demographic data, sexual activities, sexual orientation, attitudes, sexual risk behavior and sexual harassment while working as a beer promoter. Descriptive, Pearson’s χ2 and Fisher exact tests were performed to describe and determine the associations.

Findings

The findings highlight that sexual risk behaviors and sexual harassment are found among female beer promoters. In total, 62.5 percent of them ever had sexual intercourse and 25.2 percent did not use condom. For sexual harassment, most of respondents had experienced a medium level harassment especially verbal harassment (73.9 percent). It associated with currently student status (p=0.038), having sexual intercourse experience (p=0.024), and type of job (p=0.002).

Originality/value

This paper explores the sexual risk behaviors and sexual harassment among female beer promoters in the northern part of Thailand, containing the information on how common are the types of sexual risk behavior and sexual harassment experiences among a specific and hard-to-reach population.

Understanding condom use among unmarried female migrants: a psychological and personality factors modified information-motivation-behavioral skills model

BACKGROUND

In China, unmarried female migrants are vulnerable to sexual and reproductive health risks. One effective protection strategy is promoting consistent condom use (CCU).

METHODS

We conducted a cross-sectional study to apply the information-motivation-behavioral skills (IMB) model and modified it by addition of psychological and personal factors to examine the related factors of CCU and provide suggestions for intervention among unmarried female migrants.

RESULTS

Of all 903 eligible participants, only 13.8% of participants reported CCU in the past six months. Both the IMB model and the modified IMB model provided acceptable fit to the data. In both models, information had no direct or indirect influence on CCU (p > 0.05). However, behavioral skills had a positive effect on CCU (β = 0.344, p < 0.001 and β = 0.330, p < 0.001). Moreover, motivation contributed to CCU indirectly by affecting behavioral skills (β = 0.800, p < 0.001) and had no direct influence (p > 0.05). In the modified model, psychological and personality factors influenced CCU directly (β = - 0.100, p = 0.005).

CONCLUSIONS

Our results highlight the importance of conducting CCU promotion among unmarried female migrants. Future intervention strategies should focus on both the traditional IMB model constructs and the added psychological and personality factors.

Vulnerabilities and risks of HIV infection among migrants in the Thane district, India

OBJECTIVES

To explore the vulnerabilities and risks of HIV infection among female migrants compared with male migrants in the Thane district of Maharashtra, India.

STUDY DESIGN

This is a cross-sectional epidemiological study.

METHODS

Data from 35,841 migrants (men 96.2% and women 3.8%) were collected using the web-based 'Migrant Service Delivery System.' The data were then analysed in SPSS, version 23.0. Statistical analysis, including Chi-squared test and multivariate logistic regression, was used to identify factors influencing HIV infection for both male and female migrants.

RESULTS

It was observed that 2.96% of female migrants had HIV infection compared with 0.77% of male migrants. We found that 12.1% of women consumed alcohol compared with 41.9% of men, and access to bars was 1.5% among women and 3.5% in men. We observed an even larger difference between men and women in their previous history of using brothels for sex; only 5.9% of female migrants reported previously having used brothels for sex, compared with 62.9% of male migrants. Approximately 12.3% of married women and 93.6% of married men had sex with someone other than their spouse. We found that 67.0% of married women and 73.9% of married men reported using a condom during their last sexual act compared with 60.9% of unmarried women and 68.1% of unmarried men.

CONCLUSIONS

In Thane, female migrants faced higher vulnerabilities and risks of HIV infection than male migrants. Consequently, innovative strategies are required to address these particular needs of female migrants.

Gender-specific differences in high-risk sexual behaviors among methamphetamine users in Myanmar-China border city, Muse, Myanmar: who is at risk?

Background

Methamphetamine (MA) use is a significant public health concern due to its negative effects on health. However, to date, no epidemiological research has examined high-risk sexual behaviors (inconsistent condom use, having multiple sexual partners and having a history of sexually transmitted infections) among MA users. This topic is particularly important in Myanmar, which is recognized as one of the key MA production countries in the Southeast Asia region. Therefore, this study examined factors associated with high-risk sexual behaviors among MA users in Muse city, Myanmar.

Methods

A community-based cross-sectional study was conducted from January to March 2013 in Muse city, Northern Shan State, Myanmar. In total, 1183 MA users (772 male; 411 female) were recruited using respondent-driven sampling and a computer assisted self-interviewing method. Generalized estimating equation models were used to examine factors associated with high-risk sexual behaviors.

Results

A large proportion of MA users engaged in high-risk sexual behaviors (inconsistent condom use: males, 90.7%, females, 85.2%; multiple sexual partners: males, 94.2%, females, 47.2%; and history of STIs: males, 55.7%, females, 56.0%). Among males, being a multiple stimulants drug user (adjusted odds ratio [AOR] =1.77; 95% confidence interval [CI] =1.30–2.41) and being a client of sex workers (AOR = 1.41; 95% CI = 1.08–1.83) were risk factors for engaging in high-risk sexual behaviors. Among females, being a migrant worker (AOR = 2.70; 95% CI = 1.86–3.93) and being employed (AOR = 1.57; 95% CI = 1.13–2.18) were risk factors for engaging in high-risk sexual behaviors as well.

Conclusions

High-risk sexual behaviors were particularly pronounced among both male and female MA users. MA prevention programs that reflect gender considerations should be developed to pay more attention to vulnerable populations such as migrants, clients of sex workers, and less educated female MA users.

The Impact of Healthcare Access on Knowledge and Willingness for HIV Testing in Chinese Female Entertainment Workers

Chinese female entertainment workers are at high risk for HIV. We assessed the impact of healthcare access on HIV knowledge, condom use, and their willingness to receive HIV testing. We surveyed 257 entertainment workers in a cross-sectional study. Demographic, knowledge, and behavioral risk factors were examined. Of 257 women, 107 (42.1%) reported inconsistent condom use. Only 9% had prior HIV testing. Their HIV knowledge was generally poor. Having access to healthcare, being able to obtain condoms, and managers providing health information were associated with consistent condom use (all P < 0.01). Having access to healthcare was related to previous HIV testing (P < 0.01). Our study showed that having a doctor and access to healthcare had positive effects on HIV knowledge and likelihood of condom use and previous HIV testing. Chinese medical providers can play a significant role in encouraging HIV testing and outreach in migrant women employed at entertainment venues.

Poor awareness of syphilis prevention and treatment knowledge among six different populations in south China

BACKGROUND

China is facing an emerging epidemic of syphilis, and the cities in south China are most affected. Knowledge is a key factor in the prevention of syphilis infection, however, little is reported about how much people know about syphilis. This study was aimed at assessing peoples' awareness status in a city located in south China.

METHODS

Six populations were recruited for this study, including urban residents, factory workers, college students, pregnant women, female sex workers (FSWs), and men who have sex with men (MSM). A questionnaire designed by the National Center for Disease Control and Prevention was used to assess participants' awareness of syphilis knowledge. About 5% of participants were randomly selected to conduct a telephone survey for confirming the validity of fieldwork.

RESULTS

The study recruited 3470 participants, and 61.2% of participants were assigned to the awareness group. College students had the smallest percentage of awareness at 51.7% (371/718), followed by FSWs at 53.9% (200/371), factory workers at 56.0% (381/679), urban residents at 65.4% (435/665), pregnant women at 66.0% (451/683), and MSM at 81.1% (287/354). Multivariate logistic regression analysis showed that MSM and FSWs-but not factory workers and pregnant women-had more awareness of syphilis knowledge when comparing with urban residents; however, college students presented less awareness of syphilis knowledge than urban residents. Participants of younger age, of female gender, with lower education levels and without Shenzhen hukou possessed less awareness of syphilis knowledge than those of older age, of male gender, with higher education levels and with Shenzhen hukou respectively.

CONCLUSIONS

The percentages of awareness on syphilis knowledge found in this study are far from the benchmark set in the national 10-year plan. Tailored interventions for different subgroups to increase syphilis awareness are urgently warranted.

A Systematic Review of HIV Risk Behaviors and Trauma Among Forced and Unforced Migrant Populations from Low and Middle-Income Countries: State of the Literature and Future Directions

The aim of the current systematic review is to examine the relationship between trauma and HIV risk behaviors among both forced and unforced migrant populations from low and middle income countries (LMIC). We conducted a review of studies published from 1995 to 2014. Data were extracted related to (1) the relationship between trauma and HIV risk behaviors, (2) methodological approach, (3) assessment methods, and (4) differences noted between forced and unforced migrants. A total of 340 records were retrieved with 24 studies meeting inclusion criteria. Our review demonstrated an overall relationship between trauma and HIV risk behaviors among migrant populations in LMIC, specifically with sexual violence and sexual risk behavior. However, findings from 10 studies were not in full support of the relationship. Findings from the review suggest that additional research using more rigorous methods is critically needed to understand the nature of the relationship experienced by this key-affected population.

HIV risk and sexual health among female migrants in China

Sexual behavior is the dominant mode of HIV transmission in China, and young female migrants are among the populations at highest risk. This article examines how HIV-related risk behaviors among female migrants might vary according to workplace settings. Participants were young female migrants recruited from three workplace settings-factories, restaurants and entertainment venues. In a cross-sectional survey, we assessed 457 participants' sociodemographic characteristics, HIV/AIDS-related knowledge, condom use knowledge, sexual behaviors, condom use behavior and reproductive health factors. Participants working in entertainment venues were significantly more likely than those working in factories and restaurants to report sexual behavior, unprotected sex, multiple pregnancy terminations and sexually transmitted infections (STI). However, participants working in factories and restaurants reported significantly lower levels of HIV/AIDS knowledge, condom use knowledge, condom use self-efficacy and history of HIV/AIDS counseling and testing. Independent correlates of unprotected sex included employment in an entertainment venue, abortion history and sexual self-efficacy. Independent correlates of STI or genitourinary tract infection included employment in an entertainment venue, abortion history, recent migration and recent unprotected sex. These findings indicate a need for sexual and reproductive health interventions prioritizing young female migrants, and call for programs that can be incorporated into different workplace settings.

Rural-to-urban migrants are at high risk of sexually transmitted and viral hepatitis infections in China: a systematic review and meta-analysis

Background

Rapid economic development in urban China has led to a mass migration of surplus rural residents into urban areas for better employment opportunities. This study aims to identify prevalence levels and risks of sexually transmitted infections (STIs) and hepatitis among the rural-to-urban migrant population in China.

Methods

Chinese and English literature databases were searched for studies reporting prevalence of HIV, STIs and viral hepatitis among rural-to-urban migrants in China between 1990 and 2013. The estimates were summarised through a systematic review and meta-analysis. The risks of infection were compared between migrants and the general Chinese population.

Results

We identified a total of 411 eligible studies. The prevalence of HIV, syphilis, gonorrhea, genital warts and HCV among migrants were 0.23% (0.20-0.27%), 0.69% (0.57-0.84%), 2.18% (1.30-3.64%), 1.54% (0.70-3.36%) and 0.45% (0.31-3.65%), representing 4.0 (3.1-5.2), 1.9 (1.1-3.0), 13.6 (5.8-32.1), 38.5 (15.7-94.5) and 3.8 (1.9-7.3) higher odds of infection than among the general population. Construction workers, long-distance truck drivers and migrant women through marriage were migrant subgroups that were highly susceptible to STIs and hepatitis. HIV prevalence among migrant pregnant women (0.10%, 0.02-0.49%) was significantly higher than that of pregnant women in the general Chinese population (OR = 7.7, 3.4-17.4). However, no significant differences were observed in STIs and hepatitis between overall female sex workers (FSWs), men who have sex with men (MSM) and drug users (DUs), and the corresponding subgroups with a migratory background.

Conclusions

Rural-to-urban migrants have a higher risk of STIs and hepatitis than the general Chinese population, but a migratory background does not increase the infection risks of STIs and hepatitis in FSWs, MSM and DUs.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-490) contains supplementary material, which is available to authorized users.

Brief non-commercial sexual encounters among patrons of entertainment venues in Liuzhou, China

Brief non-commercial sexual encounters among patrons of social venues are increasing in China, but whether these encounters increase syphilis risk is unknown. We surveyed and tested 797 men and women at randomly selected social venues in urban Liuzhou and three surrounding counties. The percent reporting recent non-commercial one-time sex ranged from 14.5% of county women to 24.8% of urban men. 2.4% of men and 3.7% of women had a positive rapid syphilis test. Men reporting non-commercial one-time sex were significantly more likely to have a positive rapid syphilis test than other men (7.4 vs. 0.9%). Among women, commercial sex was more strongly associated with syphilis than non-commercial one-time sex (6.0 vs. 0.7%). Recent one-time sex was common and associated with syphilis among men. Venue-based HIV/STI prevention methods may be warranted among persons who do not engage in commercial sex, but frequently engage in one-time sex.

Exploring venue-associated risk: a comparison of multiple partnerships and syphilis infection among women working at entertainment and service venues

The re-emerging syphilis epidemic in China is documented among sex workers, but little is known about STI risk among the broader group of women who work at entertainment and service venues, many of whom do not self-identify as sex workers. In 2009 in Liuzhou, China, community informants identified venues where people meet sexual partners. Characteristics of a stratified random sample of venues were collected during venue visits. Female staff at 42 venues were interviewed and tested for syphilis. The results showed that venue characteristics, worker behaviors, and syphilis prevalence differed by venue type. Service venue workers had more sexual partners, were more likely to report sex work, and more likely to have a positive syphilis test than entertainment venue workers (prevalence ratio: 5.4; 95% CI 1.4-20.6). To conclude, risk of syphilis differs by venue type and is higher at service venues, even among women who do not report commercial sex.

Vulnerability to sexual violence and participation in sex work among high-end entertainment centre workers in Hunan Province, China

BACKGROUND

China has seen a proliferation of entertainment centres that are frequented by business people. Employees at these centres often are young, female rural-to-urban migrants who may be vulnerable to sexual violence and exploitation.

METHODS

Data for this study were collected using a self-administered survey among male and female employees in two high-end entertainment centres in Changsha, Hunan Province, China. We used logistic regression to examine predictors of violent and potentially exploitative experiences (partner violence, forced sex and transactional sex). Predictors included gender, ever having a same-sex partner, migration variables and employment characteristics.

RESULTS

Participants reported high levels of partner violence (16.0% ever and 9.0% in the past 3 months) and forced sex (13.9% ever and 5.5% in the past 3 months). Nineteen percent reported sex work in the past 3 months. In the multivariate regressions, ever having had a same-sex partner was associated with higher odds of ever having experienced partner violence (odds ratio (OR)=7.8, P<0.001), partner violence in the past 3 months (OR=9.0, P<0.001), ever having had transactional sex (OR=6.0, P<0.001) and transactional sex in the past 3 months (OR=5.2, P=0.001). After adjusting for transactional sex, the association between having had a same-sex partner and partner violence remained significant. Neither gender nor migration status was associated with any of the outcomes.

CONCLUSION

High-end entertainment centre workers in China are at risk for sexual violence and should be targeted with employment-based interventions.

Chieh Mei Ching Yi: A randomized controlled trial of a culturally tailored HIV prevention intervention for Chinese massage parlor women in Los Angeles

Asian heterosexual women in the U.S. have experienced relative rising HIV case rates, but there remain few studies and no evidence-based interventions that focus on this population. This study was a randomized controlled trial of a gender and ethnically tailored HIV prevention intervention for monolingual Chinese-speaking women who work as masseuses in Los Angeles. The intervention was two group-based sessions focused on HIV risk and prevention knowledge and condom skills. The control condition was a single-session HIV review. Participants were recruited using newspaper advertisements and referrals from agencies and massage schools. Two hundred women were randomly assigned to one of each condition. Retention in both conditions exceeded 90% at 3-month follow-up. Participants in both conditions demonstrated increases in knowledge on how to use male and female condoms. These effects were sustained at 3-month follow-up. The results highlight the possible efficacy of a one-workshop intervention in increasing HIV knowledge, but that more intensive participant interaction may be needed for improved condom use knowledge.

A qualitative study of perceived risk for HIV transmission among police officers in Dar es Salaam, Tanzania

Background

Understanding people’s views about HIV transmission by investigating a specific population may help to design effective HIV prevention strategies. In addition, knowing the inherent sexual practices of such a population, as well as the risky circumstances that may facilitate HIV transmission, is crucial for the said strategies to become effective. In this article, we report how police officers in Dar es Salaam, Tanzania, perceived the problem of HIV and AIDS in their local context, particularly in relation to unsafe sexual practices. The study was done with the view to recommending ways by which HIV transmission could be minimised within the police force.

Methods

The study was conducted among members of the police force in Dar es Salaam, Tanzania. Eight focus group discussions (FGDs) were conducted, with a total of 66 participants who were mixed in terms of age, gender, and marital status. Some of these were caregivers to patients with AIDS. Data were analysed using the interpretive description approach.

Results

The participants believed that both individual sexual behaviour and work-related circumstances were sources of HIV infection. They also admitted that they were being tempted to engage in risky sexual practices because of the institutional rules that prohibit officers from getting married during their training and for three years after. Nevertheless, as members of the Police Force, they stressed the fact that the risky sexual behaviour that exposes them to HIV is not limited to the force; it is rather a common problem that is faced by the general population. However, they complained, the nature of their job exposes them to road accident victims, subjecting them further to possible infection, especially when they have to handle these road accident casualties without proper protective gear.

Conclusion

Individual sexual behaviour and job-related circumstances are worth investigating if proper advice is to be given to the police regarding HIV prevention strategies. In order to improve the lives of these police officers, there is a need to review the existing institutional rules and practices to accommodate individual sexual needs. In addition, improving their working environment may minimize the risk of HIV transmission from handling casualties in emergency situations.

Sexual and reproductive health among unmarried rural-urban female migrants in Shanghai China: a comparative analysis

We compared sexual and reproductive health (SRH)-related knowledge, attitude and behavior among unmarried rural-urban female migrants in Shanghai coming from different regions of China. A total of 944 unmarried rural-urban female migrants were recruited from three districts of Shanghai. We used an interviewer-administered structured questionnaire to collect information from each participant and a multivariate logistic regression to examine the association between premarital sex and risk factors. We found the rates of premarital sex, pregnancy and abortion among unmarried rural-urban female migrants were 28.2%, 5.2% and 5.0%, respectively. Participants from the east of China were more likely to engage in premarital sex than those from the mid-west (p < 0.001). The analysis showed premarital sex was associated with age, hometown, education, current residential type, knowledge of sexual physiology and safe sex, attitude to SRH and safe sex, and permissive attitude to sex. Unmarried rural-urban female migrants lack SRH related knowledge and the data suggests high levels of occurrence of premarital sex. The results indicate that programs to promote safe sex, especially to those migrants coming from eastern China, should be a priority.

High HIV prevalence and risk of infection among rural-to-urban migrants in various migration stages in China: a systematic review and meta-analysis

BACKGROUND

Rural-to-urban migrants represent 17% of the total Chinese population and are considered a potential high-risk bridging population of HIV infection between urban and rural China.

METHOD

Based on a systematic review and meta-analysis, this study determined HIV prevalence among rural-to-urban migrants in different stages of migration. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

We identified 54 studies reporting 59 HIV prevalence levels among rural-to-urban migrants in China. Overall, 53.4% (95% confidence interval, 33.5%-72.4%) of urban patients with HIV have migratory background. The floating-out population showed a higher HIV prevalence (0.15% [0.06%-0.34%]) than did the Chinese population (0.057%; odds ratio, 2.63 [1.35-5.14]). The floating-in population showed a higher HIV prevalence (0.38% [0.29%-0.50%]), corresponding to 6.70 (6.05-7.41) times greater odds of HIV infection. Higher prevalence levels were observed among female migrants (0.69% [0.51%-0.93%]), reflecting a much higher odds of HIV infection (12.18 [11.11-13.35]). Infection risk among returning migrants (0.18% [0.12%-0.29%]) was 3.16 (2.06-4.84) times higher than the overall Chinese population. Chinese internal migrants contribute to a substantial amount of the overall HIV epidemic in China.

CONCLUSION

Migrants are at greater risk for HIV infection than the general Chinese population and likely to facilitate the geographical spread of HIV in China. Targeted strategies for health promotion and HIV prevention for migrants in China should be developed.

Predictors of reducing sexual and reproductive risk behaviors based on the information-motivation-behavioral skills (IMB) model among unmarried rural-to-urban female migrants in Shanghai, China

Background

Due to the increase of premarital sex and the lack of reproductive health services, unmarried rural-to-urban female migrants experience more risks of sex and reproductive health (SRH). This study was designed to describe SRH related knowledge, attitude and risk behaviors among unmarried rural-to-urban female migrants and examine the predictors of reducing sexual and reproductive risk behaviors based on information-motivation-behavioral skills (IMB) model and to describe the relationships between the constructs.

Methods

We conducted a cross-sectional study to assess SRH related information, motivation, behavioral skills and preventive behaviors among unmarried rural-to-urban female migrants in Shanghai, one of the largest importers of migrant laborers in China. Structural equation modeling (SEM) was used to assess the IMB model.

Results

A total of 944 subjects completed their questionnaires. The mean age was 21.2 years old (SD = 2.3; range 16 to 28). Over one-fourth of participants reported having had premarital sex (N = 261, 27.6%) and among whom 15.3% reported having had the experience of unintended pregnancy, 14.6% with the experience of abortion. The final IMB model provided acceptable fit to the data (CFI = 0.99, RMSEA = 0.034). Reducing sexual and reproductive risk behaviors was significantly predicted by SRH related information (β = 0.681, P<0.001) and behavioral skills(β = 0.239, P<0.001). Motivation (β = 0.479, P<0.001) was the significant indirect predictor of reducing sexual and reproductive risk behaviors mediated through behavioral skills.

Conclusions

The results highlight the importance and necessity of conducting reproductive health promotion among unmarried rural-to-urban female migrants in China. The IMB model could be used to predict reducing sexual and reproductive risk behaviors and it suggests future interventions should focus on improving SRH related information and behavioral skills.

Sexual attitudes, behaviours and acculturation among young migrants in Shanghai

China's rates of internal migration increased to an all-time high of over 200 million individuals at the beginning of the twenty-first century. Yet, there is a dearth of information on the lives of young migrant populations. The aim of this study was to explore how migration influences the sexual attitudes and behaviours of 18-24-year-old migrant men and women in Shanghai, China. A total of 64 migrants participated in 10 focus-group discussions and 20 in-depth interviews. Guided by acculturation theory, coded data were organised into analytic matrices to compare themes across participants. Factors associated with increased sexual-risk behaviours include acculturative stress, discrimination leading to social isolation, conflicts between traditional and modern city values and increased sexual opportunities. Premarital sex, cohabitation, unprotected sex and visiting sex workers are common among this population. Reasons for not using condoms included being unprepared, lack of knowledge and barriers in accessing reproductive services due to not having urban documentation. Local family planning programmes should help migrants negotiate traditional and modern values and partner with work-sites to provide comprehensive sexual education and services and train health professionals in the specific healthcare needs of young migrant populations.

Migration/mobility and risk factors for HIV among female sex workers in Andhra Pradesh, India: implications for HIV prevention

We examined the relation between high mobility/migration (sex work in three or more villages/towns within the past year) and HIV risk factors among a sample of female sex workers (FSWs) in Andhra Pradesh, India. We recruited FSWs aged ≥18 years (n = 673) through respondent-driven sampling for a survey on HIV risk. Adjusted logistic and linear regression models assessed high mobility in relation to sexual and physical victimization, sexually transmitted infection (STI) symptoms and treatment, condom use and negotiation, number and/or types of sex trades, number of clients and number of days worked. Twelve percent (n = 82) of FSWs were highly mobile; those with high mobility were more likely to report recent HIV risk factors: sexual violence (adjusted odds ratio [AOR] = 5.2; 95% confidence interval [CI]: 3.0-8.9), physical violence (AOR = 1.7; 95% CI: 1.1-2.7), unprotected sex for more money (AOR = 1.7; 95% CI: 1.1-3.0), at least one STI symptom (AOR = 1.9; 95% CI: 1.1-3.1), a greater number of vaginal sex trades (β = 3.9, P = 0.003), a greater number of clients (β = 2.5, P = 0.02) and anal sex with clients (AOR = 2.4; 95% CI: 1.4-4.1). Findings from this study underscore the violence and HIV-related vulnerability faced by mobile/migrant FSWs and highlight the need to inform and tailor related prevention strategies.

Multilevel and spatial analysis of syphilis in Shenzhen, China, to inform spatially targeted control measures

OBJECTIVES

The present study investigates the varied spatial distribution of syphilis cases in Shenzhen, China, and explores the individual-, neighbourhood- and district-level factors affecting the distribution.

METHODS

This study uses spatial analysis and multi-level generalised estimating equations to explore the spatial distribution of reported syphilis cases among individuals in Shenzhen, Guangdong Province, China. The spatial distribution of primary/secondary and latent cases was investigated using the Moran's I-statistic. Primary/secondary syphilis cases were compared with all syphilis cases using a three-level model with individual (n=6496), neighbourhood (n=55) and district (n=6) levels.

RESULTS

A total of 6496 syphilis cases were reported in 2009 with 35.8% primary and secondary syphilis cases. Both primary/secondary syphilis cases (Moran's I value=0.33, p<0.01) and latent syphilis cases (Moran's I value=0.19, p<0.01) showed significant spatial clustering at the neighbourhood level. Adjusting for the number of reporting hospitals, the best model found that the following characteristics were associated with primary/secondary syphilis infection: individuals who are younger in age (p=0.003), male (p<0.001), migrant labourers (p=0.047) and those who live in districts with a higher gross domestic product (p<0.001).

CONCLUSIONS

There is substantial clustering of primary and secondary syphilis cases at the neighbourhood level in Shenzhen, suggesting the need for greater STD health service provision in these clustered neighbourhoods. Spatially targeted syphilis control measures may be useful to optimise testing, treatment and partner services.

Labor migration and HIV risk: a systematic review of the literature

To inform the development of multilevel strategies for addressing HIV risk among labor migrants, 97 articles from the health and social science literatures were systematically reviewed. The study locations were Africa (23 %), the Americas (26 %), Europe (7 %), South East Asia (21 %), and Western Pacific (24 %). Among the studies meeting inclusion criteria, HIV risk was associated with multilevel determinants at the levels of policy, sociocultural context, health and mental health, and sexual practices. The policy determinants most often associated with HIV risk were: prolonged and/or frequent absence, financial status, and difficult working and housing conditions. The sociocultural context determinants most often associated with HIV risk were: cultural norms, family separation, and low social support. The health and mental health factors most often associated with HIV risk were: substance use, other STIs, mental health problems, no HIV testing, and needle use. The sexual practices most often associated with increased HIV risk were: limited condom use, multiple partnering, clients of sex workers, low HIV knowledge, and low perceived HIV risk. Magnitude of effects through multivariate statistics were demonstrated more for health and mental health and sexual practices, than for policy or sociocultural context. The consistency of these findings across multiple diverse global labor migration sites underlines the need for multilevel intervention strategies. However, to better inform the development, implementation, and evaluation of multilevel interventions, additional research is needed that overcomes prior methodological limitations and focuses on building new contextually tailored interventions and policies.

Trauma exposure, PTSD, and HIV sexual risk behaviors among labor migrants from Tajikistan

Little is known about the role of trauma and PTSD symptoms in the context of migration-associated HIV risk behaviors. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method (quantitative and qualitative) study. The mean PC-PTSD score was 1.2 with one-quarter of migrants scoring at or above the cutoff of 3 indicating likely PTSD diagnosis. PC-PTSD score was directly correlated with both direct and indirect trauma exposure, but PC-PTSD score did not predict either HIV sexual risk behaviors or HIV protective behaviors. HIV sexual risk behavior was associated with higher indirect trauma exposure. PC-PTSD score was associated with some indicators of increased caution (e.g., more talking with partners about HIV and condoms; more use of condom when drinking). Qualitative findings were used to illustrate the differences between direct and indirect traumas in terms of HIV sexual risk. The study findings call for future efforts to address labor migrant's mental health needs and to integrate trauma dimensions into HIV prevention.

Migration and unprotected sex in Shanghai, China: correlates of condom use and contraceptive consistency across migrant and nonmigrant youth

PURPOSE

Despite the exceptionally large population of young migrants in China, as well as increasing rates of HIV and sexually transmitted infections in recent years, condom use and contraceptive consistency among this population remains critically under-studied. This study examines the association between migration and condom use and contraceptive consistency.

METHODS

A cross-sectional survey of 959 youth aged 15-24 years was conducted in rural and urban Shanghai. Logistic regression was conducted to examine the association between migration status and condom use and consistent contraceptive use. Analyses are stratified by gender.

RESULTS

Overall, only 32% reported condom use at first sex, and <10% reported consistent contraceptive use. Compared with 63.6% of urban nonmigrants, 83.1% of rural-to-urban migrants reported not using a condom at first sex. Multivariate logistic regression models indicate that patterns of migration and gender clearly impact condom use and contraceptive consistency. After adjusting for background characteristics, rural-to-urban migrant males were significantly less likely to report condom use at first sex and consistent contraceptive use with first partner compared with nonmigrants and urban-to-urban migrants. Females living in rural areas who never migrate, by contrast, are least likely to report condom use and consistent contraceptive use compared with other females.

CONCLUSION

Because rural men who migrate to urban areas and rural nonmigrant young women are at particular risk, programs should target rural areas for both of these groups that would give support to young men before they leave their hometowns, as well as focusing on females who might not have the opportunity to migrate.

Childhood sexual abuse and sexual risks among young rural-to-urban migrant women in Beijing, China

BACKGROUND

Child sexual abuse (CSA) has substantial impact on women. The current study aims to explore the patterns of CSA in migrant women in China. Moreover, a relationship between experience of CSA and increased sexual risks was also examined among this vulnerable population.

METHODS

A final sample of 478 rural-to-urban migrant women was recruited from different work places in two urban districts of Beijing, China.

RESULTS

About 17% (n=80) of migrant women reported ever experienced any kind of CSA before 16 years of age. Participants who had multiple sexual partners, drank before sex and had early age of sexual debut reported higher rate of overall CSA (45.7% vs. 23%, p<0.01; 41.2% vs. 24%, p<0.05; and 47.8% vs. 24.4%, p<0.05) and contact CSA (37.1% vs. 15.6%, p<0.01; 32.4% vs. 16.8%, p<0.05; and 39.1% vs. 17%, p<0.05) compared to their counterparts. The multivariate analysis confirmed the results of bivariate analysis that a history of CSA was associated with increased sexual risks in adulthood.

CONCLUSION

The current study suggests that health-related prevention intervention programs (i.e., HIV-related sexual risks prevention intervention) targeting the migrant women population needs to take in consideration the possible experience of CSA. Moreover, effective school-based or community-based CSA prevention intervention should be conducted to reduce CSA rate and improve attention to CSA issues in rural communities in China.

HIV/STI risk by migrant status among workers in an urban high-end entertainment centre in Eastern China

Large-scale internal migration in China may be an important mechanism for the spread of HIV/sexually transmitted infections (STIs) because of the risk behaviours of migrants. We conducted a self-administered survey among 724 employees of a high-end entertainment centre in Kunshan, Jiangsu Province, China. Using logistic regression, we examined the association of hometown of origin (Kunshan city, elsewhere in Jiangsu Province, or another province in China) and consecutive years living in Kunshan with measures of HIV/STI risk behaviour. We found that increased time living in Kunshan was associated with lower odds of using condoms as contraception [odds ratio (OR) = 0.78, 95% confidence interval (CI): 0.64-0.95] and consistent condom use with a casual partner (OR = 0.66, 95% CI: 0.47-0.93), after controlling for gender, marital status age and income. The odds of having had an STI were significantly lower for Kunshan natives than those originally from outside provinces (OR = 0.25, 95% CI: 0.07-0.96), but increasing years living in Kunshan was not related to lower risk for an STI. Our findings do not support the hypothesis that migrants living far from home participate in higher risk behaviour than locals. Findings suggest that adaptation to local culture over time may increase HIV/STI risk behaviours, a troublesome finding.

Prevalence and risks for sexually transmitted infections among a national sample of migrants versus non-migrants in China

This study aims to describe and compare the gender-specific prevalence of chlamydia and gonorrhoea, sexual behaviours and experiences, and risk factors associated with sexually transmitted infections (STIs) among migrants versus rural and urban non-migrants in China. Data were abstracted from the Chinese Health and Family Life Survey conducted from 1999 to 2000, which provided a nationally representative adult (ages 20-64 years) sample. STI results were determined using a urine-based nucleic acid amplification assay. The prevalence of chlamydia for migrant women was triple that of rural non-migrant women. Migrants were more likely to engage in STI-associated risk behaviours than non-migrants (e.g. receiving money for sex). Among migrants, women were more likely than men to have STIs. The high STI prevalence among migrants highlights an urgent need to implement comprehensive prevention and intervention programmes targeting the cultural, social and structural needs of migrants in the city, especially migrant women.

Theory-based HIV-related sexual risk reduction prevention for chinese female rural-to-urban migrants

The objective of this pilot study was to evaluate the initial efficacy of a protection motivation theory-based behavioral HIV prevention intervention in increasing HIV knowledge, condom use perception, condom use intention and consistent condom use among female rural-to-urban migrants in Beijing, China. Three hundred female migrants were assigned to the intervention group (N = 200) and control group (N = 100). Data were collected at baseline and a 4-month follow-up. The results suggest that HIV-related knowledge, condom use perceptions, condom use intention and condom use skills at the follow-up were significantly improved among female migrants in the intervention group compared with those in the control group. Moreover, a significantly higher rate of consistent condom use at post intervention was found compared with that at baseline in the intervention group (17.0% vs. 32.0%, p < .05) but not in the control group (23.8% vs. 29.2%, ns). The current study suggests that the theory-based intervention can be efficacious in increasing HIV knowledge, condom use perceptions and skills, and consistent condom use among female rural-to-urban migrants in China.

Entertainment Venue Visiting and Commercial Sex in China

Entertainment venues in China play an important role in the sexually transmitted disease (STD)/HIV epidemic. Most previous studies have focused on sex workers working in entertainment venues, but little is known about their clients. This study investigated the perceptions and behavior of the patrons visiting entertainment venues. Qualitative in-depth interviews were conducted with 30 male market vendors who visited entertainment venues at least once in the past 3 months in an eastern city in China. Information about their risky behavior, attitude toward commercial sex, and STD/HIV prevention approaches was collected. Saunas, karaoke bars, and massage centers are the most frequently visited entertainment venues. Seventy-three percent of study participants reported purchasing commercial sex at these entertainment venues. Participants expressed a very liberal attitude toward commercial sex. Seeking commercial sex was perceived as a characteristic of a male's nature. The perceived risks of STD/HIV infection do not deter participants from engaging in commercial sex. Commercial sex clients reported irregular condom use and a number of other misperceptions and improper practices toward preventing STD/HIV infection. Venue-based intervention is urgently needed to target the population. The sex workers themselves could potentially serve as "health educators" to communicate prevention information to their clients and encourage safer sex behavior.

Visiting entertainment venues and sexual health in China

Entertainment venues in China are associated with risky sexual behavior. Most previous studies related to entertainment venues in China have focused on sex workers and commercial sex, but this study addressed sexual health in a sample of the general urban population. A randomly selected sample of market vendors (n = 4,510) from an eastern city was recruited and assessed to examine relationships between entertainment venue visits and sexual risk. Both behavioral (self-reports of unprotected sex) and biomedical (STD test results) measures were used. About 18% of the sample (26.8% of men and 9% of women) reported visiting entertainment venues in the past 30 days. Those who visited entertainment venues were more likely to be male, younger, single, with higher education, and to have more discretionary income. For both men and women, visiting entertainment venues was a significant predictor for unprotected sex and STD infection. Gender differences were observed in predicting unprotected sex and STD infections. Entertainment venues could be potential sites for place-based intervention programs and outreach for the general population.

Smoking knowledge, attitudes, and behaviors among rural-to-urban migrant women in Beijing, China

BACKGROUND

China has the largest population of cigarette smokers worldwide; surveys suggest rising prevalence among young women. Migratory lifestyles may confer increased susceptibility.

OBJECTIVES

we aimed to understand how migration relates to smoking among young women.

METHODS

we implemented a cross-sectional behavioral survey of rural-to-urban Chinese women (n = 206) working in restaurants and commercial sex venues, assessing smoking attitudes, behaviors, and health-risk knowledge.

RESULTS

rates of ever smoking and current smoking among restaurant workers were high compared with the rates in general population surveys (16.1% and 6.5%, respectively); rates were much higher among sex workers (54.9% and 33.3%, respectively). Multivariate analysis revealed education to be protective, whereas exposure to female-branded cigarettes was a risk for ever smoking.

CONCLUSIONS

Chinese migrant women appear to be smoking at higher rates than nonmigrant women. Priorities for future research include representative studies in multiple cities examining reasons for uptake and stimuli to quit.

Endangered womanhood: women's experiences with HIV/AIDS in China

Women in China are increasingly affected by HIV/AIDS. Current AIDS studies have examined the HIV risks faced by this gender group, paying inadequate attention to women's actual experiences with the disease. This oversight has inhibited our ability to understand the impact of gender on women's capacity to respond to HIV/AIDS in their postinfection lives. Based on a qualitative study on illness experiences of HIV-infected people, this article examines the interactions between HIV/AIDS and gender roles in the Chinese context. It was found that traditional gender norms have played a key role for HIV-infected women in their efforts to tackle this disease and to make sense of their daily lives. HIV infection has created a conflict between women's intention to fulfill their conception of "womanhood" and a decreased ability to do so, which, in turn, has adversely affected their self-perceptions and well-being. To avoid worsening the inequality women experience, therefore, we must also work on the socioeconomic conditions, for example, through delivering comprehensive care to affected families and developing a gender-sensitive welfare policy, so that the gender imparity that permeates this epidemic can be challenged and transformed.

Prevalence of human immunodeficiency virus, Chlamydia trachomatis, and Neisseria gonorrhoeae and risk factors for sexually transmitted infections among immigrant female sex workers in Catalonia, Spain

OBJECTIVES

To determine the prevalence of human immunodeficiency virus (HIV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) among immigrant female sex workers (FSW) according to their geographic area of origin and identify possible risk factors independently associated with current infection with CT and/or NG.

STUDY DESIGN

Cross-sectional study of 357 FSW in Catalonia in 2005. Information on sociodemographic and sex work characteristics, use of alcohol and drugs, sexual practices, and the use of social and health care services was collected. Oral fluid and urine samples were collected to determine the prevalence of HIV and CT/NG, respectively. Factors independently associated with CT/NG were assessed using multivariate logistic regression models.

RESULTS

A total of 36.4% of women were from Eastern Europe, 34.5% from Latin America, and 29.1% from Africa. Overall CT and NG prevalence were 5.9% [95% confidence interval (CI): 3.7-8.9] and 0.6% (95% CI: 0.1-2.0), respectively. No differences were observed by geographic origin. Three African women were HIV positive (overall HIV prevalence was 0.8%, 95% CI: 0.2-2.4). In multivariate analysis, younger age and unprotected sex with clients were associated with the presence of CT/NG.

CONCLUSIONS

The prevalence of sexually transmitted infections among FSW in Catalonia was lower than in other European countries. Even though the prevalence of HIV was only 0.8%, it could increase in the future given the high vulnerability of these women and their wide geographic mobility. It is necessary to continue with the work carried out by nongovernmental organizations (harm reduction programs, outreach programs, and safe sex workshops) as well as to facilitate the access to health centers, especially for the youngest women.

Immigration status and HIV-risk related behaviors among female sex workers in South America

This study compares immigrant (i.e., foreigner) with non-immigrant (i.e., local/native) HIV-related risk behaviors among female sex workers (FSW) in South America. A total of 1,845 FSW were enrolled in Argentina, Bolivia, Ecuador, and Uruguay. According to their nationality, 10.1% of participants were immigrant FSW. Immigrant FSW were more likely to be younger in Argentina; to work in a disco/bar in Bolivia; to be single and use illegal drugs in Ecuador; and to work in a brothel, consume alcohol, and have sex with foreign clients in Uruguay. HIV-related sexual and drug use behaviors were more common among immigrant FSW in Bolivia, Ecuador, and Uruguay. Country-specific HIV/STI prevention and control programs should be developed for immigrant FSW populations in South America.

Can variation in HIV/STD-related risk be explained by individual SES? Findings from female sex workers in a rural Chinese county

Low socioeconomic status (SES) has been linked to HIV and sexually transmitted disease (STD) at a macro level because the majority of new cases of HIV infection in the world have been reported in underdeveloped or developing countries. However, empirical data on the relationship between individual SES and HIV/STD related risk have been mixed. Employing quantitative data from 454 female sex workers (FSWs), this study was designed to examine the profile of the study sample in terms of their individual SES, HIV/STD-related sexual risk across work locations with different social, cultural, and economic conditions; and to examine the relationship between work location and HIV-related risk behaviors, controlling for individual SES. We have shown in the current study that both SES and HIV/STD-related risk behaviors significantly differed by work location. However, the difference in individual SES was not sufficient to explain the difference of HIV/STD-related risk across the work locations. The findings underscore the need for effective prevention intervention efforts targeting FSWs in rural areas. Based on the findings, we also suggest that HIV/STD intervention efforts among FSWs should take the social and cultural contextual factors of their working environment (and sexual risks) into consideration.

Women and HIV/AIDS in China: gender and vulnerability

A comprehensive literature review was conducted to determine if there was a research gap between women's vulnerability to HIV and research addressing that vulnerability in China. Türmen's article Gender and HIV/AIDS served as a framework for examining the eight determinants placing women and adolescent girls at greater risk of HIV infection than men. Eighty-eight research reports were retrieved and categorized by general characteristics and the eight determinants. Women were found to be more vulnerable than men to HIV infection in China and worldwide. While researchers reported a considerable amount of research regarding women's HIV/AIDS-related issues in China, there is insufficient attention to some risk determinants. Investigators are encouraged to take advantage of political commitment and policy changes in China to conduct more research focusing on female vulnerability and to address the effects of violence, laws, stigma, and discrimination in female HIV prevention.

Inhibition of chlamydial infection in the genital tract of female mice by topical application of a peptide deformylase inhibitor

Chlamydia trachomatis is an obligate intracellular bacterium responsible for a number of health problems, including sexually transmitted infection in humans. We recently discovered that C. trachomatis infection in cell culture is highly susceptible to inhibitors of peptide deformylase, an enzyme that removes the N-formyl group from newly synthesized polypeptides. In this study, one of the deformylase inhibitors, GM6001, was tested for potential antichlamydial activity using a murine genital C. muridarum infection model. Topical application of GM6001 significantly reduced C. muridarum loading in BALB/c mice that were vaginally infected with the pathogen. In striking contrast, growth of the probiotic Lactobacillus plantarum is strongly resistant to the PDF inhibitor. GM6001 demonstrated no detectable toxicity against host cells. On the basis of these data and our previous observations, we conclude that further evaluation of PDF inhibitors for prevention and treatment of sexually transmitted chlamydial infection is warranted.

Profile of female sex workers in a Chinese county: does it differ by where they came from and where they work?

Since the 1980s, informal or clandestine sex work in the service or entertainment industry has spread from municipalities to small towns in most areas of China. Despite recognition of the important role of female sex workers in HIV and STD epidemics in China, limited data are available regarding their individual characteristics and the social and environmental context of their work. Furthermore, most existing studies on commercial sex in China have been conducted in large cities or tourist attractions. Using data from 454 female sex workers in a rural Chinese county, the current study was designed to explore the individual profiles of commercial sex workers and to examine whether the profile and sexual risk behaviour differ by where the female sex workers came from and where they work. The sample in the current study was different from previous studies in a number of key individual characteristics. However, similarly to previous studies, the subjects in the current study were driven into commercial sex by poverty or limited employment opportunities, lived a stressful life, were subject to sexual harassment and related violence, and engaged in a number of health-compromising behaviours including behaviours that put them at risk of HIV/STD infection and depression. The findings of the current study underscore the urgent need for effective HIV/STD prevention, intervention and mental health promotion programs among female sex workers in China. The data in the current study suggest a strong association of individual profile with the economic conditions of work sites and residence status (in-province residency vs. out-of-province residency), which suggests that such efforts must take the social and cultural contextual factors of working environment (and sexual risks) into consideration.

Estimating the population of female sex workers in two Chinese cities on the basis of the HIV/AIDS behavioural surveillance approach combined with a multiplier method

OBJECTIVE

To estimate the size of the population of female sex workers (FSWs) on the basis of the HIV/AIDS behavioural surveillance approach in two Chinese cities, using a multiplier method.

METHOD

Relevant questions were inserted into the questionnaires given to two behavioural surveillance groups-female attendees of sexually transmitted disease (STD) clinics and FSWs. The size of the FSW population was derived by multiplying the number of FSWs in selected STD clinics during the study period by the proportion of FSW population who reported having attended the selected STD clinics during the same period.

RESULTS

The size of the FSW population in the urban area of Xingyi, China, was estimated to be about 2500 (95% CI 2000 to 3400). This accounted for 3.6% of the total urban adult female population. There were an estimated 17,500 FSWs in the urban area of Guiyang, China (95% CI 10,300 to 31,900) or about 3.4% of its total urban adult female population (rounded to the nearest 100).

CONCLUSIONS

The multiplier method could be a useful and cost-effective approach to estimate the FSW population, especially suitable in countries where HIV behavioural surveillance has been established in high-risk populations.

Condom use among female sex workers in China: role of gatekeepers

OBJECTIVE

The objective of this study was to assess the potential role of gatekeepers of establishments in promoting condom use among female sex workers (FSWs) in China.

GOALS

The goals of this study were to explore FSWs' perceptions of gatekeeper attitudes and support for condom use, and to assess their association with FSWs' practice, communication, intention, proper use, knowledge of correct use, and perceptions related to condom use.

STUDY

The authors conducted a cross-sectional study among 454 establishment-based FSWs in one Chinese county.

RESULTS

Perceived gatekeeper support for condom use was low among FSWs. Perceived support was positively associated with condom use communication with sexual partners, condom use frequency and intention, but not associated with proper condom use among FSWs. Perceived support was significantly associated with most condom use-related perceptions (e.g., self-efficacy of condom use, barriers to condom use, and perceived peer condom use) among FSWs.

CONCLUSIONS

Healthcare professionals should work with gatekeepers to create a supportive local environment for condom use in sex work establishments. Gatekeepers need to clearly articulate their support for condom use to the FSWs. Training and skill acquisition regarding correct use of condoms among FSWs will be necessary.