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Llangarí-Arizo LM, Broad CE, Zhou L, Martin Mateo M, Moreno CI, Moreno Cevallos M, Cooper PJ, Romero-Sandoval N, Sadiq ST. Sexually transmitted infections among at-risk women in Ecuador: implications for global prevalence and testing practices for STIs detected only at the anorectum in female sex workers. Sex Transm Infect 2024:sextrans-2023-056075. [PMID: 39117400 DOI: 10.1136/sextrans-2023-056075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/26/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES Anorectal sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), present treatment challenges, potentially increase antibiotic resistance selection and if undetected may facilitate onward transmission. However, there are limited global prevalence data for anorectal STIs. We conducted a cross-sectional study to assess the prevalence and risk factors of non-viral genital and extragenital STIs in female sex workers (FSW) and female non-sex workers (NSW) in Ecuador. METHODS 250 adult street and brothel FSWs and 250 NSWs, recruited from settlements in north-west Ecuador provided oropharyngeal and vulvo-vaginal swabs (VVS) as well as socio-demographic data. FSWs also provided anorectal swabs. PCR was used to detect CT, NG, Mycoplasma genitalium (MG) from all swabs and additionally Trichomonas vaginalis (TV) from VVS. Risk factors were analysed using logistic regression. RESULTS Prevalence of FSW vaginal, anorectal and oropharyngeal infection was 32.0% (95% CI 26.5% to 38.0%), 19.7% (95% CI 15.1% to 25.2%) and 3.2% (95% CI 1.6% to 6.2%), respectively, with most vaginal infections being TV (23.4%; 95% CI 18.5% to 29.2%). Overall FSW STI prevalence, at any anatomical site was 39.7% (95% CI 33.8% to 46.1%), with 12.1% (95% CI 8.5% to 16.9%) of infections detected only at the anorectum. Of all the CT and/or NG infections, 64.4% (95% CI 50.4% to 78.4%) were detected only at the anorectum. STI prevalence in NSWs in the vagina and oropharynx were 5.6% (95% CI 3.4% to 9.2%) and 0.8% (95% CI 0.2% to 2.9%), respectively, with most vaginal infections being MG (3.2%; 95% CI 1.6% to 6.2%). In multivariable analysis, risk factors among brothel-based FSWs for having an anorectal STI were vaginal CT, NG or MG (p<0.001), vaginal TV (p=0.029) and being 'in a relationship' (p=0.038). CONCLUSIONS High prevalence of CT and NG detected only at the anorectum in these FSWs indicate the possibility of missing significant infections if providing only genital testing and calls for greater research into the potential impact on global STI estimates if extragenital infections among at-risk women are not identified.
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Affiliation(s)
| | | | - Liqing Zhou
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Miguel Martin Mateo
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Autonomous University of Barcelona, Barcelona, Spain
- Red Internacional Grups de Recerca d'América i África Llatines-GRAAL, Barcelona, Spain
| | | | | | - Philip J Cooper
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Natalia Romero-Sandoval
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Red Internacional Grups de Recerca d'América i África Llatines-GRAAL, Barcelona, Spain
| | - Syed Tariq Sadiq
- Institute for Infection and Immunity, St George's University of London, London, UK
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Sun X, Feng C, Feng L, Xiao T, Zhao X, Liu H, Wang Z, Chen C, Zhou S, Zhou D. An exploratory transmission mode of HIV/AIDS among older people based on data from multiple sources in China. Sci Rep 2022; 12:16077. [PMID: 36168023 PMCID: PMC9515084 DOI: 10.1038/s41598-022-20146-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022] Open
Abstract
The HIV/AIDS cases and proportion in older people are continuously and rapidly increasing in China, especially in males. However, the transmission mechanism is not well understood. This study aims to explore the transmission mechanism of HIV/AIDS and potential ways to prevent or control HIV/AIDS transmission in a city in southwestern China. Data from multiple sources, including HIV/AIDS case reports in 2010–2020, a survey of HIV/AIDS cases in 2020, and sentinel surveillance data of female sex workers (FSWs) in 2016–2020 were analyzed. We explored the transmission mechanism of HIV/AIDS cases aged 50 years and older. In this city, the number of newly reported HIV/AIDS cases aged 50 years and older increased from 2010 to 2019, and decreased in 2020. The number of male and female cases aged 50 years and older both increased rapidly in 2017–2019, though the number of male cases was larger than that of female. The survey data showed that 84.7% of older male cases reported commercial sexual behavior, among whom 87.7% reported never using condom and 37.6% reported more than 10 times of commercial sexual behaviors in 1 year. In terms of price of sexual behavior, 68.3% of older male cases sought low-tier FSWs among whom the HIV/AIDS positive rate was 5.4% from the sentinel surveillance data. These results suggested HIV transmission between older men and low-tier FSWs through commercial sexual behavior. Among female cases aged 50 years and older, most reported non-marital and non-commercial heterosexual (60.5%) or regular sexual partner (31.4%) transmission, suggesting that they were infected by their spouse/regular sexual partner. Data of matched couples showed that most male cases had both marital sexual behavior and commercial sexual behavior, or acquired HIV through commercial sexual behavior, while most female cases had only marital sexual behavior. Based on these findings, we proposed a transmission mode of that local older male people and FSWs are transmitting bilaterally through commercial sexual behavior, and local older male people are spreading to local older female people through spouse or regular sexual partner route. By studying data from multiple sources, we explored the HIV transmission mode among older people. In the meantime, we found that marital status had a different impact on male and female old people in their sex behaviors.
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Affiliation(s)
- Xiwei Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Caibi Feng
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Liao Feng
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Ticheng Xiao
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Xinran Zhao
- Cornell University College of Veterinary Medicine, Ithaca, USA
| | - Hong Liu
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Zhiqiu Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chen Chen
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Shoulin Zhou
- Luzhou Center for Disease Control and Prevention, Luzhou, China
| | - Dinglun Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Lopez-Corbeto E, Sanclemente C, González V, Mansilla R, Casabona J, Folch C. HIV, Chlamydia and gonorrhoea vulnerability depending to sex work site. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:166-171. [PMID: 35216949 DOI: 10.1016/j.eimce.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Women sex workers (WSW) are one of key population on the HIV and other sexually transmitted infections (STIs) monitoring and evaluation. Socioeconomic, structural factors and other factors associated with the workplace influence exposure to these infections. The objectives of this study were to describe and compare the social characteristics, risk behaviours and HIV, chlamydia and gonorrhoeae prevalence according to sex work site (street or highway, clubs and flats). METHODS Cross-sectional study on 400 WSW in Catalonia. Socio-demographic, sex work and behavioral characteristics were collected through personal interview. Oral fluid and urine samples were collected to determine STI prevalence. RESULTS WSW that exercised in the street or highway presented more precarious conditions and a greater vulnerability related to socioeconomic factors: older population, with a lower education level and with less economic remuneration for their service. Other factors associated with lifestyle or behaviour was also observed: greater injecting drug use, longer sex work or vulnerabilities associated with structural or social determinants: less access to health services, higher proportion of forced relations and stay in prison. The overall HIV, chlamydia and gonorrhoeae prevalence was 3.0%, 1.8% and 0.5%, respectively and higher in women who exercised on the street or highway, 5.6%, 1.9% and 1.2%, respectively. CONCLUSION The information generated in this study will be useful for the design specific preventive interventions aimed at this group.
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Affiliation(s)
- Evelin Lopez-Corbeto
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y Sida de Cataluña (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain.
| | | | - Victoria González
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y Sida de Cataluña (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Servicio de Microbiología, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Rosa Mansilla
- Vigilància, Prevenció i Control de les Infeccions de Transmissió Sexual i el VIH, Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Jordi Casabona
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y Sida de Cataluña (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain; Departamento de Pediatría, Obstetricia y Ginecología y de Medicina Preventiva, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Cinta Folch
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y Sida de Cataluña (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Spain
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Jiang T, Pan X, Ma Q, Jiang J, Chen L, Wang H, Zhou X, Chen W. Characteristics of low-tier female sex workers who engage in commercial sex with old male clients in Zhejiang province, China: a cross-sectional study. BMJ Open 2021; 11:e049410. [PMID: 34785548 PMCID: PMC8596047 DOI: 10.1136/bmjopen-2021-049410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To characterise low-tier female sex workers (FSWs) who engage in commercial sex with old male clients (OMCs). DESIGN Cross-sectional study. SETTING Twenty-one counties in Zhejiang province, China. PARTICIPANTS A total of 2647 low-tier FSWs who participated in our survey from September to November 2013, and responded to the question regarding whether they engaged in commercial sex with OMCs during the previous month. MAIN OUTCOME MEASURES Data on sociodemographic characteristics, sexual behaviours, risk perception of HIV/sexually transmitted infection (STI), ever exposure to an HIV prevention service and degree of self-efficacy regarding condom use were collected via a face-to-face questionnaire administered by trained interviewers. RESULTS Of the 2647 participants, 1165 (44.0%) had engaged in commercial sex with OMCs in the previous month. Low-tier FSWs working out of roadside shops, those who had engaged in sex work for longer, those with a larger number of clients, those who had engaged in anal or oral sex during the previous month, those currently using contraception measures, those who had STI symptoms and those who had been exposed to HIV prevention services during the previous 6 months were more likely to engage in commercial sex with OMCs. FSWs with a high level of education; those working out of small venues other than streets, hair salons and roadside shops; those who charged more for commercial sex; those who had sex with young clients during the previous month and those who had seen a doctor during the previous 6 months were less likely to engage in commercial sex with OMCs. CONCLUSIONS Low-tier FSWs who engaged in commercial sex with OMCs reported more risky behaviours than those who did not engage in this behaviour. Attention should be paid to these behaviours in future interventions targeting low-tier FSWs.
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Affiliation(s)
- Tingting Jiang
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaohong Pan
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qiaoqin Ma
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jianmin Jiang
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Lin Chen
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Hui Wang
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xin Zhou
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Wanjun Chen
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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Dong Z, Ma L, Cai C, Gao GF, Lyu F. Demographic features of identified PLWHA infected through commercial and nonmarital noncommercial heterosexual contact in China from 2015 to 2018: a retrospective cross-sectional study. BMC Infect Dis 2021; 21:71. [PMID: 33441089 PMCID: PMC7807498 DOI: 10.1186/s12879-020-05757-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Understanding the demographic characteristics of people living with HIV/AIDS (PLWHA) infected through commercial heterosexual contact (CHC) or nonmarital noncommercial heterosexual contact (NMNCHC) is important for HIV/AIDS prevention and control. METHODS Cases reported through the Chinese HIV/AIDS Case Reporting System (CRS) from 2015 to 2018 were analyzed. A descriptive and preliminary inferential analysis were performed for those demographic characteristics deemed of interest. RESULTS Overall, 523,121 identified PLWHA between 2015 and 2018 in the CRS were analyzed. The constituent ratio of heterosexual transmission increased from 66.25% in 2015 to 71.48% in 2018. The proportion of CHC heterosexual transmission decreased from 40.18% in 2015 to 37.99% in 2018, while that of NMNCHC increased from 46.33% in 2015 to 49.02% in 2018. PLWHA infected through NMNCHC were significantly younger than those who were infected through CHC (Student's t test, P < 0.0001), with an average age gap ranging from 5.63 (2015) to 7.46 (2018) years, and the average age of both groups increased annually. The frequency of newly identified PLWHA who were infected through CHC had a remarkable increase among the ages of 65 and above. Gender distribution was significantly different between CHC and NMNCHC (χ2 = 8909.00(2015), 9941.90(2016), 11,004.00 (2017), 12,836.00(2018), all P < 0.0001), and the ratio of men to women in the NMCHC group was 1.50:1 (2015), 1.51:1 (2016), 1.54:1 (2017), and 1.52:1 (2018), while in the commercial heterosexual contact (CHC) group, these ratios were 11.45:1 (2015), 12.08:1 (2016), 12.53:1 (2017), and 13.28:1 (2018). Marital status was significantly different between CHC and NMNCHC (χ2 = 94.67 (2015), 109.88(2016), 58.18(2017), 152.38(2018), all P < 0.0001). As the educational level improved, the proportion of NMNCHC also increased (Cochran - Armitage test, P < 0.0001). CONCLUSIONS We found that heterosexual transmission was the primary mode of HIV transmission in China from 2015 to 2018. PLWHA infected through CHC and NMNCHC had different characteristics in age, gender, marital status, and educational level. The frequency of PLWHA infected through CHC increased substantially in the age group of 65 and above. This study provides useful baseline data for future studies on the heterosexual transmission of HIV in China.
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Affiliation(s)
- Zhilong Dong
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Liying Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Chang Cai
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - George Fu Gao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Fan Lyu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
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Wang L, Huai P, Jiao K, Liu Y, Hua Y, Liu X, Wei C, Ma W. Awareness of and barriers to using non-occupational post-exposure prophylaxis among male clients of female sex workers in two cities of China: a qualitative study. Sex Health 2021; 18:239-247. [PMID: 34148566 DOI: 10.1071/sh20203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
Background Male clients of female sex workers ('clients' hereafter) are considered high-risk and potentially a bridge population in the HIV epidemic. Non-occupational post-exposure prophylaxis (nPEP) is a safe and effective but under-utilised public health intervention to prevent HIV transmission. This study aims to explore clients' awareness of nPEP, intention of uptake, potential barriers to nPEP uptake and adherence, and suggestions for nPEP promotion in China. METHODS We conducted semi-structured in-depth interviews with 20 clients in two Chinese cities in 2018. Participants were recruited through purposive sampling. The content of the interviews was analysed using thematic content analysis in ATLAS.ti. RESULTS Overall, just a minority of participants were aware of nPEP. A majority expressed willingness to use nPEP. Potential barriers to nPEP uptake and adherence included adverse drug reactions, price, concerns of drug efficacy, privacy issues, and forgetting to take the drugs. Almost all participants expressed the need to promote nPEP among clients. Participants suggested that the promotion of nPEP should be at hospitals, online, and be integrated with HIV/AIDS health education. CONCLUSIONS Our findings suggested that nPEP guidelines should be formulated and implementation strategies should be developed to address barriers to uptake and adherence in order to successfully tap into the potential of nPEP as an effective HIV prevention tool.
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Affiliation(s)
- Lin Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Pengcheng Huai
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China
| | - Kedi Jiao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Yicong Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Yumeng Hua
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Xueyuan Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China
| | - Chongyi Wei
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA; and Corresponding authors. Emails: ;
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 West WenHua Road, Jinan 250012, China; and Corresponding authors. Emails: ;
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Zhang Y, Wang X, Pan S. Prevalence and Patterns of Extramarital Sex among Chinese Men and Women: 2000-2015. JOURNAL OF SEX RESEARCH 2021; 58:41-50. [PMID: 32783542 DOI: 10.1080/00224499.2020.1797617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite growing concern about the "sexual revolution" in China in the past decades, empirical evidence regarding the national trends in prevalence and patterns of extramarital sex (EMS) remains sparse. This study aimed to fill this gap, using data from a population-based, repeated cross-sectional survey administered at four time points during the period 2000-2015. EMS was assessed by asking whether a person in marriage had engaged in sexual activity with someone else during the relationship with his/her current partner. Our findings showed that among married adults aged 20-59, the occurrence rate of EMS nearly tripled over the period 2000-2015, increasing from 12.9% to 33.4% for men, and from 4.7% to 11.4% for women. Moreover, in the early years of this century, EMS was negatively associated with older age (50-59 years), lower educational level (elementary and below) and rural residence for men, and negatively associated with older age and positively associated with higher educational level (college and above) for women. All these differences, however, disappeared in more recent years. Overall, this study indicates a marked increase in EMS, a widening gender gap in EMS, and for each gender, a convergence of EMS across various sociodemographic groups.
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Affiliation(s)
- Yueyun Zhang
- School of Philosophy and Social Development, Shandong University
| | - Xin Wang
- School of Philosophy and Social Development, Shandong University
| | - Suiming Pan
- Institute of Sexuality and Gender, Renmin University of China
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Lopez-Corbeto E, Sanclemente C, González V, Mansilla R, Casabona J, Folch C. HIV, Chlamydia and gonorrhoea vulnerability depending to sex work site. Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30312-8. [PMID: 33199062 DOI: 10.1016/j.eimc.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Women sex workers (WSW) are one of key population on the HIV and other sexually transmitted infections (STIs) monitoring and evaluation. Socioeconomic, structural factors and other factors associated with the workplace influence exposure to these infections. The objectives of this study were to describe and compare the social characteristics, risk behaviours and HIV, Chlamydia and gonorrhoeae prevalence according to sex work site (street or highway, clubs and flats). METHODS Cross-sectional study on 400WSW in Catalonia. Socio-demographic, sex work and behavioral characteristics were collected through personal interview. Oral fluid and urine samples were collected to determine STI prevalence. RESULTS WSW that exercised in the street or highway presented more precarious conditions and a greater vulnerability related to socioeconomic factors: older population, with a lower education level and with less economic remuneration for their service. Other factors associated with lifestyle or behaviour was also observed: greater injecting drug use, longer sex work or vulnerabilities associated with structural or social determinants: less access to health services, higher proportion of forced relations and stay in prison. The overall HIV, Chlamydia and gonorrhoeae prevalence was 3.0%, 1.8% and 0.5%, respectively, and higher in women who exercised on the street or highway: 5.6%, 1.9% and 1.2%, respectively. CONCLUSION The information generated in this study will be useful for the design specific preventive interventions aimed at this group.
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Affiliation(s)
- Evelin Lopez-Corbeto
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y Sida de Cataluña (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | | | - Victoria González
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y Sida de Cataluña (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Servicio de Microbiología, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Rosa Mansilla
- Vigilància, Prevenció i Control de les Infeccions de Transmissió Sexual i el VIH, Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Jordi Casabona
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y Sida de Cataluña (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Departamentos de Pediatría, Obstetricia y Ginecología y de Medicina Preventiva, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Cinta Folch
- Centro de Estudios Epidemiológicos sobre las Infecciones de Transmisión Sexual y Sida de Cataluña (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Kampman CJG, Hoebe CJPA, Koene R, Kamp L, Jansen K, Koedijk FDH, Tostmann A, Hautvast JLA. Sexually transmitted infections in male heterosexual Dutch clients who visited German cross-border female sex workers; a 3 year retrospective study. BMC Public Health 2020; 20:1182. [PMID: 32727425 PMCID: PMC7389370 DOI: 10.1186/s12889-020-09240-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some male heterosexual clients prefer to visit a cross-border Female Sex Worker (FSW) because of cheaper sex and unsafe sex practices, and may therefore be at risk for sexually transmitted infections (STI). The objective of this study was to assess whether having commercial cross-border sex is an independent risk factor for being diagnosed with a STI. METHODS An observational retrospective study was performed using data of 8 Dutch STI clinics bordering Germany, between 2011 and 2013. All male heterosexual clients of FSWs were selected and data on country of FSW visit and occurrence of STI were used for multivariable regression analysis. RESULTS The study population consisted of 2664 clients of FSW. Most clients visited the Netherlands (82.4%), followed by visits to another country (beyond cross-border) (9.9%) and cross-border visits (7.8%). Clients of FSW were less likely to be STI positive when they were younger than 25 years(OR = 0.6, 95%CI 0.4 to 0.8 25-44 years and OR = 0.5, 95%CI 0.4 to 0.7 older than 45 years), and more likely when they had 20 or more sex partners in the last 6 months (OR = 2.9, 95%CI 1.9 to 4.4), did not use a condom during last sexual contact (OR = 2.2, 95%CI 1.6 to 2.9) and made cross-border visits (OR = 1.7, 95%CI 1.1 to 2.6). CONCLUSIONS As cross-border visits appears to be a novel independent risk factor for STI in clients of FSW, this group should therefore be advised on STI prevention.
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Affiliation(s)
- Carolina J G Kampman
- Public Health Service Twente, Postbus 1400, 7511, JM, Enschede, The Netherlands.
| | - Christian J P A Hoebe
- Public Health Service South Limburg, Heerlen, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Department of Medical Microbiology, Care and Public Health Research Institute Maastricht, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - René Koene
- Public Health Service Gelderland Zuid, Nijmegen, The Netherlands
| | - Laura Kamp
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Femke D H Koedijk
- Public Health Service Twente, Postbus 1400, 7511, JM, Enschede, The Netherlands
| | - Alma Tostmann
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jeannine L A Hautvast
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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10
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Liu H, Zhao M, Wang Y, Feldman MW, Xiao Q. The sexual networks of female sex workers and potential HIV transmission risk: an entertainment venue-based study in Shaanxi, China. Int J STD AIDS 2020; 31:402-409. [PMID: 32192372 DOI: 10.1177/0956462419886780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
People involved in commercial sex are thought to be at high risk for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) transmission. To explore the characteristics of female sex workers’ (FSWs) sexual networks and how FSWs and their sex partners could serve as ‘bridges’ in HIV/AIDS transmission, egocentric sexual networks (where a subject is asked to identify his or her sexual contacts and their relationships) of 66 FSWs in Xi'an city, Shaanxi Province of China, were studied. Convenience sampling was used to collect FSWs’ socio-demographic and sexual behavior data, which we analyzed using social network and descriptive statistical methods. Results show that some egocentric sexual networks were connected by sex partners, and these were integrated into several components of a sexual network. According to centrality indicators, FSWs and their commercial sex partners (especially regular clients) served as key nodes within high-risk groups and as bridges between high-risk groups and the general population. The cluster of high-risk groups with cohesive sub-networks had larger network size (P < 0.001), more complex network structures, and more high-risk members (P < 0.05) than other isolated networks. The sexual network of FSWs was characterized by multiple sexual relations (680), unstable relationships (50.15%), and a high rate of inconsistent condom use with non-commercial sex partners (31.22%). By linking commercial and non-commercial sexual networks, the FSWs and their clients can become effective bridges for HIV/AIDS spread from high-risk groups to the general population.
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Affiliation(s)
- Huijun Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Min Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Ying Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Marcus W Feldman
- Morrison Institute for Population and Resource Studies, Stanford University, Stanford, CA, USA
| | - Qunying Xiao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.,Institute of Innovation and Entrepreneurship, School of Economics and Management, Xi'an Technological University, Xi'an, China
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11
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Geary RS, Copas AJ, Sonnenberg P, Tanton C, King E, Jones KG, Trifonova V, Johnson AM, Mercer CH. Sexual mixing in opposite-sex partnerships in Britain and its implications for STI risk: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Int J Epidemiol 2020; 48:228-242. [PMID: 30541028 PMCID: PMC6380304 DOI: 10.1093/ije/dyy237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 01/29/2023] Open
Abstract
Background The extent to which individuals are similar to their sexual partners influences STI-transmission probabilities, yet there is a dearth of empirical data, especially those representative of the population. Methods Analyses of data reported by 10 759 sexually active people aged 16–74 y interviewed for a British national probability survey undertaken in 2010–12. Computer-assisted self-interviews asked about partner numbers and characteristics of participants’ three most recent partnerships (MRPs). Opposite-sex MRPs were weighted to represent all such partnerships in the past year (N = 16 451). Estimates of disassortative age mixing (≥±5-y difference), ethnic mixing (partner of a different ethnic group) and geographical mixing (partner from a different region/country when they first met) were calculated, stratified by gender, age group and partnership status (casual/steady). Multivariable regression examined how these disassortative mixing measures were associated with STI-risk measures: condom use at first sex together at the partnership-level and, at the participant-level, STI-risk perception and reporting STI diagnoses. Results Disassortative age mixing occurred in around one-third of opposite-sex partnerships, with men ≥5 y older in most cases, although this proportion varied by participant’s gender and age group. Ethnic mixing occurred less frequently (11.3% of men’s and 8.6% of women’s partnerships) as did geographical mixing (14.1 and 16.3%, respectively). Disassortative mixing was more common among casual vs steady partnerships. Condom use at first sex was less likely in women’s partnerships that were age-disassortative [adjusted odds ratio (AOR): 0.79, 95% confidence interval (CI): 0.69–0.95], whereas men reporting disassortative ethnic mixing were more likely to perceive themselves at STI risk (AOR: 1.76, 95% CI: 1.23–2.52) and report STI diagnoses (AOR: 2.37, 95% CI: 1.22–4.59). Conclusions Disassortative mixing, although uncommon among opposite-sex partnerships in Britain, is independently associated with STI risk, warranting consideration in STI-prevention efforts.
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Affiliation(s)
- Rebecca S Geary
- Institute for Global Health, University College London, London, UK
| | - Andrew J Copas
- Institute for Global Health, University College London, London, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
| | - Clare Tanton
- Institute for Global Health, University College London, London, UK
| | - Eleanor King
- Institute for Global Health, University College London, London, UK
| | - Kyle G Jones
- Institute for Global Health, University College London, London, UK
| | | | - Anne M Johnson
- Institute for Global Health, University College London, London, UK
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12
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Zeng P, Liu J, Zhang C, Zhang B, Liu W, Huang M, Ma H, Zhao Y, Guo R, He M, Liu Y, Liao D, Sullivan M, Wang J, Cai W, Ness P, Shan H. Current risk factors for HIV infection among blood donors in seven Chinese regions. Transfusion 2020; 60:326-333. [PMID: 31912898 DOI: 10.1111/trf.15659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND In China, there is a rising concern on the increasing trends of HIV infections in high-risk groups, who make blood donations that might potentially challenge the blood safety. Analyses on current risk factors for HIV infection among Chinese blood donors are urgently needed for developing effective strategies to defer high-risk donors and to warrant the safety of the blood supply. STUDY DESIGN AND METHODS We recruited 313 HIV-positive and 762 HIV-negative donors from seven study sites in China and evaluated donor demographic characteristics, current medical and behavioral risk factors associated with HIV infection in a case-control survey. Univariable analyses examined the relationship between HIV infection and donor and donation characteristics, medical and behavioral risks, living conditions, and lifestyles. Multivariable logistic regression analyses evaluated the association between selected individual risks and HIV infection. Regression tree analysis was used to select covariates correlated with both HIV infection and individual risks and thus need to be controlled for in logistic regression models. RESULTS Being a man who has sex with men was associated with the highest odds of HIV infection. Not using a condom, having sex with HIV-infected individuals, having sex partners with sexually transmitted diseases (STDs), having more than two concurrent sex partners, or having an STD were all associated with more than five times higher odds of having HIV. Having remunerated sex was associated with a 2.4 increased odds of having HIV infection. CONCLUSION High-risk sexual behaviors were among the major risks for HIV infection among Chinese blood donors.
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Affiliation(s)
- Peibin Zeng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Liu
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | | | - Bowei Zhang
- Henan Provincial Blood Center, Zhenzhou, Henan, China
| | - Wei Liu
- Guangxi Center for Disease Prevention and Control, Nanning, Guangxi, China
| | - Mei Huang
- Mianyang Blood Center, Mianyang, Sichuan, China
| | - Hongli Ma
- Luoyang Blood Center, Luoyang, Henan, China
| | - Yuwei Zhao
- Chengdu Blood Center, Chengdu, Sichuan, China
| | - Rong Guo
- Xinjiang Provincial Blood Center, Urumqi, Xinjiang, China
| | - Miao He
- Institute of Blood Transfusion, Chinese Academic of Medical Science, Chengdu, Sichuan, China
| | - Yu Liu
- Institute of Blood Transfusion, Chinese Academic of Medical Science, Chengdu, Sichuan, China
| | - Dan Liao
- RTI International, Research Triangle Park, North Carolina
| | | | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academic of Medical Science, Chengdu, Sichuan, China
| | - Wei Cai
- Department of Pathology, Stanford University, Palo Alto, California
| | - Paul Ness
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Hua Shan
- Department of Pathology, Stanford University, Palo Alto, California
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13
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Zhu J, Hu D, Yin Y, Zhu Z, Wang N, Wang B. HIV prevalence and correlated factors among male clients of female sex workers in a border region of China. PLoS One 2019; 14:e0225072. [PMID: 31697754 PMCID: PMC6837524 DOI: 10.1371/journal.pone.0225072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/27/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives To assess the prevalence of human immunodeficiency virus (HIV) infection and the correlated risk factors among male clients of female sex workers (FSWs) in a Chinese–Vietnamese border region in Yunnan Province, China. Methods A cross-sectional survey was conducted between 2014 and 2015 in Hekou County, Yunnan Province, China. Convenience sampling and snowball sampling methods were used to recruit male clients for a questionnaire survey to collect information on demographics, sexual behavior, and drug use. Blood and urine samples were collected for testing of HIV/sexually transmitted infections (STIs) and drug use. Multivariate logistic regression was used to examine factors correlated with HIV infection. Results Of 776 respondents who participated in the study, 721 (92.91%) were Chinese and 55 (7.09%) were Vietnamese. Overall HIV prevalence in male clients of FSWs was 2.06%, 128 (16.49%) were infected with HSV-2, and five (0.64%) tested syphilis-positive. Two-thirds (68.81%) of respondents reported always using condoms with FSWs, and 89.05% reported condom use in the last episode of commercial sex. Male clients from Vietnam were significantly more likely to take morphine (9.09%) compared with Chinese male clients of FSWs. Age ≥50 years (OR: 8.11, 95%CI: 1.26–52.16) and morphine positivity (OR: 7.35, 95%CI: 1.42–38.06) were associated with HIV infection in the multivariate logistic regression model. Conclusion The relatively high proportion of male clients of FSWs who have numerous sexual partners and use condoms less frequently make them serve as important bridges for HIV transmission from FSWs to the low-risk general population. The positive association between morphine positivity and HIV infection confirmed illegal drug use as another important route for acquiring HIV infection in addition to sexual transmission, indicating that innovative interventions addressing both drug use and risky sexual behaviors are greatly required for male clients. Respondents aged ≥50 years have a higher risk of HIV infection, which emphasizes that older male clients of FSWs should be focused in future HIV prevention interventions in the border regions of China.
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Affiliation(s)
- Jing Zhu
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Dan Hu
- Department of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yueqi Yin
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Zhibin Zhu
- Hekou Center for Disease Control and Prevention, Hekou, Yunnan, P.R. China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Bei Wang
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
- * E-mail:
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14
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Seidu AA, Darteh EKM, Kumi-Kyereme A, Dickson KS, Ahinkorah BO. Paid sex among men in sub-Saharan Africa: Analysis of the demographic and health survey. SSM Popul Health 2019; 11:100459. [PMID: 32875050 PMCID: PMC7451820 DOI: 10.1016/j.ssmph.2019.100459] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 06/12/2019] [Accepted: 07/21/2019] [Indexed: 11/19/2022] Open
Abstract
Background Paying for sex is regarded as a risky sexual behavior (RSB) among heterosexual men. Men paying for sex are considered to be a bridging population for sexually transmitted infections (STIs). Despite the link between paid sex and sexual and reproductive health outcomes such as STIs, little is known about the prevalence and factors associated with paid sex among men in sub-Saharan Africa. This study examined the prevalence of paid sex and the socio-demographic factors associated with it among men in sub-Saharan Africa. Methods The study made use of pooled data from the Demographic and Health Surveys (DHS) conducted from January 1, 2010 to December 3, 2016 in 27 countries in sub-Saharan Africa. Binary and multivariable logistic regression models were used to investigate the relationship between the explanatory and the outcome variables. Results The results of the study showed that of the 139,427 men who participated in the study, 4.3% reported they had paid for sex in the 12 months preceding the survey. Men in Mozambique had the highest proportion (13.6%) of paying for sex in the 12 months preceding the survey. The results of the multivariable analysis indicated that men from DR Congo [AOR = 9.74; 95% CI = 7.45-12.73], men who had completed only primary level of education [AOR = 1.31; 95% CI = 1.18-1.45], men aged 25-34 years [AOR = 2.84; 95% CI = 2.26-3.56], men belonging to "other" religious groups [AOR = 1.20; 95% CI = 1.09-1.32] and men who were employed [AOR = 1.73; 95% CI = 1.58-1.90] had higher odds of paying for sex. Men who were divorced [AOR = 4.52; 95% = 3.89-5.25], men who read newspaper/magazine almost every day [AOR = 1.34; 95% CI = 1.12-1.63], men who listened to radio almost every day [AOR = 1.19; 95% CI = 1.05-1.36] and men who watched television at least once a week [AOR = 1.10; 95% CI = 1.01-1.19] also had higher odds of paying for sex. On the other hand, men in rural areas [AOR = 0.88; 95%CI = 0.82-0.95], men in the richest wealth quintile [AOR = 0.83; 95%CI = 0.74-0.93] and those with tertiary level of education [AOR = 0.77; 95% CI = 0.65-0.90] had lower odds of paying for sex. Conclusion The odds of paid sex were high among men with only primary level of education, men aged 25-34, men who professed 'other' religious affiliation, men who are employed and men who are divorced. However, paid sex was low among men in the richest wealth quintile, men with tertiary level of education and men living in rural areas. This means that the decision to pay for sex is influenced by several social and demographic factors. Hence, these factors should be taken into consideration for sexual and reproductive health interventions and services. Policy and interventional measures should aim at reducing high-risk behavior of men who pay for sex.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Ghana
- Corresponding author.
| | | | | | | | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Australia
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15
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Wu P, Dong WM, Rou K, Dong W, Zhou C, Chen X, Zheng J, Scott SR, Wu Z. HIV-positive clients of female sex workers in Hunan Province, China: a mixed methods study assessing sexual relationships and risk behavior by type of partner. BMC Public Health 2019; 19:1129. [PMID: 31420032 PMCID: PMC6698027 DOI: 10.1186/s12889-019-7446-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/06/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In China, clients of female sex workers (CFSWs) have a low rate of condom use and a high prevalence of human immunodeficiency virus (HIV). However, little is known about the high-risk sexual behaviors of HIV-positive CFSWs. METHODS In 2014, 327 CFSWs diagnosed with HIV for 6 months or longer completed a face-to-face questionnaire for a quantitative survey. In addition, 32 HIV-positive CFSWs were recruited to participate in in-depth interviews (18 participated in both, 14 participated in-depth interviews only) to explore reasons for extramarital sexual behaviors and inconsistent condom use. The quantitative data on sexual risk behaviors were analyzed using chi-square tests. Interviews were coded inductively for emerging themes. RESULTS Among the participants of the quantitative survey, 41.6% (136/327) had sex with regular sexual partners only in the past 6 months, of whom 64.0% (87/136) had consistent condom use; 27.5% (90/327) of the participants had sex with irregular sexual partners in the past 6 months, of which, 46.7% (42/90) had consistent condom use. The qualitative study suggested that HIV positive sero-status, willingness to protect their spouses or regular sexual partners, and lacking a sense of responsibility to protect their commercial and casual sexual partners, influence CFSWs' sexual behaviors. CONCLUSIONS HIV-positive CFSWs continue to practice unsafe sexual behaviors with regular and irregular partners after HIV diagnosis, but were more willing to protect their regular partners. Future interventions targeting HIV-positive CFSWs should not only be confined to sero-discordant couples, but also need to instill a sense of responsibility to protect the commercial and casual partners and reduce the number of concurrent partners.
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Affiliation(s)
- Peili Wu
- School of Public Health, Anhui Medical University, Hefei, Anhui China
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Willa M. Dong
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Wei Dong
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Chu Zhou
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Xi Chen
- Hunan Provincial Center for Disease Control & Prevention, Changsha, Hunan China
| | - Jun Zheng
- Hunan Provincial Center for Disease Control & Prevention, Changsha, Hunan China
| | - Sarah R. Scott
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
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Abstract
The knowledge of sexual practices of heterosexual males (HM) in Israel is limited despite the increase inthe incidence of sexually transmitted diseases (STI). This study assessed sexual practices among Israeli HM and the associations between demographic characteristics and sexual risk behaviors. The Cross-sectional study included a representative sample of 913 Jewish HM aged 18-44, which completed a questionnaire including their demographics, sexual practices, and risky sexual behavior. Of all participants, 66.8% had monogamous sex with their steady partner. These participants were more likely to be older, religious, involved ina limited repertoire of sexual practices, and less likely to engage in risky sexual behavior. Of the participants, 9.6% were in steady relationships but had concomitant sexual casual partner/s. They were more likely to be secular, paid for sex, and had more lifetime sexual partners. Of all the participants, 23.6% were singles and had sex with casual partner/s. They were more likely to be younger and engage in risky sexual behavior. Of all participants, 10.3% were involved in risky sexual behavior. These men were more likely to be singles, pay for sex and have more lifetime sexual partners. We conclude that preventive interventions aimed to prevent STI-infections should target HM who are in singles and those in steady relationships and have concomitant sex partners.
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Affiliation(s)
- Guy Shilo
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Zohar Mor
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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17
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Poon AN, Han L, Li Z, Zhou C, Li Y, Huang L, Liao M, Shepard C, Bulterys M. Acceptability and willingness of HIV pre-exposure prophylaxis amongst female sex workers in China. AIDS Care 2019; 31:1555-1564. [PMID: 31046413 DOI: 10.1080/09540121.2019.1612001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) is a highly effective prevention method. It is an attractive self-initiated approach to reduce the spread of HIV amongst female sex workers (FSW). PrEP, however, has not yet achieved its potential to reduce HIV infections partially due to a general lack of awareness from women who may benefit. Aims of this cross-sectional study of 1,466 FSW in China were to understand: levels of awareness of and willingness to use PrEP among female sex workers (FSW) in China, and factors contributing to willingness to use PrEP. We found that awareness (10.2%) and willingness (35.5%) to use PrEP were low in our survey areas. Low PrEP willingness is likely reflective of the overall poor knowledge and understanding of HIV risk and prevention. FSW that demonstrated greater HIV knowledge through having been tested or having greater decision-making involvement in condom use were more willing to use PrEP. Study findings may be used to inform future HIV prevention activities, including possible use of PrEP among FSW at higher risk of incident HIV infection in China.
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Affiliation(s)
- Adrienne N Poon
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
| | - Lifeng Han
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
| | - Zhijun Li
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
| | - Chu Zhou
- National Centre for AIDS/STD Prevention and Control, Chinese Centre for Disease Control and Prevention , Beijing , People's Republic of China
| | - Yan Li
- Department of HIV/AIDS, Guangdong Provincial Centre for Disease Control and Prevention , Guangzhou , People's Republic of China
| | - Lu Huang
- Department of HIV/AIDS/STD, Guizhou Provincial Centre for Disease Control and Prevention , Guiyang , People's Republic of China
| | - Meizhen Liao
- Department of HIV/AIDS, Shandong Provincial Centre for Disease Control and Prevention , Jinan , People's Republic of China
| | - Colin Shepard
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
| | - Marc Bulterys
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
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18
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Chen B, Chen J, Shao Y, Hu D, Ding X, Wen Y. Need for Intervention Services for Promotion of Condom Use by Female Sex Workers to Consider Size of Entertainment Venues: A Cross-Sectional Study. Med Sci Monit Basic Res 2019; 25:1-7. [PMID: 30598520 PMCID: PMC6407326 DOI: 10.12659/msmbr.913161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Consistent condom use among female sex workers (FSWs) is a key intervention in China’s AIDS Control Program. Female sex workers (FSWs) in China are at increased risk for acquiring HIV/AIDS because of low knowledge about HIV transmission and inconsistent use of condoms, the grade of venues may play a role in HIV/AIDS-related knowledge and consistent condom use of female sex workers. Material/Methods A cross-sectional study was conducted among 802 FSWs in 2016 in Fuyang, China. A self-administered questionnaire was used to assess whether there is a need of different intervention services promotion of consistent condom use among FSWs in different-grade entertainment venues. Results Multivariate logistic regression analysis indicated that knowledge scores of HIV transmission routes and peer education were associated with consistent condom use in large-size venues, while peer education was associated with consistent condom use in mid-size venues. Knowledge scores of HIV non-transmission routes, knowledge scores of AIDS prevention/control, and peer education were associated with consistent condom use in small venues. Conclusions Our data suggested that the strategies for strengthen interventions on health benefits of consistent condom use of FSWs should differ by size of venue.
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Affiliation(s)
- Baifeng Chen
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Jian Chen
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Yinbao Shao
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Daibao Hu
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Xinping Ding
- Fuyang Center for Diseases Prevention and Control, Fuyang, Anhui, China (mainland)
| | - Yufeng Wen
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
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19
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Rich R, Leventhal A, Sheffer R, Mor Z. Heterosexual men who purchase sex and attended an STI clinic in Israel: characteristics and sexual behavior. Isr J Health Policy Res 2018; 7:19. [PMID: 29945677 PMCID: PMC6020288 DOI: 10.1186/s13584-018-0213-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background Commercial sex shares a role in HIV and sexually transmitted infections (STI) transmission. Men who pay for sex (MPS) may transmit HIV/STI to other populations which are low-risk. This study aimed to test our hypothesis that MPS engage in high-risk sexual behaviors associated with HIV/STI transmission more so than non-MPS. Methods This cross-sectional study included heterosexual men who attended an STI clinic between 2003 and 2010. Demographic, clinical, behavioral and laboratory data were compared between MPS and non-MPS to identify factors associated with high-risk sexual behavior and STI-burden. Results Of the first visits of 6156 heterosexual men who attended the STI-clinic during the study period, 1649 (26.7%) were MPS. MPS were more commonly older, married and non-Israeli born compared with non-MPS. MPS were more likely to engage in risk-behaviors associated with HIV/STI-transmission, including a greater number of lifetime sexual partners, substance use and previous STI diagnoses. Determinants associated with STI-diagnoses at the current visit included being non-Israeli born, presenting with STI symptoms, reporting a greater number of lifetime sexual partners and having sexual encounters with non-Israeli individuals. Conclusions Approximately 25% of all men who attended the clinic were MPS. They were more likely to engage in risk-behaviors associated with HIV/STI transmission compared to non-MPS. These findings highlight the need to establish interventions for MPS that both continue to encourage condom use and address the potential perils pertaining to risky sexual behaviors.
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Affiliation(s)
- Rivka Rich
- School of Public Health, Hebrew University, Jerusalem, Israel. .,Ministry of Health, Public Health Services, Jerusalem, Israel.
| | - Alex Leventhal
- School of Public Health, Hebrew University, Jerusalem, Israel
| | - Rivka Sheffer
- Ministry of Health, Public Health Services, Jerusalem, Israel
| | - Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel.,School of Public Health, Tel Aviv University, Tel Aviv, Israel
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Lai J, Qin C, Nehl EJ, Jiang J, Huang Y, Liang B, Xu Y, Huang J, Xu Z, Ning C, Liao Y, Zang N, Wei W, Qin F, Yu J, Ye L, Qin X, Liang H. HIV prevalence among female sex workers in Guigang City, Guangxi, China: an 8-year consecutive cross-sectional study. BMC Public Health 2018; 18:450. [PMID: 29618343 PMCID: PMC5885366 DOI: 10.1186/s12889-018-5380-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 03/26/2018] [Indexed: 11/22/2022] Open
Abstract
Background Female sex workers (FSW) are a population that are at high risk for HIV infection, and their HIV/AIDS knowledge levels and sexual behaviors are of concern. This study describes changes in HIV prevalence and factors associated among female sex workers in Guigang City, Guangxi, one of the highest HIV prevalence areas in China. Methods Data were derived from an annual cross-sectional venue-based survey, 2008 to 2015, in the form of sentinel surveillance. The participants were recruited using cluster sampling. FSW aged 16 years and above who completed a questionnaire and HIV testing. Both descriptive and multi-level analyses were used to explore factors associated with changes in HIV prevalence. Results Seven thousand four hundred ninety-six FSW were recruited in this study. HIV prevalence among FSW in Guigang City fell into two periods, one with an increasing trend (2008–2011) and one with a decline (2012–2015). Differences between these time periods included age, relationship status, HIV knowledge, consistent condom use, lifetime illicit drug use, history of sexually transmitted infection in the past year, HIV testing, receipt of a condom distribution and education program or HIV counseling and testing, and peer education services. Conclusions Since 2012, a reduction in HIV prevalence among FSW in Guigang City has been observed. The decline of HIV prevalence was associated with coinciding changes in demographic characteristics of FSW, improvement of HIV knowledge and safer sexual behaviors, and a program that promotes condom use, HIV counseling & testing, and peer education.
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Affiliation(s)
- Jingzhen Lai
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Chunwei Qin
- Guigang Center for Disease Control and Prevention, No.7 Jianshexi Road, Guigang, 537000, Guangxi, China
| | - Eric J Nehl
- Rollins School of Public Health, Emory University, 1518 Clifton Road. NE, Atlanta, GA, 30322, USA
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Yunxuan Huang
- Guigang Center for Disease Control and Prevention, No.7 Jianshexi Road, Guigang, 537000, Guangxi, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Yuexiang Xu
- Guigang Center for Disease Control and Prevention, No.7 Jianshexi Road, Guigang, 537000, Guangxi, China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Zhiliang Xu
- Guigang Center for Disease Control and Prevention, No.7 Jianshexi Road, Guigang, 537000, Guangxi, China
| | - Chuanyi Ning
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, No.22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Yanyan Liao
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, No.22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Ning Zang
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, No.22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Wudi Wei
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Fengxiang Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Jun Yu
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China.
| | - Xionglin Qin
- Guigang Center for Disease Control and Prevention, No.7 Jianshexi Road, Guigang, 537000, Guangxi, China.
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China. .,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, No.22 Shuangyong Road, Nanning, 530021, Guangxi, China.
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21
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McClair TL, Hossain T, Sultana N, Burnett-Zieman B, Yam EA, Hossain S, Yasmin R, Sadiq N, Decker MR, Ahmed S. Paying for Sex by Young Men Who Live on the Streets in Dhaka City: Compounded Sexual Risk in a Vulnerable Migrant Community. J Adolesc Health 2017; 60:S29-S34. [PMID: 28109337 DOI: 10.1016/j.jadohealth.2016.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/15/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Dhaka City is home to thousands of migrants from Bangladesh's rural areas who often live in the streets. Prior studies examine street youth's practice of selling sex as a survival mechanism. We assess their less-studied practice of paying for sex and its association with sexual risk behaviors and outcomes. METHODS As part of the global Link Up project, trained interviewers recruited 447 young men who live on the streets, ages 15-24, from seven Dhaka City "hotspots" to participate in a survey about sexual health. Among those who ever had sex, we examined frequencies and conducted bivariate analyses of sociodemographic characteristics by paying for sex status. We then conducted bivariate and multivariate logistic regression analyses of paying for sex in the last 12 months and sexual health behaviors and outcomes. RESULTS Median participant age was 18 years. Among those who ever had sex (N = 321), 80% reported paying for sex in the last 12 months and 15% reported selling sex in the last 12 months. In multivariate analyses, those who paid for sex had significantly increased odds of reporting sexually transmitted infection-related symptoms in the last six months (adjusted odds ratio = 1.76, 95% confidence interval [CI] = 1.17-2.64) and engaging in unprotected last sex with a nonprimary partner (adjusted odds ratio = 2.19, CI = 1.58-3.03). CONCLUSIONS The adverse factors associated with paying for sex among young men who live on the streets in Dhaka City highlight the need for programs to educate on HIV/sexually transmitted infection prevention and promote condom use, STI screening/treatment, and HIV testing in this population.
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Affiliation(s)
- Tracy L McClair
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | | | | | | | | | | | | | | | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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22
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Yang Y, Yang C, Latkin C, Luan R, Nelson KE. Condom Use During Commercial Sex Among Male Clients of Female Sex Workers in Sichuan China: A Social Cognitive Theory Analysis. AIDS Behav 2016; 20:2309-2317. [PMID: 26910337 PMCID: PMC5294912 DOI: 10.1007/s10461-015-1239-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There has been little theory-based research focusing on condom use among male clients of female sex workers (CFSW) in China. The current study applied social cognitive theory to condom use behaviors of CFSW in China. Face-to-face structured interviews were conducted among 584 CFSW recruited through snowball sampling. Bivariate and multivariate logistic regression models were applied to examine factors associated with consistent condom use. A minority (30.65 %) of respondents reported using condoms consistently with FSW, and 7 of 12 social cognitive dimensions/subdimensions were found to be significantly influential. The most significant factors were self-efficacy [adjusted prevalence ratio (APR) = 2.11, 95 %, CI = 1.74-2.43] and personal pleasure reduction (APR = 0.3, 95 % CI = 0.15-0.6). HIV-related knowledge, perceived HIV susceptibility, condom cost, condom efficacy, and embarrassment of carrying condoms were not associated with consistent condom uses with FSW. Findings from the current study suggest future prevention programs should target sex venues, and condom access should ensure both quantity and quality. Peer education should focus on knowledge education and peer norms, and knowledge education should include information on HIV infection severity and how to increase pleasure with condom use.
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Affiliation(s)
- Yi Yang
- Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, China, 611137,
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St. 2 FL, Baltimore, MD 21205,
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St. 2 FL, Baltimore, MD 21205,
| | - Carl Latkin
- Department of Health, Behavior and Society, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, Maryland 21205, 410-955-3972
| | - Rongsheng Luan
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China, 610041,
| | - Kenrad E Nelson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E7638, Baltimore, MD 21205,
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Mantell JE, LeVasseur MT, Sun X, Zhou J, Mao J, Peng Y, Zhou F, DiCarlo AL, Kelvin EA. What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China? Glob Public Health 2016; 10:947-67. [PMID: 26274897 DOI: 10.1080/17441692.2015.1045918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
China's rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of sexually transmitted infections (STIs), having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings.
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Affiliation(s)
- Joanne E Mantell
- a HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA
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24
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Kohler PK, Campos PE, Garcia PJ, Carcamo CP, Buendia C, Hughes JP, Mejia C, Garnett GP, Holmes KK. Sexually transmitted infection screening uptake and knowledge of sexually transmitted infection symptoms among female sex workers participating in a community randomised trial in Peru. Int J STD AIDS 2016; 27:402-10. [PMID: 25941053 PMCID: PMC4742423 DOI: 10.1177/0956462415584488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/07/2015] [Indexed: 11/15/2022]
Abstract
This study aims to evaluate condom use, sexually transmitted infection (STI) screening, and knowledge of STI symptoms among female sex workers in Peru associated with sex work venues and a community randomised trial of STI control. One component of the Peru PREVEN intervention conducted mobile-team outreach to female sex workers to reduce STIs and increase condom use and access to government clinics for STI screening and evaluation. Prevalence ratios were calculated using multivariate Poisson regression models with robust standard errors, clustering by city. As-treated analyses were conducted to assess outcomes associated with reported exposure to the intervention. Care-seeking was more frequent in intervention communities, but differences were not statistically significant. Female sex workers reporting exposure to the intervention had a significantly higher likelihood of condom use, STI screening at public health clinics, and symptom recognition compared to those not exposed. Compared with street- or bar-based female sex workers, brothel-based female sex workers reported significantly higher rates of condom use with last client, recent screening exams for STIs, and HIV testing. Brothel-based female sex workers also more often reported knowledge of STIs and recognition of STI symptoms in women and in men. Interventions to promote STI detection and prevention among female sex workers in Peru should consider structural or regulatory factors related to sex work venues.
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Affiliation(s)
- Pamela K Kohler
- Departments of Global Health, Psychosocial & Community Health, University of Washington, Seattle, WA, USA
| | | | - Patricia J Garcia
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P Carcamo
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Clara Buendia
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Carolina Mejia
- Department of Health Services, University of Washington, Seattle, USA
| | - Geoff P Garnett
- HIV/AIDS and TB, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - King K Holmes
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
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25
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Girchenko P, Ompad DC, Kulchynska R, Bikmukhametov D, Dugin S, Gensburg L. Correlates of Lifetime History of Purchasing Sex Services by Men in Saint Petersburg and Leningrad Oblast, Russia. J Urban Health 2015; 92:1105-16. [PMID: 26446875 PMCID: PMC4675736 DOI: 10.1007/s11524-015-9990-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Commercial sex workers (CSWs) in the Russian Federation are at high risk of HIV infection and transmission as a result of unsafe sexual and injecting behaviors. Their clients might be at increased risk of acquiring HIV; however, little is known about the population of men purchasing sex services. This study aims to investigate factors associated with a history of purchasing sex services by men in Saint Petersburg and Leningrad Oblast, Russian Federation. Data were collected as part of a cross-sectional study offering free anonymous rapid HIV testing in Saint Petersburg and Leningrad Oblast in 2014; in total, 3565 men aged 18 years and older provided information about their behaviors associated with risk of acquiring HIV during face-to-face interviews. Prevalence of CSW use in our study was 23.9%. Multivariable analyses using log-binomial regression were stratified by self-reported HIV testing during the 12 months preceding the study interview. In both strata, older age, multiple sex partners, and a history of sex with an injection drug user (IDU) were associated with an elevated prevalence ratio (PR) for history of purchasing sex services, although the strength of the association differed by strata. Among men who reported recent HIV testing, condom use (PR = 1.22, 90% confidence interval (CI) 1.0, 1.48) was associated with a history of purchasing sex services, and among men who did not report recent HIV testing, having a consistent sex partner was associated with purchasing sex services (PR = 1.23, 90% CI 1.1, 1.37). The high prevalence of CSW service use and associations found in this study raise serious concerns about potential for sexual HIV transmission and should be investigated more closely.
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Affiliation(s)
- P Girchenko
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Room 131, Rensselaer, NY, 12144-3456, USA. .,New York State International Training and Research Program, New York, NY, USA.
| | - D C Ompad
- Global Institute of Public Health, New York University, New York, NY, USA.,Center for Drug Use and HIV Research, New York University, New York, NY, USA.,Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA
| | - R Kulchynska
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Room 131, Rensselaer, NY, 12144-3456, USA.,New York State International Training and Research Program, New York, NY, USA
| | - D Bikmukhametov
- Department of Internal Medicine #1, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Neubrandenburg, Germany
| | - S Dugin
- Fund for Social and Medical Programs Humanitarian Action, Saint Petersburg, Russian Federation
| | - L Gensburg
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Room 131, Rensselaer, NY, 12144-3456, USA
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26
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Huang W, Dong Y, Chen L, Song D, Wang J, Tao H, Zaller N, Zhang H, Operario D. HIV risk and sexual health among female migrants in China. Health Promot Int 2015; 31:595-605. [PMID: 26048866 DOI: 10.1093/heapro/dav049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Wen Huang
- School of Public Health, Anhui Medical University, Anhui, China
| | - Yanyan Dong
- School of Public Health, Anhui Medical University, Anhui, China
| | - Lin Chen
- School of Public Health, Anhui Medical University, Anhui, China
| | - Dandan Song
- School of Public Health, Anhui Medical University, Anhui, China
| | - Jun Wang
- School of Public Health, Anhui Medical University, Anhui, China
| | - Haidong Tao
- Luyang District Center for Disease Control and Prevention, Hefei, Anhui Providence, China
| | - Nickolas Zaller
- Fay W. Boozman College of Public Health, University of Arkansas, Little Rock, AR, USA
| | - Hongbo Zhang
- School of Public Health, Anhui Medical University, Anhui, China
| | - Don Operario
- School of Public Health, Brown University, 121 South Main Street, Providence, RI, USA
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27
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Huang W, Operario D, Dong Y, Zaller N, Song D, He H, Tao H, Xia J, Zhang H. HIV-related risk among female migrants working in entertainment venues in China. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 15:329-39. [PMID: 23921562 DOI: 10.1007/s11121-013-0423-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
China has experienced a surge in internal migration during the past decade, and migrant populations have been identified as a high-risk group for HIV and other sexually transmitted infections (STIs). Young female migrants often find employment in entertainment venues (bars, karaoke parlors, and massage parlors) located in metropolitan cities, and sex work transactions frequently occur in these venues. We examined factors associated with risk for HIV, other STIs, and reproductive health challenges in a cross-sectional study of 358 young female migrants, ages 18-29, working in entertainment venues in a rapidly growing urban city in China. Results indicate high levels of behavioral risk for HIV and other STIs, low rates of HIV testing, and high prevalence of problem drinking and mental health problems, including recent depression symptoms and suicidal ideation. Factors associated with increased STIs and genitourinary tract infections included commercial sex work, early sexual debut, abortion history, illicit drug use, and anxiety. Factors associated with increased HIV testing included employment in an affluent entertainment venue, education level, knowledge about where to obtain free HIV tests, condom use, and general HIV/AIDS knowledge. Findings of this study highlight the insufficient coverage of current public health services to female migrants working in entertainment venues and call for more assertive prevention interventions to mitigate risk for sexual, reproductive, behavioral, and mental health problems in this mobile population.
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Affiliation(s)
- Wen Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, 69 Meishan Road, Hefei, 230032, Anhui Province, China
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28
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Abstract
Obtaining representative information from hidden and hard-to-reach populations is fundamental to describe the epidemiology of many sexually transmitted diseases, including HIV. Unfortunately, simple random sampling is impractical in these settings, as no registry of names exists from which to sample the population at random. However, complex sampling designs can be used, as members of these populations tend to congregate at known locations, which can be enumerated and sampled at random. For example, female sex workers may be found at brothels and street corners, whereas injection drug users often come together at shooting galleries. Despite the logistical appeal, complex sampling schemes lead to unequal probabilities of selection, and failure to account for this differential selection can result in biased estimates of population averages and relative risks. However, standard techniques to account for selection can lead to substantial losses in efficiency. Consequently, researchers implement a variety of strategies in an effort to balance validity and efficiency. Some researchers fully or partially account for the survey design, whereas others do nothing and treat the sample as a realization of the population of interest. We use directed acyclic graphs to show how certain survey sampling designs, combined with subject-matter considerations unique to individual exposure-outcome associations, can induce selection bias. Finally, we present a novel yet simple maximum likelihood approach for analyzing complex survey data; this approach optimizes statistical efficiency at no cost to validity. We use simulated data to illustrate this method and compare it with other analytic techniques.
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29
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Jones KG, Johnson AM, Wellings K, Sonnenberg P, Field N, Tanton C, Erens B, Clifton S, Datta J, Mitchell KR, Prah P, Mercer CH. The prevalence of, and factors associated with, paying for sex among men resident in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Sex Transm Infect 2014; 91:116-23. [PMID: 25404706 PMCID: PMC4345903 DOI: 10.1136/sextrans-2014-051683] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Men who pay for sex (MPS) are considered a bridging population for sexually transmitted infections (STI). However, the extent, characteristics and role of MPS in transmission is poorly understood. We investigate these questions using data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). METHODS We performed complex survey analyses of data from 6293 men aged 16-74 years resident in Britain who completed Natsal-3, a probability sample survey undertaken during 2010-2012, using computer-assisted personal interviewing and computer-assisted self-interview. RESULTS 11.0% (95% CI10.1% to 11.9%) of all men reported ever paying for sex. Among MPS, 18.4% (95% CI 18.2% to 18.7%) of their lifetime sexual partners were paid. 3.6% (95% CI 3.1% to 4.2%) of men had paid for sex in the past 5 years. Partners of MPS constitute 14.7% of all reported partners and MPS report 15.6% of all reported STI diagnoses in the past 5 years. Paying for sex in the past 5 years was strongly associated with reporting larger numbers of sexual partners (adjusted OR, AOR for 5+ partners, past 5 years, 31.50, 95% CI 18.69 to 53.09). After adjusting for partner numbers, paying for sex remained strongly associated with reporting new foreign partners outside the UK (AOR 7.96; 95% CI 4.97 to 12.73) and STI diagnosis/es (AOR 2.34; 95% CI 1.44 to 3.81), all in the past 5 years. Among men ever paying for sex, 62.6% (95% CI 58.3% to 66.8%) reported paying for sex outside the UK, most often in Europe and Asia. CONCLUSIONS MPS in Britain remain at greater risk of STI acquisition and onward transmission than men who do not. They report high numbers of partners, but the minority are paid partners. They are an important core group in STI transmission.
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Affiliation(s)
- Kyle G Jones
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Kaye Wellings
- Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Nigel Field
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Clare Tanton
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Bob Erens
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Soazig Clifton
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK NatCen Social Research, London, UK
| | - Jessica Datta
- Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Kirstin R Mitchell
- Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Phillip Prah
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Catherine H Mercer
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
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30
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Goodman-Meza D, Pitpitan EV, Semple SJ, Wagner KD, Chavarin CV, Strathdee SA, Patterson TL. Hazardous drinking and HIV-risk-related behavior among male clients of female sex workers in Tijuana, Mexico. Am J Addict 2014; 23:502-9. [PMID: 25066863 DOI: 10.1111/j.1521-0391.2014.12138.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/14/2014] [Accepted: 04/12/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Male clients of female sex workers (FSWs) are at high risk for HIV. Whereas the HIV risks of alcohol use are well understood, less is known about hazardous alcohol use among male clients of FSWs, particularly in Mexico. We sought to identify risk factors for hazardous alcohol use and test associations between hazardous alcohol use and HIV risk behavior among male clients in Tijuana. METHOD Male clients of FSWs in Tijuana (n = 400) completed a quantitative interview in 2008. The AUDIT was used to characterize hazardous alcohol use. Multivariate logistic regression was used to determine independent associations of demographic and HIV risk variables with hazardous alcohol use (vs. non-hazardous). RESULTS Forty percent of our sample met criteria for hazardous alcohol use. Variables independently associated with hazardous drinking were reporting any sexually transmitted infection (STI), having sex with a FSW while under the influence of alcohol, being younger than 36 years of age, living in Tijuana, and ever having been jailed. Hazardous drinkers were less likely ever to have been deported or to have shared injection drugs. DISCUSSION AND CONCLUSIONS Hazardous alcohol use is associated with HIV risk, including engaging in sex with FSWs while intoxicated and having an STI among male clients of FSWs in Tijuana. SCIENTIFIC SIGNIFICANCE We systematically described patterns and correlates of hazardous alcohol use among male clients of FSWs in Tijuana, Mexico. The results suggest that HIV/STI risk reduction interventions must target hazardous alcohol users, and be tailored to address alcohol use.
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Affiliation(s)
- David Goodman-Meza
- Division of Global Public Health, Department of Medicine, University of California at San Diego, La Jolla, California
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Kinsler JJ, Blas MM, Cabral A, Carcamo C, Halsey N, Brown B. Understanding STI Risk and Condom Use Patterns by Partner Type Among Female Sex Workers in Peru. Open AIDS J 2014; 8:17-20. [PMID: 24949112 PMCID: PMC4062928 DOI: 10.2174/1874613601408010017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 11/30/2022] Open
Abstract
While brothel-based sex work is regulated by the Peruvian government, there is little data on STI risk factors reported by female sex workers (FSW). This study compared high risk behaviors among 120 Peruvian FSW from government regulated brothels with both clients and non-commercial partners. Our study found that 12% of FSW reported unprotected vaginal sex with clients (compared to 75% with non-commercial partners), and 42% reported unprotected anal sex with clients (compared to 87% with non-commercial partners). Group differences were observed in the expectation to have oral sex (32% for partners vs 60% for clients; p<0.01), and a history of anal sex (65% for partners vs 32% for clients; p<0.01) and both vaginal and anal sex with the same partners (46% for partners vs 25% for clients; p<0.001). These findings suggest that FSW constitute an important bridge population for STI/HIV transmission in Peru.
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Affiliation(s)
- Janni J Kinsler
- Department of Community Health Sciences, University of California, Los Angeles, USA
| | - Magaly M Blas
- Unit of Epidemiology, HIV and STD, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alejandra Cabral
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Cesar Carcamo
- Unit of Epidemiology, HIV and STD, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Neal Halsey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Brandon Brown
- Program in Public Health, University of California, Irvine, 653 E. Peltason Dr., AIRB Rm. 2024, Irvine, CA 92697-3957, USA
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Liu XY, Hao C, Jiang H, Sun L, Zhou JB, Yin YP, Tang W, Jiang N, Mahapatra T, Mahapatra S, Chen XS, Yang HT, Fu GF, Huan XP. Syphilis and its correlates among heterosexual males attending sexually transmitted infection clinics - observation from a multicity cohort in Jiangsu Province, China. PLoS One 2014; 9:e95289. [PMID: 24743839 PMCID: PMC3990697 DOI: 10.1371/journal.pone.0095289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/25/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives To estimate the prevalence of HIV and syphilis, incidence of syphilis and to identify the correlates of syphilis infection among heterosexual male attendees of sexually transmitted infection (STI) clinics (MSC). Methods A cohort study of one-year duration was conducted in Yangzhou and Changzhou cities in Jiangsu province of China. The baseline survey commenced in June 2009, recruited 1225 consenting adult MSCs (609 in Yangzhou and 617 in Changzhou) through STI-clinic based convenience sampling. Results Baseline HIV and syphilis prevalence were 0.49% and 17.29% respectively. Syphilis incidence rate was 7.22 per 100 person-years (6.53 in Yangzhou and 7.76 in Changzhou) during the 6-month follow-up with retention fractions of 27.38% and 35.15% for Yangzhou and Changzhou respectively. Majority of the participants were middle-aged, high school educated, married, living with partners and non-migrants. Very few subjects reported recent and consistent condom-use with regular partners. Although considerable number of MSCs reported recent sexual exposure with female sex workers (FSW) and non-FSW casual partners, the proportion of reported condom use was very low during those exposures. In multivariate analyses higher age, having recent sex with FSWs and being HIV-positive were associated with higher syphilis sero-positivity while higher education was protective. In bivariate analyses, being married, divorced/widowed, official residency of the study cities and non-use of condom with regular partners predicted higher risk. Conclusions Considering the potential bridging role of MSCs between high and low-risk populations, effective intervention strategies among them targeting the correlates of syphilis infection are urgently called for in Jiangsu province of China.
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Affiliation(s)
- Xiao-Yan Liu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Chao Hao
- Changzhou Center for Disease Prevention and Control, Nanjing, China
| | - Hui Jiang
- Yangzhou Center for Disease Prevention and Control, Nanjing, China
| | - Lin Sun
- Yangzhou Center for Disease Prevention and Control, Nanjing, China
| | - Jian-Bo Zhou
- Changzhou Center for Disease Prevention and Control, Nanjing, China
| | - Yue-Ping Yin
- National Center for STDs Control, China CDC, Nanjing, China
| | - Weiming Tang
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ning Jiang
- National Center for STDs Control, China CDC, Nanjing, China
| | - Tanmay Mahapatra
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sanchita Mahapatra
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | | | - Hai-Tao Yang
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Geng-Feng Fu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xi-Ping Huan
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
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Yingying H, Abler L, Suiming P, Henderson GE, Xin W, Xingliang Y, Parish WL. Population-based sexual behavior surveys in China: Liuzhou compared with other prefectural cities. AIDS Behav 2014; 18 Suppl 2:S118-25. [PMID: 24174289 PMCID: PMC3943943 DOI: 10.1007/s10461-013-0645-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sexual behaviors in China are rapidly changing; simultaneously, sexually transmitted infections (STI)/HIV prevalence is increasing in the general population. To investigate these major shifts, we examined sexual behaviors and self-reported STI in one prefectural city in southern China, Liuzhou, and compared it to other prefectural cities throughout China. We used adults age 18-39 from two sets of population-based surveys that paralleled each other in both content and method. The first set was the Liuzhou survey conducted in 2008 (n = 398). The second set consisted of two national surveys collected in 2006 and 2010 (n = 2,186). Liuzhou respondents reported more active social and sexual behaviors than their national counterparts, including more socializing, dancing, drinking excessively, sexual activity among never married men and women, purchasing commercial sex among men, one-night stands among men, multiple sexual partnerships and self-reported STI among both men and women. Women in Liuzhou reported greater sexual risk behavior than their national counterparts, although overall they reported less than their male counterparts; they were also more likely to have had an abortion than women in other prefectural cities. Our findings provide a comprehensive overview of the sexual context of Liuzhou among the general population, which may help explain the greater STI/HIV prevalence in Liuzhou.
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Affiliation(s)
- Huang Yingying
- Department of Sociology, Institute of Sexuality and Gender, Renmin University of China, Beijing, China
| | - Laurie Abler
- Duke Global Health Institute, Duke University, Durham, NC
| | - Pan Suiming
- Department of Sociology, Institute of Sexuality and Gender, Renmin University of China, Beijing, China
| | - Gail E. Henderson
- Department of Social Medicine, UNC School of Medicine, Chapel Hill, NC
| | - Wang Xin
- School of Philosophy and Social Development, Shandong University, Shandong, China
| | - Yao Xingliang
- Harbin Engineering University, Harbin, Heilongjiang, China
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Ompad DC, Bell DL, Amesty S, Nyitray AG, Papenfuss M, Lazcano-Ponce E, Villa LL, Giuliano AR. Men who purchase sex, who are they? An interurban comparison. J Urban Health 2013; 90:1166-80. [PMID: 23719715 PMCID: PMC3853174 DOI: 10.1007/s11524-013-9809-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Most research concerning clients of commercial sex workers (CSWs) relies upon CSW reports of client characteristics and behavior. We describe correlates of ever purchasing sex among 3,829 men from three cities: São Paulo, Brazil; Cuernavaca, Mexico; and Tampa, USA. A computer-assisted self-interview collected data on demographics and sexual behavior. There were significant site differences-26.5 % paid for sex in São Paulo, 10.4 % in Cuernavaca, and 4.9 % in Tampa. In all cities, men who had sex with men and women (versus sex with women only) were more likely to have ever paid for sex. In São Paulo and Cuernavaca, CSW clients were older, had higher educational attainment, and were less likely to be married. In Tampa, older age was associated with being a CSW client but not education and marital status. In São Paulo and Cuernavaca, CSW clients had more partners than men who had never paid for sex. In São Paulo, CSW clients initiated vaginal sex at an earlier age, while in Cuernavaca they were more likely to self-report a sexually transmitted infection. CSW clients varied with respect to demographics across the three cities while the association between paying for sex and risky sexual behavior seems to be somewhat conserved. These findings suggest that interventions among CSW clients should focus on condom use with commercial and non-commercial partners as these men may be at increased risk for transmitting and acquiring sexually transmitted infections to and from their sex partners. Better understanding of client characteristics is needed for targeting interventions and creating culturally appropriate content.
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Affiliation(s)
- Danielle C Ompad
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS) and Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human Development, New York University, 411 Lafayette Street, 5th floor, New York, NY, 10003, USA,
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Zhang C, Hong Y, Li X, Qiao S, Zhou Y, Su S. Psychological stressors in the context of commercial sex among female sex workers in China. Health Care Women Int 2013; 36:753-67. [PMID: 24180467 DOI: 10.1080/07399332.2013.838247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Because of the illegality and stigma associated with female sex workers (FSWs) in China, data were limited regarding their psychological stressors examined through the lens of occupational health. Analyzing qualitative data from 16 gatekeepers and 38 FSWs, we explored these stressors in the context of commercial sex in China. We found that FSWs faced a continuum of stressors that resulted from poverty, limited employment, lack of social protection, violence perpetrated by clients, and limited social support from peers and stable partners. We call for empowerment and a structural approach to address the needs of FSWs to improve their psychological well-being.
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Affiliation(s)
- Chen Zhang
- a Institute of Global Health, Vanderbilt University , Nashville , Tennessee , USA
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Wang J, Liu J, Huang Y, Yang T, Yao F, Dong X, Wen G, Bi X, Zhao M, Wen X, Huang M, Lü Y, Ma H, Yu Q, Wright D, Guo N, Ness P, Shan H. An analysis of risk factors for human immunodeficiency virus infection among Chinese blood donors. Transfusion 2013; 53:2431-40. [PMID: 23305132 DOI: 10.1111/trf.12062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/23/2012] [Accepted: 10/23/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Information regarding the risk factors for human immunodeficiency virus (HIV) infection among Chinese donors is important for understanding the trend of HIV transmission routes and for developing effective donor behavioral screening policies. STUDY DESIGN AND METHODS In 2009 to 2011, a total of 77 HIV-positive and 649 HIV-negative consented donors who screened nonreactive for hepatitis B virus, hepatitis C virus, syphilis, and alanine aminotransferase in four Retrovirus Epidemiology Donor Study-II Chinese regions received and completed a questionnaire by mail regarding their recent and past medical procedures, drug use, and sexual behaviors, etc. Exploratory and confirmatory factor analyses grouped questions into three risk factors. Multivariable logistic regression analysis examined the relationship between risk factors and HIV status adjusting for center, age, sex, and education. RESULTS The three risk factors were test-seeking tendency, medical-related risks, and behavioral risks. In multivariable logistic regression analysis, greater test-seeking tendency and behavioral risks were associated with HIV infection, with the adjusted odds ratios (ORs) being 2.2 (95% confidence interval [CI], 1.2-4.1) and 3.8 (95% CI, 1.8-7.9), respectively, but medical risks were not (OR, 1.2; 95% CI, 0.6-2.2). In comparison to less high school education, high school and more education was associated with lower risks for HIV infection, with the ORs being 0.35 (95% CI, 0.17-0.70) and 0.17 (95% CI, 0.09-0.33), respectively. CONCLUSIONS Test-seeking tendency and high-risk sexual behaviors are important predictors of HIV infection in Chinese blood donors, suggesting that the health history inquiry used in donor selection process needs improvement to defer high-risk donors more effectively.
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Affiliation(s)
- Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, P.R. China; Johns Hopkins Medical Institutions, Baltimore, Maryland; Kunming Blood Center, Kunming, Yunnan, P.R. China; Urumqi Blood Center, Urumqi, Xinjiang, P.R. China; Mianyang Blood Center, Mianyang, Sichuan, P.R.China; Luoyang Blood Center, Luoyang, Henan, P.R. China; Westat, Inc., Rockville, Maryland
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Ojeda VD, Burgos JL, Rangel AG, Lozada R, Vera A. U.S. drug use and migration experiences of Mexican female sex workers who are injection drug users. J Health Care Poor Underserved 2012; 23:1733-49. [PMID: 23698687 PMCID: PMC4232365 DOI: 10.1353/hpu.2012.0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe U.S.-based drug/sex behaviors and correlates of lifetime U.S. drug use by Mexican female sex workers who inject drugs (FSW-IDUs). METHODS Between 2008-2010, 315 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. RESULTS Twenty-seven percent (n=85) of FSW-IDUs were U.S. migrants; of these, 46% (n=39) were deportees. One-half of U.S.-migrant FSW-IDUs consumed illicit drugs in the U.S., and two-thirds of these injected drugs in the U.S. Among U.S. injectors, over 75% ever received or shared used injection equipment. The majority (92%) of U.S.-migrant FSW-IDUs never obtained U.S. drug treatment services. HIV prevalence was 4% among U.S.-migrant and 5% among non-U.S. migrant FSW-IDUs; 100% of U.S.-migrant and 75% of non-U.S. migrant FSW-IDUs were unaware of their HIV status. CONCLUSIONS Binational coordination to improve access to substance use treatment and HIV testing services in Mexico and the U.S. among marginalized binational migrants may be critical to containing HIV transmission.
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Affiliation(s)
- Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, UCSD School of Medicine, University of California, San Diego, 10111 N. Torrey Pines Road, La Jolla, CA 92093-0507, USA.
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Li X, Hong Y, Poston D. Preventing HIV in women: a top priority in China's efforts in fighting AIDS. AIDS Care 2011; 23 Suppl 1:1-4. [PMID: 21660746 DOI: 10.1080/09540121.2011.575121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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