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Cai G, Liu Y, Zhuang J, Chen Z, Lu Y, Wu J, Hu Z, Zhang J, He F. Differences in socio-demographics status, risk behaviours, healthcare uptake and HIV/ sexually transmitted infections (STIs) between brothel-based and street-based female sex workers in Yunnan, China. Int J STD AIDS 2024:9564624241239480. [PMID: 38507707 DOI: 10.1177/09564624241239480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Heterosexual contact is the primary mode of HIV transmission in China and commercial sex is thought to play a crucial role in China's epidemic. Female sex workers (FSWs) in China tend to be either brothel-based (BSWs) or street-based (SSWs), but few studies have investigated the differences between these important segments of this difficult-to-reach, high-risk population. Our aim was to explore the differences between SSWs and BSWs in terms of socio-demographic characteristics, sexual and risky practices, HIV/STI-related knowledge, health services, HIV/STI prevalence and other aspects. METHODS A cross-sectional survey was conducted in Yunnan Province of China in partnership with a local FSW-friendly non-governmental organization. Face-to-face interviews using a structured questionnaire were conducted to collect data on socio-demographic characteristics, sex work history, sexual behaviours, HIV/STI-related knowledge, HIV testing history, and healthcare services uptake. Blood samples were taken for HIV and syphilis testing, and urine samples for gonorrhea and chlamydia testing. Descriptive statistics were used to evaluate differences between SSWs and BSWs. RESULTS A total of 185 BSWs and 129 SSWs were included in the study. SSWs were older and less educated, had more dependents and more clients, lower condom use and accessed fewer healthcare services. Moreover, 37.2% of SSWs and 24.9% of BSWs were found to have HIV/STI infection. Unfortunately, the awareness related to STIs was relatively low in both groups, especially SSWs. CONCLUSIONS Our study provides evidence that confirms the disproportionately high vulnerability of SSWs to HIV and other STIs, underscoring the urgent need for the Chinese health and public health sectors to prioritize outreach to SSWs. Awareness and educational programs, condom distribution, testing and health check-ups should be included in a comprehensive strategy for HIV/STI prevention in this high-risk population.
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Affiliation(s)
- Guoxi Cai
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Public Health, Nagasaki Prefectural Institute of Environment and Public Health, Nagasaki, Japan
| | - Yufen Liu
- National Centre for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Jinman Zhuang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, China
| | - Zishan Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, China
| | - Yixiao Lu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-Sen University, Shenzhen, China
| | - Jiwen Wu
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Human Anatomy and Histoembryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, China
| | - Jianping Zhang
- Department of the Child-Adolescent and Maternal Care of Faculty of Public Health, Kunming Medical University, Kunming, China
| | - Fei He
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Environment Factors and Cancer, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Digital Institute of Tumor Big Data, Fujian Medical University, Fuzhou, China
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Zhu X, Zhu Z, Gu L, Zhan Y, Gu H, Yao Q, Li X. Spatio-temporal variation on syphilis from 2005 to 2018 in Zhejiang Province, China. Front Public Health 2022; 10:873754. [PMID: 36117594 PMCID: PMC9480496 DOI: 10.3389/fpubh.2022.873754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/01/2022] [Indexed: 01/21/2023] Open
Abstract
Background Syphilis has spread throughout China, especially in Zhejiang Province which endangers the health and lives of people. However, the spatial and temporal epidemiological studies of syphilis in Zhejiang are not thorough enough. The temporal and spatial variation and the relevant factors of syphilis incidence should be analyzed for more effective prevention and control in Zhejiang, China. Methods Data on confirmed cases of syphilis in Zhejiang Province from 2005 to 2018 was used and the spatio-temporal distributions were described. The spatial autocorrelation analysis and SaTScan analysis were performed to identify spatio-temporal clusters. A Bayesian spatial Conditional Autoregression (CAR) model was constructed to explore the relationships between syphilis incidence and common social and natural indicators. Results 474,980 confirmed cases of syphilis were reported between 2005 and 2018 with a large peak in 2010. Farmers and unemployed people accounted for the largest proportion of confirmed cases. And the significant spatial clusters of syphilis were concentrated in the north of Zhejiang Province, especially in more economically developed regions. Seven spatio-temporal clusters were identified and the main three high-risk areas were located in Hangzhou (RR = 1.62, P < 0.05), Zhoushan and Ningbo (RR = 1.99, P < 0.05), and Lishui (RR = 1.68, P < 0.05). The findings showed that the morbidity of syphilis was positively correlated with the Gross Domestic Product (GDP) per capita, the number of health technicians per 10,000 people, the proportion of the elderly and air temperature were negatively correlated with the proportion of the urban population, the proportion of men and precipitation. Conclusions The spatio-temporal analysis revealed that the prevalence of syphilis was still serious in Zhejiang Province. Syphilis high-risk areas were mainly located in the more developed coastal regions where more targeted intervention measures were required to be implemented. The study highlighted the need to strengthen Sexually Transmitted Diseases (STD) screening and health education for high-risk groups and improve the coverage of syphilis testing to reduce hidden syphilis cases.
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Affiliation(s)
- Xiaoxia Zhu
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhixin Zhu
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lanfang Gu
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yancen Zhan
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Gu
- Center for Medical Science and Technology Education Development, Hangzhou, China
| | - Qiang Yao
- Department of Disease Prevention Control and Occupational Health, Zhejiang Provincial Health Commission, Hangzhou, China,*Correspondence: Xiuyang Li
| | - Xiuyang Li
- Department of Epidemiology & Biostatistics, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China,Qiang Yao
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Wang Y, Dooley K, Wang C, Smith K. Biomedical contraceptives and their association with condom use consistency among female sex workers in China: results from a national cross-sectional study. Ann Epidemiol 2022; 74:104-110. [DOI: 10.1016/j.annepidem.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/20/2022] [Accepted: 07/30/2022] [Indexed: 12/01/2022]
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Stigma in a Collectivistic Culture: Social Network of Female Sex Workers in China. AIDS Behav 2022; 26:297-309. [PMID: 34312739 DOI: 10.1007/s10461-021-03383-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
In this egocentric network study, we explored Chinese collectivism in relation to social network characteristics and sex work-related stigma among mid-age female sex workers (FSWs). Respondent-driven sampling was used to recruit 1245 mid-age FSWs from three cities in China. We found that a one standard deviation (SD) increase in FSWs' collectivism was associated with a 0.18 SD decrease in social support (95% CI - 0.32, - 0.04), a 0.20 SD decrease in network effective size (i.e., the diversity of a social network; 95% CI - 0.30, - 0.10), and a 0.21 SD decrease in network betweenness (i.e., the "bridging potential" of egos within their networks; 95% CI - 0.33, - 0.09). Among participants who perceived more sex work stigma, the association between collectivism and FSWs' network betweenness was attenuated. In a collective culture emphasizing group values and honor, belonging to a less interconnected social network may give FSWs a structural advantage to cope with stigma and secure social support.
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Hu L, Wu G, Lu R, Zhu H, Qiu H, Jing D, Ye M. Changing trends of HIV, syphilis, HCV infections and behavioural factors among female sex workers in Chongqing, China: findings from six serial surveillance surveys. BMJ Open 2020; 10:e036654. [PMID: 33046464 PMCID: PMC7552845 DOI: 10.1136/bmjopen-2019-036654] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To explore the prevalence and changing trends of HIV, syphilis, hepatitis C virus (HCV) infections and risk behaviours among female sex workers (FSWs) and to provide reference and theoretical basis for formulating targeted interventions. DESIGN Six consecutive cross-sectional surveys. SETTING Chongqing, China. PARTICIPANTS FSWs were included if they (1) were aged ≥16 years, (2) provided commercial sex for money or goods during the previous month and (3) were willing to participate in the survey and could provide verbal informed consent. This study included 16 791 of 16 810 participants recruited between 2013 and 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The prevalence of HIV/syphilis/HCV infection. RESULTS The HIV and HCV prevalence among FSWs in Chongqing was stable during the study period, but the prevalence of syphilis had an increasing trend, particularly among low-tier and middle-tier FSWs. Improvements in HIV-related knowledge, condom use, injecting drug use and participation in HIV-related services were observed. However, no change was found in the prevalence of drug use. HIV infection was correlated with no condom use in the last commercial sex (adjusted OR (aOR) 3.48, 95% CI 1.90 to 6.37) and syphilis infection (aOR 4.88, 95% CI 1.95 to 12.18). Syphilis infection was correlated with inconsistent condom use (aOR 1.30, 95% CI 1.02 to 1.65), HIV infection (aOR 5.88, 95% CI 2.40 to 14.41), HCV infection (aOR 7.68, 95% CI 4.37 to 13.49) and sexually transmitted infection (STI) diagnosis in the past year (aOR 3.81, 95% CI 2.40 to 6.03). HCV infection was associated with injecting drug use (aOR 8.91, 95% CI 4.45 to 17.86) and syphilis infection (aOR 7.88, 95% CI 4.49 to 13.83). CONCLUSIONS Comprehensive interventions targeting FSWs, particularly low-tier and middle-tier FSWs, should be increasingly implemented to prevent and control HIV, syphilis and other STIs.
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Affiliation(s)
- Ling Hu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Guohui Wu
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Rongrong Lu
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Hua Zhu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Hongfang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Dan Jing
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Mengliang Ye
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
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Ahinkorah BO, Budu E, Seidu AA, Hagan JE, Agbaglo E, Hormenu T, Schack T, Yaya S. Consistent condom use among men who pay for sex in sub-Saharan Africa: Empirical evidence from Demographic and Health Surveys. PLoS One 2020; 15:e0236552. [PMID: 32776965 PMCID: PMC7416936 DOI: 10.1371/journal.pone.0236552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Paying for sex has often been associated with risky sexual behavior among heterosexual men, and men who pay for sex are considered as a bridging population for sexually transmitted infections. Consistent condom use during paid sex is essential for reducing sexually transmitted infections, including HIV/AIDS. In this study, we assessed the prevalence and predictors of consistent condom use among men who pay for sex in sub-Saharan Africa. MATERIALS AND METHODS We pooled data from 29 sub-Saharan African countries' Demographic and Health Surveys. A total of 3,353 men in sub-Saharan Africa who had paid for sex in the last 12 months preceding the surveys and had complete information on all the variables of interest were used in this study. The outcome variable for the study was consistent condom use for every paid sex in the last 12 months. Both bivariate and multivariable logistic regression analyses were carried out. Results were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Statistical significance was declared at p< 0.05. RESULTS Overall, the prevalence of consistent condom use during paid sex in sub-Saharan Africa was 83.96% (CI = 80.35-87.56), ranging from 48.70% in Benin to 98% in Burkina Faso. Men aged 35-44 [AOR, 1.39 CI = 1.04-1.49], men in the richest wealth quintile [AOR, 1.96 CI = 1.30-3.00], men with secondary level of education [AOR, 1.69 CI = 1.17-2.44], and men in Burkina Faso [AOR = 67.59, CI = 8.72-523.9] had higher odds of consistent condom use during paid sex, compared to men aged 15-19, those in the poorest wealth quintile, those with no formal education, and men in Benin respectively. Conversely, Muslim men had lower odds [AOR = 0.71, CI = 0.53-0.95] of using condom consistently during paid sex, compared to Christian men. CONCLUSION Empirical evidence from this study suggests that consistent condom use during paid sex encompasses complex social and demographic characteristics. The study also revealed that demographic characteristics such as age, wealth quintile, education, and religion were independently related to consistent condom use for paid sex among men. With sub-Saharan Africa having the highest sexual and reproductive health burden in the world, continuous application of evidence-based interventions (e.g., educational and entrepreneurial training) that account for behavioural and social vulnerabilities are required.
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Affiliation(s)
- Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Hormenu
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
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Wu Z, Wang Y, Detels R, Bulterys M, McGoogan JM. The US CDC Global AIDS Program in China. HIV/AIDS IN CHINA 2020. [PMCID: PMC7121485 DOI: 10.1007/978-981-13-8518-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The China-US Cooperation-Global AIDS Program (GAP) was a strategic technical collaboration program jointly implemented by the US Centers for Disease Control and Prevention and the Chinese Center for Disease Control and Prevention. This program developed, piloted, launched, and evaluated a broad range of projects supporting national and local HIV prevention and control programs; evidence-based decision-making; strengthening systems and capacity at national, provincial, and local levels; prioritizing high-risk geographic areas and populations; developing innovative approaches for scale-up; answering important scientific questions that can be most effectively answered in China but also with global implications for the HIV response; and increasing China’s engagement with the global public health community and sharing critical lessons learned. A productive working relationship with well-conceived models, a results-based activity implementation plan, and proper linkage to the domestic policy process has made a significant contribution to HIV control and prevention in China.
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Affiliation(s)
- Zunyou Wu
- National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yu Wang
- Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA USA
| | - Marc Bulterys
- U.S. Centers for Disease Control and Prevention, Global AIDS Program, China Office, Beijing, China
| | - Jennifer M. McGoogan
- National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
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Dong X, Sun M, Wang J, Yang Z, Hu B. Understanding the Hierarchical Relationships in Female Sex Workers' Social Networks Based on Knowledge, Attitude, and Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203841. [PMID: 31614585 PMCID: PMC6843495 DOI: 10.3390/ijerph16203841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/23/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022]
Abstract
Female sex workers (FSWs) represent a high-risk population for HIV infection and transmission. In general, their fellow FSWs (peers) also play a role in their level of susceptibility to HIV/AIDS. This paper draws from interview data of 93 FSWs to construct a multi-layer FSW social network model based on their knowledge, attitude, and practice (KAP). Statistical analyses of the correlation among the three dimensions of KAP as well as their social interactions indicated that FSWs had basic knowledge of HIV/AIDS prevention but demonstrated little enthusiasm in acquiring relevant information. Their knowledge, attitude, and practice were highly positively correlated. Their attitude was more likely to be negatively influenced by their companions, while their practice was more likely to be positively affected. Besides, FSWs exhibited high homophily in KAP with their neighbors. Thus, during HIV/AIDS interventions, FSWs should receive individualized education based on their specific KAP. Considering the high level of homophily among FSWs, their propensity to be positive or negative in their KAP are significantly influenced by their companions. Making full use of peer education and social interaction-based interventions may help prevent and control the spread of HIV/AIDS.
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Affiliation(s)
- Xianlei Dong
- School of Business, Shandong Normal University, Jinan 250358, China;
| | - Mengge Sun
- National Science Library, Chinese Academy of Science, Beijing 100190, China;
- Department of Library Information and Archives Management, UCAS, Beijing100039, China
| | - Jingguo Wang
- Information Systems and Operation Management, College of Business, University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Zhihan Yang
- Statistics with Data Science, School of Mathematics, The University of Edinburgh, Edinburgh EH8 9YL, UK;
| | - Beibei Hu
- School of Business, Shandong Normal University, Jinan 250358, China;
- Correspondence: ; Tel.: +86-13280027089
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Zhou C, Hsieh E, Rou K, Tillman J, Dong W, Feng XX, Yang YZ, Yang YJ, Sun XG, Zang HJ, Wu YZ, Wu Z. Short-term acceptability of female condom use among low-fee female sex workers in China: a follow-up study. BMC Womens Health 2019; 19:77. [PMID: 31200702 PMCID: PMC6570840 DOI: 10.1186/s12905-019-0773-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-fee female sex workers (FSW) lack power to effectively negotiate male condom use with clients. Female condoms (FCs) may provide an alternative strategy. This study was conducted to assess the acceptability of FC use among low-fee FSWs, and to identify appropriate candidates for future FC promotion. METHODS A one-month follow-up study was conducted. At entry into the study, eligible participants completed a baseline questionnaire and were given 10 FCs. At the one-month follow up encounter, the number of used FC packages were counted and each participant completed a follow-up questionnaire. Logistic regression was used to identify variables associated with more frequent use of FCs (> 2 times). RESULTS A total of 312 low-fee FSWs were enrolled at baseline and all participants completed the follow-up evaluation. Among them, 123 (39.4%) participants had used more than two FCs. Participants who were illiterate or had completed at most primary school education (OR: 2.4, 95% CI: 1.4-7.2), charged ≤30 RMB per client (≤30 vs. 51-80 RMB, OR: 3.8, 95% CI: 1.9-7.6), or had consistently used condoms with regular clients in the past month (OR: 2.4, 95%CI: 1.4-4.2) were more likely to use FCs. CONCLUSION Low-fee FSWs charging ≤30 RMB per client, and those who are less educated may be appropriate initial candidates for FC promotion in China. Strategies to consider include teaching FSWs tactics for negotiation of FC use that can initially be applied with regular clients, and providing education to maximize ease-of use, and minimize discomfort with FC usage.
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Affiliation(s)
- Chu Zhou
- Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Evelyn Hsieh
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut USA
| | - Keming Rou
- Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Jonas Tillman
- Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Wei Dong
- Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Xian-xiang Feng
- Division of HIV Prevention, Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi Zhuang Autonomous Region China
| | - Yan-zhen Yang
- Division of HIV Prevention, Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi Zhuang Autonomous Region China
| | - Yu-jun Yang
- Division of HIV Prevention, Zhangjiajie Center for Disease Control and Prevention, Zhangjiajie, Hunan Province China
| | - Xian-guo Sun
- Division of HIV Prevention, Zhangjiajie Center for Disease Control and Prevention, Zhangjiajie, Hunan Province China
| | - Hai-jian Zang
- Division of HIV Prevention, Pingnan Center for Disease Control and Prevention, Pingnan, Guangxi Zhuang Autonomous Region China
| | - Ying-zhen Wu
- Division of HIV Prevention, Pingnan Center for Disease Control and Prevention, Pingnan, Guangxi Zhuang Autonomous Region China
| | - Zunyou Wu
- Division of Prevention and Intervention, 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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Guida J, Hu L, Liu H. Sexual Behavior With Noncommercial Partners: A Concurrent Partnership Study Among Middle-Aged Female Sex Workers in China. JOURNAL OF SEX RESEARCH 2019; 56:670-680. [PMID: 29452001 PMCID: PMC6188845 DOI: 10.1080/00224499.2018.1434115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Female sex workers (FSWs) often engage in concurrent partnerships, meaning they have multiple sexual relationships at the same time. The objective of this study was to investigate sexual concurrency and its associations with condom use and syphilitic infections among FSWs over age 35. Respondent-driven sampling was used to recruit 1,245 FSWs in Nanning, Hefei, and Qingdao, China. FSWs were asked to report whether they had concurrent partners in the past six months. Concurrency was defined as engagement in sex with commercial clients and (1) husbands and boyfriends (n = 167); (2) husbands only (n = 301); or (3) boyfriends only (n = 469). FSWs with only commercial clients were used as the comparison group (n = 308). Across all groups, the percentage of FSWs with prevalent and active syphilis ranged from 19.6% to 25.6% and 9.1% to 11.5%, respectively. Condom use was low with noncommercial sexual partners and was more likely to be used when FSWs' boyfriends had other partners. Three components of the theory of planned behavior were significantly associated with consistent condom use. Concurrent relationships may lead to increased transmission of syphilis at the workplace and family levels. Effective interventions should target concurrency with both commercial and noncommercial partners.
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Affiliation(s)
- Jennifer Guida
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park
| | - Liangyuan Hu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park
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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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Ong JJ, Fu H, Smith MK, Tucker JD. Expanding syphilis testing: a scoping review of syphilis testing interventions among key populations. Expert Rev Anti Infect Ther 2018; 16:423-432. [PMID: 29633888 PMCID: PMC6046060 DOI: 10.1080/14787210.2018.1463846] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Syphilis is an important sexually transmitted infection (STI). Despite inexpensive and effective treatment, few key populations receive syphilis testing. Innovative strategies are needed to increase syphilis testing among key populations. Areas covered: This scoping review focused on strategies to increase syphilis testing in key populations (men who have sex with men (MSM), sex workers, people who use drugs, transgender people, and incarcerated individuals). Expert commentary: We identified many promising syphilis testing strategies, particularly among MSM. These innovations are separated into diagnostic, clinic-based, and non-clinic based strategies. In terms of diagnostics, self-testing, dried blood spots, and point-of-care testing can decentralize syphilis testing. Effective syphilis self-testing pilots suggest the need for further attention and research. In terms of clinic-based strategies, modifying default clinical procedures can nudge physicians to more frequently recommend syphilis testing. In terms of non-clinic based strategies, venue-based screening (e.g. in correctional facilities, drug rehabilitation centres) and mobile testing units have been successfully implemented in a variety of settings. Integration of syphilis with HIV testing may facilitate implementation in settings where individuals have increased sexual risk. There is a strong need for further syphilis testing research and programs.
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Affiliation(s)
- Jason J. Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Central Clinical School, Monash University, Victoria, Australia
| | - Hongyun Fu
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Eastern Virginia Medical School, Norfolk, USA
| | - M. Kumi Smith
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
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Surti SB, Kosambiya JK, Khokhar N, Patni MM, Gohil AH, Kamdar ZN, Umrigar D, Verma R, Mulla S. Rapid Response to Syphilis Outbreak among Female Sex Workers. Indian J Community Med 2017; 42:214-217. [PMID: 29184321 PMCID: PMC5682720 DOI: 10.4103/ijcm.ijcm_254_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Outbreak of syphilis, i.e., 16 cases of rapid plasma reagin (RPR) reactive cases of syphilis was reported in Community Based Organization (CBO) Sahyog of Surat, India, from April to August 2014. The aim of the study was to find risk factors and take immediate actions to prevent spread. Materials and Methods: Outbreak investigation of 16 Female Sex Workers of CBO Sahyog in Surat who were found Rapid Plasma Reagin (RPR) and Treponema Pallidum Hemagglutination Assay (TPHA) positive from April to August 2014; was carried out. Clinico-epidemiological and laboratory-based evidence for different sexually transmitted infections (STIs) conducted at Government Medical College, New Civil Hospital, Surat. Root cause analysis (RCA) of index case was carried out. Results: Desk review for the past 3 years data of STI revealed total STI cases as 88 (2011), 95 (2012), and 130 (2013), of which 4, 2, and 2 found RPR reactive, respectively. Data from April to August 2014 revealed 16 RPR reactive cases and confirmed by TPHA. On examination, one had ulcerative cervical lesion, rest did not have any symptoms of syphilis. Eleven had vaginal/cervical discharge, 11 had lower abdominal pain. A total of 11 had unprotected sex, 7 encountered condom tear in the past 6 months, and 5 reported sexual violence. Seven had sexual activity under influence of alcohol. Laboratory investigation revealed two as HIV-positive. RPR reactivity reported highest (9 out of 16) from same area of hotspot. RCA of probable index case revealed factors responsible as violence and nonuse of condoms. Conclusions: Outbreak investigation revealed one probable index case. All 16 treated with injection Penidure. Violence or condom tear is responsible for the spread. Crisis management team should be strengthened.
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Affiliation(s)
- Shaily B Surti
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - J K Kosambiya
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Neeta Khokhar
- Department of Microbiology, Government Medical College, Surat, Gujarat, India
| | | | - Alpesh H Gohil
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Zeel N Kamdar
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Dipak Umrigar
- Department of Dermatology, Government Medical College, Surat, Gujarat, India
| | - Ragini Verma
- Department of Obstetrics and Gynaecology, Government Medical College, Surat, Gujarat, India
| | - Summaiya Mulla
- Department of Microbiology, Government Medical College, Surat, Gujarat, India
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Ma Q, Jiang J, Pan X, Cai G, Wang H, Zhou X, Jiang T, Chen L. Consistent condom use and its correlates among female sex workers at hair salons: a cross-sectional study in Zhejiang province, China. BMC Public Health 2017; 17:910. [PMID: 29183301 PMCID: PMC5706376 DOI: 10.1186/s12889-017-4891-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 11/06/2017] [Indexed: 11/15/2022] Open
Abstract
Background This study investigated condom use among female sex workers (FSWs) at hair salons during commercial sexual interactions over 1 month. We explored the associations of such use with various sexual behaviours, HIV/STI risk perception and related knowledge, self-efficacy regarding condom use, exposure to behavioural interventions, and other factors. This type of information has not been reported in China and is critical for designing and modifying programs aimed at preventing HIV/STI transmission in this group of FSWs and their clients. Methods Our data were derived from a large cross-sectional study conducted among low-tier FSWs in 21 counties within Zhejiang province, China. Data were collected from September to November 2013.Bivariable and multiple logistic regression analyses were used to identify factors associated with self-reported consistent condom use among FSWs working at hair salons. Results Of 1682 FSWs working at hair salons, 50.5% consistently used condom with clients during the previous month. Multivariable analysis revealed that condom use for commercial sex, consistent vaginal douching after commercial sex, adopting contraceptive measures, high scores on perceived self-efficacy regarding condom use, and exposure to interventions were associated with self-reported consistent condom use; early initiation of commercial sex, experiences with oral sex, rarely/sometimes/often using oral contraceptives, and having seen a doctor were associated with not using condoms. Conclusions Commercial sex is not effectively protected, and behavioural interventions targeting FSWs should take into account the various factors that are correlated to condom use.
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Affiliation(s)
- Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, 310051, China
| | - Jianmin Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, 310051, China.
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, 310051, China
| | - Gaofen Cai
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, 310051, China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, 310051, China
| | - Xin Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, 310051, China
| | - Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, 310051, China
| | - Lin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, 310051, China
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Abstract
Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or via vertical transmission during pregnancy. T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochaetes and often imitate those of other diseases. The spirochaete has a long latent period during which individuals have no signs or symptoms but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase in the prevalence of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement are needed to ensure that syphilis is given a high priority on the global health agenda. More investment is needed in research on the interaction between HIV and syphilis in MSM as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.
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Affiliation(s)
- Rosanna W Peeling
- London School of Hygiene &Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - David Mabey
- London School of Hygiene &Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mary L Kamb
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China
| | - Justin D Radolf
- Department of Medicine, UConn Health, Farmington, Connecticut, USA
| | - Adele S Benzaken
- Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
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Zhu J, Jiang Y, Shi Y, Zheng B, Xu Z, Jia W. Clinical manifestations and treatment outcomes of syphilitic uveitis in HIV-negative patients in China: A retrospective case study. Medicine (Baltimore) 2017; 96:e8376. [PMID: 29069031 PMCID: PMC5671864 DOI: 10.1097/md.0000000000008376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Syphilitic chorioretinitis should be included in differential diagnosis of any form of ocular inflammation. A significantly higher proportion of human immunodeficiency virus (HIV)-positive patients with ocular syphilis as compared to HIV-negative cases have been reported in published studies. However, the clinical signs and symptoms are more insidious in HIV-negative patients who are easily misdiagnosed. We report a series of cases of ocular syphilis and describe the clinical manifestations and treatment outcomes of syphilitic chorioretinitis in HIV-negative patients in China.This was a retrospective case series study. The clinical records of patients with syphilis chorioretinitis were reviewed. Demographic information and findings of fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (SD-OCT) were analyzed. All patients received the standard treatment. Ophthalmology examination and laboratory evaluation were repeated every 3 months. All changes were recorded. The treatment was considered successful if the patients had no inflammation in both eyes and rapid plasma reagin titer was negative after therapy.The study examined 41 eyes of 28 HIV-negative patients. The main complaints were blurry vision, floaters, and visual field defect. Twenty-seven eyes presented with panuveitis, and all had posterior involvement, including uveitis, vasculitis, chorioretinitis, and optic neuritis. The most common manifestations were uveitis and retinal vasculitis. Disc hyperfluorescence and persistent dark spots were the most common findings on FFA and ICGA. The ill-defined inner segment/outer segment junction was the most frequent manifestation on SD-OCT. Patients were diagnosed with syphilitic uveitis based on positive serological tests. Best-corrected visual acuity (BCVA) was improved in 34 eyes after treatment. Eleven patients were misdiagnosed before serological tests were performed. The delay in treatment led to long-standing cystoid macular edema and optic neuropathy, which were associated with poor BCVA (P = .037).The common manifestations of syphilitic chorioretinitis were uveitis, retinal vasculitis, and optic neuritis. Further diagnosis should be prompted by FFA, ICGA, and SD-OCT when ocular manifestation is suspected. The standard treatment for neurosyphilis was effective. If patients are presumed to be in low-risk groups such as HIV-negative, delays in diagnosis, and therapy may be likely. It is necessary to reiterate the importance of including syphilis uveitis as a differential diagnosis for any form of ocular inflammations, especially posterior uveitis and optic neuropathy.
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Affiliation(s)
- Jiang Zhu
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Yuan Jiang
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Yewen Shi
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Bo Zheng
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Zhiguo Xu
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Wei Jia
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
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Chen G, Cao Y, Yao Y, Li M, Tang W, Li J, Babu GR, Jia Y, Huan X, Xu G, Yang H, Fu G, Li L. Syphilis incidence among men who have sex with men in China: results from a meta-analysis. Int J STD AIDS 2017; 28:170-178. [PMID: 26992411 PMCID: PMC5026914 DOI: 10.1177/0956462416638224] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/03/2016] [Indexed: 11/17/2022]
Abstract
The recent upsurge of syphilis infections among men who have sex with men (MSM) is one of the major challenges facing China. However, the overall burden is still not clear. This study aims to summarize the incidence of syphilis among MSM in China by using meta-analysis. We comprehensively searched PubMed-MEDLINE, China National Knowledge Infrastructure and Chinese Wanfang databases. Articles published between December 2009 and March 2015 that met the inclusion criteria were considerably involved in this meta-analysis. Two reviewers performed a quality assessment of the studies and extracted data for estimating the overall syphilis incidence. STATA 12.0 was used to summarize the overall incidence of syphilis. In all, 14 studies from 13 papers were included in this study. Follow-up duration of these studies ranged from six to 36 months, while drop-out rates ranged from 11.9% to 83.6%. The individual incidence rates of the included studies varied from 3.1/100 person-years (95% CI, 0.8-5.3/100 person-years) to 38.5/100 person-years (95% CI, 28.9-48.1/100 person-years), with a pooled incidence of 9.6/100 person-years (95% CI, 7.0-12.2/100 person-years). The subgroup meta-analysis revealed that incidence estimates were 38.5/100 person-years (95% CI, 28.9-48.1/100 person-years), 12.1/100 person-years (95% CI, 7.0-17.2/100 person-years), 11.2/100 person-years (95% CI, 0.7-23.1/100 person-years), 8.9/100 person-years (95% CI, 6.5-11.2/100 person-years), 5.7/100 person-years (95% CI, 3.4-8.0/100 person-years) and 3.1/100 person-years (95% CI, 0.8-5.3/100 person-years) in Northeast, North, Southwest, East, South and Northwest China, respectively. Syphilis incidence among Chinese MSM is high, and this may increase the spread of other sexually transmitted infections, including human immunodeficiency virus. It is essential to integrate syphilis control programs with HIV control programs. This can be achieved by establishing public health response systems to monitor and control the epidemic of syphilis and HIV together in China.
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Affiliation(s)
- Guohong Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ya Cao
- Department of Biological Science and Technology and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Yuan Yao
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Ming Li
- Department of Biological Science and Technology and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
| | - Jianjun Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Giridhara R Babu
- Public Health Foundation of India, IIPH-H, Bangalore Campus, Bangalore, India
| | - Yue Jia
- School of Life Science, Xiamen University, Xiamen, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Genxing Xu
- Department of Biological Science and Technology and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Haitao Yang
- Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Lei Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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18
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Dai T, Wu X, Zhou S, Wang Q, Li D. Clinical manifestations and cerebrospinal fluid status in ocular syphilis in HIV-Negative patients. BMC Infect Dis 2016; 16:245. [PMID: 27266701 PMCID: PMC4895961 DOI: 10.1186/s12879-016-1586-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/19/2016] [Indexed: 01/09/2023] Open
Abstract
Background Syphilis with ocular involvement has reemerged as a critical health problem. The aim of the present study was to explore the clinical manifestations and cerebrospinal fluid (CSF) status in ocular syphilis in human immunodeficiency virus (HIV)-negative patients. Methods The clinical records of patients with ocular syphilis presenting to the Shanghai Xuhui Central Hospital in the period from January 2011 to December 2012 were retrospectively reviewed. Results The median age of 25 HIV-negative patients with ocular syphilis was 53 years, 18 patients (72.0 %) were males and 7 (28.0 %) were females. None of them self-identified themselves as men who had sex with men (MSM). The ocular lesions included: uveitis (13 cases), optic neuropathy (6 cases), retinal vasculitis (5 cases), retinal detachment (3 cases), and neuroretinitis (4 cases). Serum toluidine red unheated serum test (TRUST) titer ranged from 1 to 512, with a median of 64. Overall, 18 (72.0 %) of the 25 patients had abnormal CSF results, 15 (60.0 %) CSF samples had elevated white blood cell counts, 13 (52.0 %) had elevated protein levels, and 9 (36.0 %) had reactive CSF Venereal Disease Research Laboratory (VDRL) test, respectively. Mann–Whitney U tests showed higher serum TRUST titer (>32) correlated with the abnormal CSF results. Conclusions The demographic characteristics of patients with ocular syphilis in this study were different from previous reports. The study showed a high CSF abnormal rate in HIV-negative patients. The recommendation for CSF examination from all patients with ocular syphilis, including HIV-negative cases, is strongly supported by the present data.
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Affiliation(s)
- Ting Dai
- Department of Dermatology, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China.
| | - Xinjun Wu
- Department of Neurology, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China
| | - Shaona Zhou
- Department of Dermatology, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China
| | - Qianqiu Wang
- Department of Clinical Management, National Center for STD Control, Nanjing, Jiangsu, People's Republic of China
| | - Daning Li
- Department of Dermatology, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China.
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Yu YJ, Li X, Tam CC, Zhou Y, Chen Y, Shen Z. Demographic and behavioral correlates of HIV/STI among Vietnamese female sex workers in southwest China. AIDS Care 2016; 28:1455-60. [PMID: 27240573 DOI: 10.1080/09540121.2016.1189500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs - a rapidly increasing, vulnerable population in southwest China. The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14-66) recruited over five years (2010-2014) from 35 National Sentinel Surveillance sites in Guangxi. Analyses included Fisher's exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.
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Affiliation(s)
- Yeon Jung Yu
- a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA
| | - Xiaoming Li
- a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA
| | - Cheuk Chi Tam
- b Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Yuejiao Zhou
- c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China
| | - Yi Chen
- c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China
| | - Zhiyong Shen
- c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China
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Liu H, Dumenci L, Morisky DE, Xu Y, Li X, Jiang B. Syphilis among middle-aged female sex workers in China: a three-site cross-sectional study. BMJ Open 2016; 6:e010420. [PMID: 27165644 PMCID: PMC4874114 DOI: 10.1136/bmjopen-2015-010420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES This study addresses the lack of empirical studies about the epidemic of syphilis among middle-aged female sex workers (FSWs). The objectives of this study were to investigate prevalence of syphilis, and its potential risk factors among middle-aged FSWs in China. DESIGN A cross-sectional study with respondent-driven sampling (RDS). SETTING A multisite study conducted at three Chinese cites (Nanning, Hefei, and Qingdao) with different levels of sexually transmitted diseases in 2014. PARTICIPANTS 1245 middle-aged female sex workers who were over 35 years old (about 400 per study site). MAIN OUTCOME MEASURES Unprotected commercial sex, and syphilis and HIV infection were biologically tested and measured. RESULTS The RDS-adjusted prevalence of active syphilis was 17.3% in Hefei, 9.9% in Qingdao, and 5.4% in Nanning. The RDS-adjusted prevalence of prevalent syphilis was between 6.8% and 33.6% in the three cities. The proportion of unprotected sex in the past 48 h verified by the prostate-specific antigen test (PSA) was between 27.8% and 42.4%. Multiple log-binomial regression analyses indicate that middle-aged FSWs who had 5 or more clients in the past week prior to interviews and engaged in unprotected sex were more likely to be active syphilitic cases. Middle-aged FSWs who had rural residency were less likely to be active syphilitic cases. CONCLUSIONS In contrast with previous studies that reported low prevalence of syphilis and high prevalence of protected sex among FSWs in China, both the prevalence of syphilis and unprotected sex were high among middle-aged FSWs. Evidence-based intervention programmes should be developed and evaluated among this vulnerable population in China and other countries with similar settings.
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Affiliation(s)
- Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Levent Dumenci
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Yongfang Xu
- Department of AIDS/STD Prevention, Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Xiaojing Li
- Department of AIDS/STD Prevention, Hefei Center for Disease Control and Prevention, Hefei, Anhui, China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandon, China
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Liu H. Egocentric Network and Condom Use Among Mid-Age Female Sex Workers in China: A Multilevel Modeling Analysis. AIDS Patient Care STDS 2016; 30:155-65. [PMID: 27028182 DOI: 10.1089/apc.2015.0349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The epidemics of sexually transmitted infections (STIs) have spread among older adults in the world, including China. This study addresses the deficiency of studies about the multiple contextual influences on condom use among mid-age female sex workers (FSWs) over 35 years old. A combination of an egocentric network design and multilevel modeling was used to investigate factors of condom use over mid-age FSWs (egos) particular relationships with sexual partners (alters). Of the 1245 mid-age FSWs interviewed, 73% (907) reported having at least one sexual partner who would provide social support to egos. This generated a total of 1300 ego-alter sex ties in egos' support networks. Condoms were consistently used among one-third of sex ties. At the ego level, condoms were more likely to be used consistently if egos received a middle school education or above, had stronger perceived behavioral control for condom use, or consistently used condoms with other sex clients who were not in their support networks. At the alter level, condoms were not consistently used over spousal ties compared to other ties. Condoms were less likely to be used among alters whom ego trusted and provided emotional support. Cross-level factors (egos' attitudes toward condom use and emotional support from alters) documented a significant positive interaction on consistent condom use. Given the low frequency of condom use, future interventions should focus on mid-age FSWs and their partners within and beyond their support networks.
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Affiliation(s)
- Hongjie Liu
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland
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Liao M, Su S, Yan K, Zhu X, Huang P, Li J, Jiang Z, Zhang X, Zhang N, Tao X, Kang D, Zhao J. Dual Epidemics of Drug Use and Syphilis Among Chinese Female Sex Workers: Results of Eight Consecutive Cross-Sectional Surveys from 2006 to 2013 in Qingdao, China. AIDS Behav 2016; 20:655-66. [PMID: 26696263 DOI: 10.1007/s10461-015-1229-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Eight consecutive annual cross-sectional surveys were conducted to examine the trend of the prevalence of HIV, syphilis, drug use and their correlates among female sex workers (FSWs) in Qingdao, China. Among sampled FSWs over the 8 years, a higher proportion of older, married or cohabited, higher education levels and more on-call FSWs were observed in recent years. The syphilis prevalence increased significantly from 1.0 % in 2006 to 13.5 % in 2013, with illicit drug use rate ranging from 21.8 % in 2007 to 55.5 % in 2010. Multivariate logistic regression analyses showed that drug use, syphilis and unprotected vaginal sex predicted each other. The dual epidemics of illicit drug use and syphilis among FSWs underscore the urgency to implement a tailored intervention to curb the dual epidemics while also preventing an HIV epidemic in the context of diversified commercial sex dynamic.
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23
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Liu Z, Zhang C, Kakudo K, Cui X, Mu K, Zhou C, Wang Y, Chen S, Zhou G. Diagnostic pitfalls in pathological diagnosis of infectious disease: patients with syphilitic lymphadenitis often present with inconspicuous history of infection. Pathol Int 2016; 66:142-147. [PMID: 28544669 DOI: 10.1111/pin.12384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
Abstract
Retrospective study was applied to 16 cases of syphilitic lymphadenitis to elucidate the pathological diagnostic features. The typical morphology of syphilitic lymphadenitis includes: (i) well preserved or partially destroyed lymph node structure; (ii) reactive hyperplasia of lymph follicles with broadened germinal centers in the cortex and medulla of the lymph node; (iii) thickened fibrotic lymph node capsules with infiltration of plasma cells; and (iv) phlebitis and endarteritis in varying degree. Additional morphology includes: (i) focal histiocytes with ingested debris; (ii) noncaseating granuloma with epithelioid histiocytes and disperse giant cells; and (iii) hyperplastic centroblast and occasionally isolated mononuclear Reed-Sternberg cell-like giant cells. Treponema pallidum was identified in 15 of the 16 cases by immunohistochemical staining. The histopathological diagnosis of syphilitic lymphadenitis poses difficulty in differentiation from other infectious or neoplastic lymphadenopathies. The newly established Treponema pallidum antibody is sensitive to identification of Treponema pallidum in formalin fixed paraffin embedded tissue.
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Affiliation(s)
- Zhiyan Liu
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Chunyan Zhang
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Nara, Japan
| | - Xiujie Cui
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Kun Mu
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Chengjun Zhou
- Department of Pathology, The second Hospital of Shandong University, Jinan, Shandong, China
| | - Yan Wang
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China.,Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Shiming Chen
- Department of Pathology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Gengyin Zhou
- Department of Pathology, Shandong University School of Medicine, Jinan, Shandong, China
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Verdery AM, Merli MG, Moody J, Smith J, Fisher JC. Brief Report: Respondent-driven Sampling Estimators Under Real and Theoretical Recruitment Conditions of Female Sex Workers in China. Epidemiology 2015; 26:661-5. [PMID: 26214337 PMCID: PMC4617539 DOI: 10.1097/ede.0000000000000335] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We compare the performance of multiple respondent-driven sampling estimators under different sample recruitment conditions in hidden populations of female sex workers in the midst of China's ongoing epidemic of sexually transmitted infections. We first examine empirically calibrated simulations grounded in survey data to evaluate the relative performance of each estimator under ideal sampling conditions consistent with respondent-driven sampling assumptions and under conditions that mimic observed respondent-driven sampling recruitment processes. One estimator, which incorporates respondents' reports on their network of contacts, substantially out-performs the others under all conditions. We then apply the estimators to empirical samples of female sex workers collected in two Chinese cities that include unique data on respondents' networks. These empirical results are consistent with the simulation results, suggesting that traditional respondent-driven sampling estimators overestimate the proportion of female sex workers working in low tiers of sex work and are likely to overstate the sexually transmitted infection risk profiles of these populations.
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Affiliation(s)
- Ashton M. Verdery
- Department of Sociology and Criminology, Population Research Institute, The Pennsylvania State University, University Park, Pennsylvania
| | - M. Giovanna Merli
- Duke Population Research Institute, Sanford School of Public Policy, Department of Sociology, and Duke Global Health Institute, Duke University, Durham, NC
| | - James Moody
- Duke Population Research Institute, Department of Sociology, Duke University, Durham, NC
- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jeffrey Smith
- Department of Sociology, University of Nebraska, Lincoln, NE
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25
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Chow EP, Tung K, Tucker JD, Muessig KE, Su S, Zhang X, Jing J, Zhang L. Behavioral Interventions Improve Condom Use and HIV Testing Uptake Among Female Sex Workers in China: A Systematic Review and Meta-Analysis. AIDS Patient Care STDS 2015. [PMID: 26217931 DOI: 10.1089/apc.2015.0043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Condomless commercial sex work is a common mode of HIV transmission in China. This study systematically reviews the impacts of behavioral interventions on condom use and HIV testing uptake among female sex workers (FSW) in China. Chinese and English language peer-reviewed articles published between January 2000 and December 2013 were searched in five electronic databases. Odds ratios (OR) were calculated by comparing the levels of improvements in condom use and HIV testing uptake by various intervention strategies. Study quality was assessed for included studies. This review followed the PRISMA guidelines and was registered in PROSPERO. One hundred and twenty-eight studies met inclusion criteria. Meta-analyses indicated that FSW in the post-intervention period were 2.3-5.0 times more likely to use condoms with male clients in their last sexual act and 2.3-3.4 times more likely to use condoms consistently in the last month than in the pre-intervention period. In particular, multiple session intervention were more effective in improving condom use among FSW with male clients (OR=5.6, [4.0-7.8]) than a single session intervention (OR=3.3, [2.8-3.8]). Behavioral interventions also improved past-12-month HIV testing uptake 4.6-fold (95% CI, 2.9-7.4). Comprehensive intervention programs were more effective (OR=8.1, [4.0-16.7]) in improving HIV testing uptake compared with health education only programs (OR=2.7, [1.6-4.5]). Longer intervention duration (>12 months) did not increase effectiveness in improving condom use or HIV testing rate among Chinese FSWs. Behavioral interventions are effective in improving condom use and HIV testing uptake among Chinese FSW. This review highlights both the potentials and limitations of condom promotion interventions targeting female sex workers.
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Affiliation(s)
- Eric P.F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Keith Tung
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Joseph D. Tucker
- The University of North Carolina Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathryn E. Muessig
- The University of North Carolina Project-China, Guangzhou, China
- Department of Health Behavior, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, North Carolina
| | - Shu Su
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Xiaohu Zhang
- China Food and Drug Administration Institute of Executive Development, Beijing, China
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Zhang
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
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26
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Merli MG, Moody J, Mendelsohn J, Gauthier R. Sexual Mixing in Shanghai: Are Heterosexual Contact Patterns Compatible With an HIV/AIDS Epidemic? Demography 2015; 52:919-42. [PMID: 25904346 PMCID: PMC4466078 DOI: 10.1007/s13524-015-0383-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
China's HIV prevalence is low, mainly concentrated among female sex workers (FSWs), their clients, men who have sex with men, and the stable partners of members of these high-risk groups. We evaluate the contribution to the spread of HIV of China's regime of heterosexual relations, of the structure of heterosexual networks, and of the attributes of key population groups with simulations driven by data from a cross-sectional survey of egocentric sexual networks of the general population of Shanghai and from a concurrent respondent-driven sample of FSWs. We find that the heterosexual network generated by our empirically calibrated simulations has low levels of partner change, strong constraints on partner selection by age and education, and a very small connected core, mainly comprising FSWs and their clients and characterized by a fragile transmission structure. This network has a small HIV epidemic potential but is compatible with the transmission of bacterial sexually transmitted infections (STIs), such as syphilis, which are less susceptible to structural breaks in transmission of infection. Our results suggest that policies that force commercial sex underground could have an adverse effect on the spread of HIV and other STIs.
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Affiliation(s)
- M Giovanna Merli
- Duke Population Research Institute, Sanford School of Public Policy, Department of Sociology and Duke Global Health Institute, Duke University, Box 90312, Durham, NC, 27708, USA,
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Chen Y, Shen Z, Morano JP, Khoshnood K, Wu Z, Lan G, Zhu Q, Zhou Y, Tang S, Liu W, Chen J, Tang Z. Bridging the epidemic: a comprehensive analysis of prevalence and correlates of HIV, hepatitis C, and syphilis, and infection among female sex workers in Guangxi Province, China. PLoS One 2015; 10:e0115311. [PMID: 25723548 PMCID: PMC4344209 DOI: 10.1371/journal.pone.0115311] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/21/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) are at highest risk for contracting HIV and facilitating the current heterosexual HIV epidemic in Guangxi, China, yet little is known of the impact of recent harm reduction campaigns in the province. We analyzed sentinel surveillance data collected between 2010 and 2012 in Guangxi to explore correlations between the prevalence of HIV, hepatitis C (HCV), and syphilis and risk behaviors of different categories of FSWs in Guangxi. METHODS The sentinel surveillance data for 5,1790 FSWs in all 14 prefectures and 64 city/county regions of Guangxi, China from 2010 to 2012 were collected. Differences between three categories of FSWs (grouped by venue) and disease trends (HIV, HCV, and syphilis) by year were analyzed using bivariate and multivariate logistic regression analyses as to evaluate risk factors correlated with HIV, HCV, or syphilis infection. RESULTS HIV and HCV prevalence remained constant across the three FSW categories; however, syphilis prevalence showed a significant increase from 5.7% to 7.3% for low-tier FSWs. Most cases with HIV, HCV, syphilis and intravenous drug use were seen in low-tier FSWs. Testing positive for HIV and syphilis were most correlated with being HCV positive (AOR 4.12 and AOR 4.36), only completing elementary school (AOR 3.71 and AOR 2.35), low tier venues (AOR 2.02 and AOR 2.00), and prior STI (AOR 1.40 and AOR 3.56), respectively. HCV infection was correlated with ever injecting drugs (AOR 60.65) and testing positive for syphilis (AOR 4.16) or HIV (AOR 3.74). CONCLUSIONS This study highlights that low tier FSWs with lower formal education levels are the most vulnerable population at risk for acquiring and transmitting HIV, HCV, and syphilis in Guangxi, China. Condom distribution with evolution to safer sex practices are the reasons to explain the non-increasing prevalence of HIV, HCV in Guangxi for 2010-2012.
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Affiliation(s)
- Yi Chen
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Zhiyong Shen
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Jamie P. Morano
- University of South Florida, Morsani College of Medicine, Division of Infectious Disease and International Medicine, and College of Public Health, Tampa, Florida, United States of America
| | - Kaveh Khoshnood
- Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, China Centers for Disease Control and Prevention, Beijing, China
| | - Guanghua Lan
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Qiuying Zhu
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Shuai Tang
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Wei Liu
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Jie Chen
- Health and Family Planning Commission of Guangxi, Zhuang Autonomous Region, Nanning, China
| | - Zhenzhu Tang
- Guangxi Centers for Disease Control and Prevention, Nanning, China
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28
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QIN J, YANG T, WANG H, FENG T, LIU X. Potential Predictors for Serofast State after Treatment among HIV-Negative Persons with Syphilis in China: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:155-69. [PMID: 25905049 PMCID: PMC4401873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/11/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several studies have been conducted in China in order to investigate the potential predictors of serofast state after treatment among syphilitic patients. However, there is a remarkable diversity among the results. This meta-analysis was conducted to assess potential predictors of serofast among syphilitic patients in China. METHODS International and national electronic databases were searched up to September 2013. Reference lists of retrieved articles were also reviewed. Cohort or case-control studies addressing risk factors of serofast among syphilitic patients were included in this study. RESULTS We assessed 27 separate studies involving overall 6682 HIV-negative participants with syphilis of which 1962 remained in the serofast state. The serofast was positively associated with older age(P trend=0.001), female(summary risk ratio[sRR]=1.50, 95%CI:1.34-;1.68), latent syphilis(sRRlatent vs primary=3.17, 95%CI: 2.66-;3.77; sRRlatent vs secondary=2.00, 95%CI: 1.48-;2.69) as well as non-penicillin treatment(sRR =2.99, 95%CI:2.45-;3.67), but negatively associated with higher baseline titers(sRR>1:32 vs ≤1:32=0.63, 95%CI: 0.54-;0.75). Compared with healthy group and serological cure group, respectively, the levels of CD4 (+), IL-2, and IL-6 among serofast patients were decreased (standardized mean difference[SMD]<0, P<0.05), but the levels of CD8(+) and IL-10 were increased(SMD>0, P<0.05). Some studies also hinted the serofast was associated with subtypes i of treponema pallidum(TP) repeat gene (RR i vs d=4.67,95%CI: 1.31-;16.69) and TP occult infection. CONCLUSION The age, gender, stage of infection, baseline titers, treatment drug, cellular immune suppression and disorders, TP occult infection and subtypes i of TP repeat gene should be considered as important predictors of serofast. However, until now the definition and mechanism of serofast has still been not clear.
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Affiliation(s)
- Jiabi QIN
- Division of Medical Genetics, Maternal and Child Health Hospital of Hunan Province, Hunan, China
- Skate Key Laboratory of Medical Genetics, Central South University, Hunan, China
| | - Tubao YANG
- Dept. of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China
| | - Hua WANG
- Division of Medical Genetics, Maternal and Child Health Hospital of Hunan Province, Hunan, China
| | - Tiejian FENG
- Dept. of Dermatology and Venereal Disease, Shenzhen Center for Chronic Disease Control and Prevention, Shenzhen, China
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Huang ZJ, Hu D, Chang R, Zaccaro H, Iguchi M, Zheng H, He N. Female streetwalkers' perspectives on migration and HIV/STI risks in a changing economic and social environment: a qualitative study in Shanghai, China. CULTURE, HEALTH & SEXUALITY 2015; 17:763-776. [PMID: 25587711 PMCID: PMC4382416 DOI: 10.1080/13691058.2014.990518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
China's 30-year economic boom has created a unique social and economic market for commercial sex, as well as for a workforce of migrant women from rural China. This qualitative study explores the impact of the rapidly changing social and economic environment on migration patterns, knowledge of sexually transmitted infections (STIs), STI risk behaviours and health beliefs among female streetwalkers in Shanghai. Qualitative data were collected in 2010 through semi-structured in-depth interviews with 16 streetwalkers to characterise their migration passages, sexual health and behaviours, and peer networks. Many streetwalkers reported histories of childhood impoverishment, of family or partner violence or trauma, of migration consistent with the timeline and routes of economic development and of a scarcity in health, social or economic support. Their knowledge of the prevention and treatment of HIV and STIs was limited. They had little bargaining power on condom use and the majority resorted to vaginal douching and self-management with antibiotics as preventative measures. The study identifies streetwalkers' perspectives on the changing environment, their options and actions and, finally, HIV/STI risks that were unique to this hidden population.
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Affiliation(s)
- Z. Jennifer Huang
- Department of International Health, Georgetown University, Washington, DC, USA
| | - Dier Hu
- Department of International Health, Georgetown University, Washington, DC, USA
| | - Ruth Chang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Heather Zaccaro
- Department of International Health, Georgetown University, Washington, DC, USA
| | - Martin Iguchi
- Department of Psychology, Georgetown University, Georgetown University, Washington, DC, USA
| | | | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
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30
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Tao XH, Jiang T, Shao D, Xue W, Ye FS, Wang M, He MH. High prevalence of syphilis among street-based female sex workers in Nanchang, China. Indian Dermatol Online J 2014; 5:449-55. [PMID: 25396127 PMCID: PMC4228639 DOI: 10.4103/2229-5178.142491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Female sex workers (FSWs) play a critical role in the heterosexual transmission of human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) in China. Several studies reported that street-based FSWs have higher risk behaviors than establishment-based FSWs. Therefore, street-based FSWs should be specifically targeted for HIV and STIs intervention programs. Objectives: This study aims to investigate the prevalence rates and risk factors of HIV and syphilis among FSWs in Nanchang, China. Materials and Methods: Using convenience sampling methods, 361 street-based FSWs were recruited from August 2011 to February 2012. All participants completed an anonymous questionnaire on socioeconomic and sex behavioral information and were tested for HIV and syphilis. Risk for HIV and syphilis infection was assessed using univariate and multivariate logistic regression analyses. Results: No HIV infections were found. The prevalence rate of syphilis was 43.5%. Nearly 46.1% of street-based FSWs reported having education for no more than 6 years. Having reproductive tract infections at current visit, duration of sex work more than 5 years, indulgence in unprotected sex trade in the last time, unprotected sex trade in the last month, and unprotected sex with boyfriend or spouse in the last month were reported by 35.2%, 43.5%, 33.8%, 60.4%, and 93.1% street-based FSWs, respectively. In multivariate logistic regression analysis, having reproductive tract infections at current visit [odds ratio (OR), 12.10; 95% confidence interval (CI), 6.01-24.37], duration of sex work more than five years (OR, 4.26; 95% CI, 2.40-7.54), and unprotected sex trade in the last month (OR, 1.85; 95% CI, 1.06-3.22) were independently associated with syphilis infection. Conclusion: The prevalence rate of syphilis among street-based FSWs is very high. Most street-based FSWs in our survey had low education, long experience of commercial sex, and high rate of inconsistent condom use. Comprehensive interventions targeting this high-risk group, especially scaling up screening and ensuring consistent use of condoms during sex are needed.
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Affiliation(s)
- Xiao Hua Tao
- Department of Dermatology and STD, Dermatology Hospital of Jiangxi Province, The Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Tao Jiang
- Department of Gynaecology, The First People's Hospital of Jiujiang, Jiujiang, 332000, Jiangxi Province, China
| | - Dan Shao
- Department of Dermatology and STD, Dermatology Hospital of Jiangxi Province, The Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Wei Xue
- Department of Dermatology and STD, Dermatology Hospital of Jiangxi Province, The Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Fa Shun Ye
- Department of Dermatology and STD, Dermatology Hospital of Jiangxi Province, The Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Ming Wang
- Department of Dermatology and STD, Dermatology Hospital of Jiangxi Province, The Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Mei Hua He
- Department of Dermatology and STD, Dermatology Hospital of Jiangxi Province, The Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
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31
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Oliveira Lopes RH, Carrijo IJ, Correa ME, Moreira Puga MA, Motta Castro ARC, Leone Oliveira SMDV, Rosa Croda JH, Rezende GR, Bandeira LM, Lemos EF, Simionatto S. Prevalence of syphilis diagnosed in female inmates of city Ponta Porã. BMC Proc 2014. [PMCID: PMC4204088 DOI: 10.1186/1753-6561-8-s4-p81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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32
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Li J, Jiang N, Yue X, Gong X. Vaginal douching and sexually transmitted infections among female sex workers: a cross-sectional study in three provinces in China. Int J STD AIDS 2014; 26:420-7. [PMID: 25015933 DOI: 10.1177/0956462414543937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/23/2014] [Indexed: 11/15/2022]
Abstract
Though vaginal douching is a common practice among female sex workers that could increase the risk of HIV and adverse reproductive health outcomes, it has drawn limited attention. From November 2010 to January 2011, a convenience sample of female sex workers was recruited in three cities in China. Face-to-face interviews were conducted to gather socio-demographic and behavioural information. Blood samples were collected for syphilis serological tests. Endo-cervical swabs were collected and tested for Neisseria gonorrhoeae and Chlamydia trachomatis by polymerase chain reaction. A logistic regression model was used to determine factors associated with vaginal douching and the association between vaginal douching and sexually transmitted infection. A total of 1032 eligible female sex workers were enrolled. The overall prevalence of any sexually transmitted infection (syphilis, Chlamydia trachomatis or Neisseria gonorrhoeae) and vaginal douching with disinfectant were 23.4% and 23.1%, respectively. Factors independently associated with douching practice included study sites, venue types, ethnicity, having regular partner and sexually transmitted infection history. No significant association was found between vaginal douching and current sexually transmitted infection. Vaginal douching with disinfectant after sex with clients seemed to be a prevalent practice among female sex workers in China. Prevention programmes targeting female sex workers should incorporate components about the adverse health outcomes associated with vaginal douching.
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Affiliation(s)
- Jing Li
- National Center for STD Control, Chinese Academy of Medical Sciences and Peiking Union Medical College, Institute of Dermatology, Nanjing, China
| | - Ning Jiang
- National Center for STD Control, Chinese Academy of Medical Sciences and Peiking Union Medical College, Institute of Dermatology, Nanjing, China
| | - Xiaoli Yue
- National Center for STD Control, Chinese Academy of Medical Sciences and Peiking Union Medical College, Institute of Dermatology, Nanjing, China
| | - Xiangdong Gong
- National Center for STD Control, Chinese Academy of Medical Sciences and Peiking Union Medical College, Institute of Dermatology, Nanjing, China
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33
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Merli MG, Moody J, Smith J, Li J, Weir S, Chen X. Challenges to recruiting population representative samples of female sex workers in China using Respondent Driven Sampling. Soc Sci Med 2014; 125:79-93. [PMID: 24834869 DOI: 10.1016/j.socscimed.2014.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 03/03/2014] [Accepted: 04/16/2014] [Indexed: 11/18/2022]
Abstract
We explore the network coverage of a sample of female sex workers (FSWs) in China recruited through Respondent Drive Sampling (RDS) as part of an effort to evaluate the claim of RDS of population representation with empirical data. We take advantage of unique information on the social networks of FSWs obtained from two overlapping studies--RDS and a venue-based sampling approach (PLACE)--and use an exponential random graph modeling (ERGM) framework from local networks to construct a likely network from which our observed RDS sample is drawn. We then run recruitment chains over this simulated network to assess the assumption that the RDS chain referral process samples participants in proportion to their degree and the extent to which RDS satisfactorily covers certain parts of the network. We find evidence that, contrary to assumptions, RDS oversamples low degree nodes and geographically central areas of the network. Unlike previous evaluations of RDS which have explored the performance of RDS sampling chains on a non-hidden population, or the performance of simulated chains over previously mapped realistic social networks, our study provides a robust, empirically grounded evaluation of the performance of RDS chains on a real-world hidden population.
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Affiliation(s)
- M Giovanna Merli
- Sanford School of Public Policy & Duke Global Health Institute, Duke Population Research Institute, Duke University, Box 90312, Durham, NC 27708, USA; Department of Sociology, Duke University, Durham, NC 27708, USA.
| | - James Moody
- Department of Sociology, Duke University, Durham, NC 27708, USA
| | - Jeffrey Smith
- Department of Sociology, University of Nebraska, Lincoln, NE 68508, USA
| | - Jing Li
- National Center for STD Control, 12 Jiangwangmiao Street, Nanjing 210042, China
| | - Sharon Weir
- The Carolina Population Center and the Department of Epidemiology, Gillings School of Global Public Health, Campus Box 8120, University of North Carolina at Chapel Hill, Chapel Hill, NC 27546, USA
| | - Xiangsheng Chen
- National Center for STD Control, 12 Jiangwangmiao Street, Nanjing 210042, China
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Zhou C, Rou K, Dong WM, Wang Y, Dong W, Zhou Y, Chen X, Jia M, Liu W, Zheng J, Ma Y, Li Y, Wu Z. High prevalence of HIV and syphilis and associated factors among low-fee female sex workers in mainland China: a cross-sectional study. BMC Infect Dis 2014; 14:225. [PMID: 24767104 PMCID: PMC4026051 DOI: 10.1186/1471-2334-14-225] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/19/2014] [Indexed: 11/24/2022] Open
Abstract
Background The prevalence of HIV and syphilis among middle and high-fee female sex workers (FSWs) has been widely reported but little is known among low-fee FSWs. This study aims to determine the prevalence and associated factors of HIV and syphilis among low-fee FSWs in China. Methods A cross-sectional study design was used. A convenience sample of low-fee FSWs was recruited from venues by outreach workers in 12 cities. Structured questionnaire interviews and blood sampling for HIV and syphilis were carried out. Univariate and multivariate logistic regression were used for assessing potential associated factors. Results This study enrolled 781 low-fee FSWs. There were 37 (4.7%) HIV positive participants and 117 (15.0%) participants were infected with syphilis. Final multivariate analysis identified five factors associated with HIV infection: older age (OR:2.6, 95% CI:1.1-6.1), local household registration (OR:3.3, 95% CI:1.5-6.9), employed in Yunnan province (OR:2.7, 95% CI:1.1-6.7), soliciting in self-rented rooms and “market day” buildings (OR:3.9, 95% CI:1.5-10.0), injection drug use in the past 6 months (OR:13.5, 95% CI:4.5-40.1); and four factors associated with syphilis infection: older age (OR:1.8, 95% CI:1.2-2.9), employed in Yunnan province (OR:2.1, 95% CI:1.2-3.6), soliciting in self-rented rooms and “market day” buildings (OR:2.3, 95% CI:1.4-3.7) , and no consistent condom use with clients in the past 30 days (OR:1.6, 95% CI:1.0-2.6). Conclusions A high prevalence of HIV and syphilis were found among low-fee FSWs. Those soliciting in self-rented rooms and “market day” buildings with the lowest income, and injection drug users (IDUs) in this population should take priority in further intervention strategies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing, Changping District 102206, China.
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Muessig KE, Smith MK, Maman S, Huang Y, Chen XS. Advancing the prevention agenda for HIV and other sexually transmitted infections in south China: social science research to inform effective public health interventions. AIDS Behav 2014; 18 Suppl 2:S222-31. [PMID: 24443101 PMCID: PMC3982310 DOI: 10.1007/s10461-014-0695-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite widespread biomedical advances in treatment and prevention, HIV and other sexually transmitted infections (STI) continue to affect a large portion of the world's population. The profoundly social nature of behaviorally driven epidemics and disparities across socioeconomic divides in the distribution of HIV/STI and care outcomes emphasize the need for innovative, multilevel interventions. Interdisciplinary approaches to HIV/STI control are needed to combine insights from the social and biological sciences and public health fields. In this concluding essay to a Special Issue on HIV/STI in south China, we describe the evolution of the region's HIV/STI epidemics and the government response, then synthesize findings from the 11 studies presented in this issue to extend seven recommendations for future HIV/STI prevention and care research in China. We discuss lessons learned from forging international collaborations between the social and biological sciences and public health to inform a shared research agenda to better meet the needs of those most affected by HIV and other STI.
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Affiliation(s)
- Kathryn E. Muessig
- Department of Health Behavior, 306 Rosenau Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7440 USA. Phone: 1-443-320-3152
| | - M. Kumi Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, 306 Rosenau Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7440 USA. Phone: 1-443-320-3152
| | - Yingying Huang
- Department of Sociology, Renmin University, Beijing, China
| | - Xiang-sheng Chen
- National Center for STD Control and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing, Jiangsu 210042, China (Tel: 86-25-845478901. Fax: 86-25-85424903)
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Correlates of chlamydia and gonorrhea infection among female sex workers: the untold story of Jiangsu, China. PLoS One 2014; 9:e85985. [PMID: 24454950 PMCID: PMC3893281 DOI: 10.1371/journal.pone.0085985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/03/2013] [Indexed: 12/04/2022] Open
Abstract
Objective(s) To estimate the prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in the Jiangsu Province, China and measure the association of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections with their potential correlates. Design A cross-sectional study on a representative sample of FSWs in Yangzhou and Changzhou cities of Jiangsu was conducted. Methods 185 sex-work venues in Yangzhou and 174 in Changzhou were selected by stratified random sampling. 2972 FSWs (1108 in Yangzhou and 1864 in Changzhou), aged 15 years or more, who agreed to participate and provided blood sample for HIV and syphilis testing were interviewed in these venues. Cervical specimens from 849 randomly chosen participants were then tested for CT and NG. Results Proportions of young, school-educated, currently married FSWs who were living alone, migrated from other provinces and engaged in unprotected vaginal intercourse in past 3 months (UVI) were relatively high. Prevalence of HIV, syphilis, CT and NG were 0.20%, 4.88%, 14.61% and 5.42% respectively. Younger age, living alone or with persons other than partners/family members, engaging in UVI and having other STIs seemed to be associated with higher risk of CT or NG infection. Being divorced/widowed and working in middle/low-level venues were identified as additional risk factors for NG. Conclusions Based on a representative sample, this initial effort to identify the correlates of CT/NG infections among FSWs of Jiangsu revealed that focused interventions targeting high-risk FSWs are urgently required for controlling STI epidemics in Yangzhou and Changzhou where substantial number of STI cases were identified.
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Gao J, Xu J, Sheng Y, Zhang X, Zhang C, Li Y, Liang B, Sun L, Yang S, Zhang X. Increasing trend of syphilis and infection resistance: a retrospective study. Int J Infect Dis 2013; 17:e971-6. [DOI: 10.1016/j.ijid.2013.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/10/2013] [Accepted: 05/13/2013] [Indexed: 11/30/2022] Open
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Cai R, Tan JG, Chen L, Richardus JH, de Vlas SJ. Prevalence and risk factors of syphilis infection among female sex workers in Shenzhen, China: an observational study (2009-2012). Trop Med Int Health 2013; 18:1531-8. [PMID: 24118535 DOI: 10.1111/tmi.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate prevalence and risk factors of syphilis infection among female sex workers (FSWs) in Shenzhen, China. METHODS Observational study among (2009-2012) 1653 FSWs recruited by venue-based sampling using questionnaire-based interviews for socio-demographics, behaviours and syphilis testing results. Logistic regression was used to assess risk factors of syphilis infection. RESULTS The overall syphilis prevalence was 4.7%, showing a slightly decreasing trend. Factors significantly associated with syphilis infection were inconsistent condom use (OR = 1.87, P = 0.015), illicit drug use (OR = 5.45, P < 0.001) and older age in years (OR = 1.08, P < 0.001). Venues where FSWs were recruited and duration of commercial sex work were not significantly associated with syphilis infection (P > 0.05). CONCLUSIONS Syphilis is still common among FSWs in Shenzhen, China. Current comprehensive prevention programmes (e.g. condom promotion and peer education) should be continued to maintain and increase safe sexual practices and to reduce illicit drug use among FSWs. Expanding point-of-care syphilis screening programmes may be an important strategy for early diagnosis. We recommend timely and effective treatment programmes to be linked to such screening programmes.
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Affiliation(s)
- R Cai
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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McLaughlin MM, Chow EPF, Wang C, Yang LG, Yang B, Huang JZ, Wang Y, Zhang L, Tucker JD. Sexually transmitted infections among heterosexual male clients of female sex workers in China: a systematic review and meta-analysis. PLoS One 2013; 8:e71394. [PMID: 23951153 PMCID: PMC3741140 DOI: 10.1371/journal.pone.0071394] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 06/29/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Female sex workers have been the target of numerous sexually transmitted infection (STI) prevention strategies in China, but their male clients have attracted considerably less public health attention and resources. We sought to systematically assess the prevalence of HIV, syphilis, gonorrhea, and chlamydia among heterosexual male clients of female sex workers in China. METHODS/PRINCIPAL FINDINGS Original research manuscripts were identified by searching Chinese and English language databases, and 37 studies analyzing 26,552 male clients were included in the review. Client STI prevalence across studies was heterogeneous. Pooled prevalence estimates and 95% confidence intervals were 0.68% (0.36-1.28%) for HIV, 2.91% (2.17-3.89%) for syphilis, 2.16% (1.46-3.17%) for gonorrhea, and 8.01% (4.94-12.72%) for chlamydia. CONCLUSIONS/SIGNIFICANCE The pooled prevalence estimates of HIV, syphilis, gonorrhea, and chlamydia among clients in this review exceed the prevalences previously reported among population-representative samples and low-risk groups in China. However, heterogeneity across studies and sampling limitations prevent definitive conclusions about how the prevalence of STIs in this population compares to the general population. These findings suggest a need for greater attention to clients' sexual risk and disease prevalence in China's STI research agenda in order to inform effective prevention policies.
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Affiliation(s)
| | - Eric P. F. Chow
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Cheng Wang
- Guangdong Provincial Center for STI & Skin Diseases Control, Guangzhou, China
| | - Li-Gang Yang
- Guangdong Provincial Center for STI & Skin Diseases Control, Guangzhou, China
| | - Bin Yang
- Guangdong Provincial Center for STI & Skin Diseases Control, Guangzhou, China
| | - Jennifer Z. Huang
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, United States of America
| | - Yanjie Wang
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Lei Zhang
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Joseph D. Tucker
- UNC Project – China, Guangzhou, China
- Guangdong Provincial Center for STI & Skin Diseases Control, Guangzhou, China
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Association of Sexually Transmitted Infections With High-Risk Human Papillomavirus Types. Sex Transm Dis 2013; 40:493-5. [DOI: 10.1097/olq.0b013e31828b32b8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhou Y, Li X, Zhang C, Tan G, Stanton B, Zhang X, Cui Y. Rates of HIV, syphilis, and HCV infections among different demographic groups of female sex workers in Guangxi China: evidence from 2010 national sentinel surveillance data. AIDS Care 2013; 25:1433-41. [PMID: 23438031 DOI: 10.1080/09540121.2013.772282] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To examine the prevalence of HIV, syphilis, and hepatitis C virus (HCV) infections by demographic characteristics and identify the subgroups of female sex workers (FSW) who are at a higher risk of the infections. Secondary analysis of the 2010 National Sentinel Surveillance (NSS) data was conducted in the current study. A total of 12,622 FSW recruited from 35 NSS sites in Guangxi, China were included in the analysis. FSW were tested for HIV, syphilis, and HCV. The overall prevalence of HIV, syphilis, and HCV infections were 1.0, 6.1, and 1.0%, respectively. The prevalence of HIV and syphilis infections was significantly higher among women who were 40 years of age or older, worked in small commercial sex venues or on the street, were divorced or widowed, or had no formal schooling. A very high HIV infection prevalence (8.2%) was observed among a small number of cross-border foreign FSW (n=49). The prevalence of HCV infection did not differ by most of the demographic characteristics. Living in other provinces or being a Zhuang-ethnic served as protective factors for HCV. The multivariable analyses confirmed the bivariate results suggesting higher prevalence of HIV and syphilis infections among FSW who were older, divorced or widowed, or had no formal schooling. Future HIV intervention prevention efforts among FSW need to pay particular attention to these women in order to effectively curtail the infections among this most-at-risk population as well as to prevent the further spread of HIV and syphilis to other populations.
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Chen XS, Liang GJ, Wang QQ, Yin YP, Jiang N, Zhou YJ, Yang LG, Liu Q, Wang HC, Wang B. HIV prevalence varies between female sex workers from different types of venues in southern China. Sex Transm Dis 2013; 39:868-70. [PMID: 23064536 DOI: 10.1097/olq.0b013e318264c3ba] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We conducted a cross-sectional study on prevalence of human immunodeficiency virus (HIV) and syphilis among female sex workers (FSWs) recruited from different types of venues in 6 cities in China. Among 5322 FSWs (1379 were from high-tier venues, 2482 from middle-tier venues, and 1461 from low-tier venues, respectively), overall HIV prevalence was 0.54% (95% confidence interval [CI], 0.37%- 0.76%). By typology of venues where FSWs solicited clients, the prevalence was 1.37% (95% CI, 0.89%-2.11%) in low-tier venues, 0.28% (95% CI, 0.14%- 0.58%) in middle-tier venues, and 0.07% (95% CI, 0.01%-0.41%) in high-tier venues. The final logistic regression model showed an association of having had HIV infection with working in low-tier venues (adjusted odds ratio 2.73; 95% CI, 1.12-6.67) and coming from Guangxi Province (adjusted odds ratio, 7.89; 95% CI, 1.65-37.64). It can be concluded that FSWs working in low-tier venues (on the streets or public outdoor places) had higher risk of HIV infection than other venues. Such subgroup of FSWs should be efficiently covered by the current HIV/STD surveillance and intervention programs in China.
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Affiliation(s)
- Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China.
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Chen XS, Yin YP, Liang GJ, Wang QQ, Jiang N, Liu Q, Fu GF, Yang B, Zhou YJ, Shi MQ, Wang B. The prevalences of Neisseria gonorrhoeae and Chlamydia trachomatis infections among female sex workers in China. BMC Public Health 2013; 13:121. [PMID: 23390952 PMCID: PMC3574829 DOI: 10.1186/1471-2458-13-121] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 01/31/2013] [Indexed: 11/17/2022] Open
Abstract
Background Sexually transmitted infections (STIs) have become a major public health problem among female sex workers (FSWs) in China. There have been many studies on prevalences of HIV and syphilis but the data about Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections are limited in this population in China. Methods A cross-sectional study was performed among FSWs recruited from different types of venues in 8 cities in China. An interview with questionnaire was conducted, followed by collection of a blood and cervical swab specimens for tests of HIV, syphilis, NG and CT infections. Results A total of 3,099 FSWs were included in the study. The overall prevalence rates of HIV, syphilis, NG and CT were 0.26%, 6.45%, 5.91% and 17.30%, respectively. Being a FSW from low-tier venue (adjusted odds ratios [AOR]=1.39) had higher risk and being age of ≥ 21 years (AOR=0.60 for 21–25 years; AOR=0.29 for 26–30 years; AOR=0.35 for 31 years or above) had lower risk for CT infection; and having CT infection was significantly associated with NG infection. Conclusions The high STI prevalence rates found among FSWs, especially among FSWs in low-tier sex work venues, suggest that the comprehensive prevention and control programs including not only behavioral interventions but also screening and medical care are needed to meet the needs of this population.
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Affiliation(s)
- Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China.
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Chen XS, Yin YP, Shen C, Liu GG, Zhu ZJ, Wei WH, Wang HC, Huang SJ, Li J, Tucker JD, Mabey DC, Peeling RW. Rapid syphilis testing uptake for female sex workers at sex venues in Southern China: implications for expanding syphilis screening. PLoS One 2012; 7:e52579. [PMID: 23300709 PMCID: PMC3531440 DOI: 10.1371/journal.pone.0052579] [Citation(s) in RCA: 12] [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: 08/29/2012] [Accepted: 11/20/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Accessibility of syphilis testing services is critical in syphilis control programs for female sex workers (FSWs), but few FSWs attend public STI clinics or other testing sites. Introduction of free rapid syphilis testing (RST) into outreach programs for FSWs will help improve test uptake. METHODS Commercial sex venues were identified in two cities in South China. In cooperation with health advocacy organizations, health outreach teams from local public health or medical facilities approached all types of sex venues in study areas to offer free RST. Acceptability and uptake of RST among FSWs were evaluated. RESULTS A total of 2812 FSWs were offered RST and 2670 (95.0%) accepted syphilis testing. 182 (6.8%) FSWs had a positive RST result among whom 136 (74.7%) were willing to attend an STD clinic for confirmatory testing and treatment. More than half (89, 66.4%) of those with syphilis were not willing to notify their sex partners. Multivariate logistic analysis showed that syphilis test uptake was associated with residing in Jiangmen (AOR, 1.78; 95% CI, 1.15-2.77), older age (AOR, 2.11, 95% CI, 1.17-3.79 for age of 31 years or above), and not working at a service venue (AOR, 1.60; 95% CI, 1.10-2.34). CONCLUSIONS RST at sex venues is well accepted by FSWs when it is integrated into ongoing outreach services. Such programs provide excellent opportunities for expanding syphilis screening efforts among specific subgroups of FSW who are difficult to reach through clinic-based programs.
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Affiliation(s)
- Xiang-Sheng Chen
- National Center for Sexually Translated Disease (STD) Control and Chinese Academy of Medical Sciences Institute of Dermatology, Nanjing, China.
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Zhang XD, Temmerman M, Li Y, Luo W, Luchters S. Vulnerabilities, health needs and predictors of high-risk sexual behaviour among female adolescent sex workers in Kunming, China. Sex Transm Infect 2012; 89:237-44. [PMID: 23220781 PMCID: PMC3625825 DOI: 10.1136/sextrans-2012-050690] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives This study assessed social and behavioural predictors for sexual risk taking and sexually transmitted infections (STIs) including HIV among adolescent female sex workers (FSWs) from Kunming, China. Additionally, health services needs and use were assessed. Methods A cross-sectional survey was conducted in 2010. Using snowball and convenience sampling, self-identified FSWs were recruited from four urban areas in Kunming. Women consenting to participate were administered a semi-structured questionnaire by trained interviewers identified from local peer-support organisations. Following interview, a gynaecological examination and biological sampling to identify potential STIs were undertaken. Descriptive and multivariable logistic regression analyses were performed. Results Adolescent FSWs had a mean age of 18.2 years and reported numerous non-paying sexual partners with very low rate of consistent condom use (22.2%). Half (50.3%) the respondents had sex while feeling drunk at least once in the past week, of whom 56.4% did not use condom protection. STI prevalence was high overall (30.4%) among this group. Younger age, early sexual debut, being isolated from schools and family, short duration in sex work, and use of illicit drugs were found to be strong predictors for unprotected sex and presence of an STI. Conversely, having access to condom promotion, free HIV counselling and testing, and peer education were associated with less unprotected sex. The majority reported a need for health knowledge, free condoms and low-cost STI diagnosis and treatment. Conclusions There is an urgent need to improve coverage, accessibility and efficiency of existing interventions targeting adolescent FSWs.
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Affiliation(s)
- Xu-Dong Zhang
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, P3 B-9000, Ghent 650500, Belgium.
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