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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; 35:584-592. [PMID: 38507707 DOI: 10.1177/09564624241239480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Jiang T, Pan X, Ma Q, Jiang J, Chen L, Wang H, Zhou X, Chen W. Characteristics of low-tier female sex workers who engage in commercial sex with old male clients in Zhejiang province, China: a cross-sectional study. BMJ Open 2021; 11:e049410. [PMID: 34785548 PMCID: PMC8596047 DOI: 10.1136/bmjopen-2021-049410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To characterise low-tier female sex workers (FSWs) who engage in commercial sex with old male clients (OMCs). DESIGN Cross-sectional study. SETTING Twenty-one counties in Zhejiang province, China. PARTICIPANTS A total of 2647 low-tier FSWs who participated in our survey from September to November 2013, and responded to the question regarding whether they engaged in commercial sex with OMCs during the previous month. MAIN OUTCOME MEASURES Data on sociodemographic characteristics, sexual behaviours, risk perception of HIV/sexually transmitted infection (STI), ever exposure to an HIV prevention service and degree of self-efficacy regarding condom use were collected via a face-to-face questionnaire administered by trained interviewers. RESULTS Of the 2647 participants, 1165 (44.0%) had engaged in commercial sex with OMCs in the previous month. Low-tier FSWs working out of roadside shops, those who had engaged in sex work for longer, those with a larger number of clients, those who had engaged in anal or oral sex during the previous month, those currently using contraception measures, those who had STI symptoms and those who had been exposed to HIV prevention services during the previous 6 months were more likely to engage in commercial sex with OMCs. FSWs with a high level of education; those working out of small venues other than streets, hair salons and roadside shops; those who charged more for commercial sex; those who had sex with young clients during the previous month and those who had seen a doctor during the previous 6 months were less likely to engage in commercial sex with OMCs. CONCLUSIONS Low-tier FSWs who engaged in commercial sex with OMCs reported more risky behaviours than those who did not engage in this behaviour. Attention should be paid to these behaviours in future interventions targeting low-tier FSWs.
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Affiliation(s)
- Tingting Jiang
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaohong Pan
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qiaoqin Ma
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jianmin Jiang
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Lin Chen
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Hui Wang
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xin Zhou
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Wanjun Chen
- Department of HIV/STD prevention and control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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Nigussie T, Mamo Y, Qanche Q, Yosef T, Wondimu W, Asefa A. HIV Preventive Behaviors and Associated Factors among Gold Mining Workers in Dima District, Southwest Ethiopia, 2019: Community-Based Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4797590. [PMID: 34708123 PMCID: PMC8545504 DOI: 10.1155/2021/4797590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/11/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND HIV/AIDS is becoming more prevalent over time, resulting in a considerable number of deaths. In 2017, 36.9 million (35.1 million adults) people worldwide were living with HIV, 1.8 million people were newly infected with HIV, and 940 000 people died from AIDS-related illnesses. Mining workers are at a high risk of contracting HIV and infecting others, and effective prevention is a critical. OBJECTIVE To assess HIV preventive behaviors and associated factors among gold mining workers in Dima district, southwest Ethiopia, 2019. METHODS AND MATERIALS A community-based cross-sectional study was conducted from November 1st to 30th, 2019. A convenience sampling technique was used to get mining workers for the interview.The data were collected through face-to-face interviews. The collected data were coded and entered into EpiData version 4.2.0.101, cleaned, and analyzed using SPSS version 21 statistical software. A binary logistic regression was conducted to determine the association using odds ratios at 95% confidence intervals. A P value of less than 0.05 considered the level of significance for HIV preventive behaviors. RESULTS From a total of 455 mining worker, 279 (61.3%) of them have good practices of HIV prevention. Factors associated with good preventive practice were not alcohol drinkers (AOR = 2.86, 95% CI: 1.30-6.29), not chew khat (AOR = 2.09, 95% CI: 1.09-4.02), having good knowledge about HIV (AOR = 1.81, CI: 1.16-2.83), favorable attitude towards HIV prevention (AOR = 4.76, 95% CI: 3.02-7.49), and high perceived susceptibility to HIV (AOR = 2.63, 95% CI: 1.63-4.24). CONCLUSION Only about 61% of the mining workers in the study area were practiced HIV preventive behaviors. Not alcohol drinkers, having good knowledge about HIV, having a favorable attitude toward HIV prevention, and having high perceived susceptibility to HIV were factors associated with the practice of HIV preventive behaviors. Efforts have to be made by local governments and other concerned bodies to increase preventive behavior.
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Affiliation(s)
- Tadesse Nigussie
- Department of Reproductive Health and Nutrition, School of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Yitagesu Mamo
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, College of Medicine and Health Sciences, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Qaro Qanche
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Tewodros Yosef
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Wondimagegn Wondimu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Adane Asefa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan-Aman, Ethiopia
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Nanthaprut P, Manojai N, Chanlearn P, Mattawanon N, Chiawkhun P, Homkham N, Traisathit P. Comparison of HIV-Positive Incidence Among Transgender Women and Men Who Have Sex with Men at Stand-Alone and Mobile Voluntary Counseling and Testing Facilities in Chiang Mai Province, Thailand. AIDS Patient Care STDS 2021; 35:116-125. [PMID: 33835852 DOI: 10.1089/apc.2020.0258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is still a major cause of death in Thais and new cases of infection are still emerging among the key population comprising men who have sex with men (MSM), sex workers and their clients, and transgender women (TGW) and people who inject drugs. The objective of this study was to compare the incidence of HIV infection between MSM and TGW who were tested at stand-alone and mobile HIV voluntary counseling and testing (VCT) centers and to identify factors associated with HIV-positive individuals from the two services. We conducted an observational study using MSM and TGW individuals with unknown HIV status from the databases at a stand-alone center and a mobile VCT belonging to the MPlus in Chiang Mai province, Thailand. Factors associated with HIV-positive status were identified using logistic regression model. HIV VCT data were obtained for 6971 individuals at both MPlus center and mobile care unit. Among 3033 and 3938 clients tested at each facility, respectively, 168 (5.6%) and 101 (2.6%) clients were HIV positive. Individuals tested at the stand-alone centers were at a 1.91-fold higher risk of being HIV positive compared with those tested at the mobile VCT unit. Individuals who were 20-24 or >24 years old, sex workers, or sexually transmitted infection positive were more likely to be HIV positive. Our results show the beneficial effect of mobile HIV VCT facilities that enable testing of more of the at-risk population. Developing mobile VCT activities that attract a particular target population is needed to be able to reach the 90-90-90 goals. This study was approved by the Ethics Committee of the Faculty of Medicine, Chiang Mai University (0BG-2562-06418).
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Affiliation(s)
- Pimwarat Nanthaprut
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Natnita Mattawanon
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phisanu Chiawkhun
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Research Center in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Chiang Mai, Thailand
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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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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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Poon AN, Han L, Li Z, Zhou C, Li Y, Huang L, Liao M, Shepard C, Bulterys M. Acceptability and willingness of HIV pre-exposure prophylaxis amongst female sex workers in China. AIDS Care 2019; 31:1555-1564. [PMID: 31046413 DOI: 10.1080/09540121.2019.1612001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) is a highly effective prevention method. It is an attractive self-initiated approach to reduce the spread of HIV amongst female sex workers (FSW). PrEP, however, has not yet achieved its potential to reduce HIV infections partially due to a general lack of awareness from women who may benefit. Aims of this cross-sectional study of 1,466 FSW in China were to understand: levels of awareness of and willingness to use PrEP among female sex workers (FSW) in China, and factors contributing to willingness to use PrEP. We found that awareness (10.2%) and willingness (35.5%) to use PrEP were low in our survey areas. Low PrEP willingness is likely reflective of the overall poor knowledge and understanding of HIV risk and prevention. FSW that demonstrated greater HIV knowledge through having been tested or having greater decision-making involvement in condom use were more willing to use PrEP. Study findings may be used to inform future HIV prevention activities, including possible use of PrEP among FSW at higher risk of incident HIV infection in China.
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Affiliation(s)
- Adrienne N Poon
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
| | - Lifeng Han
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
| | - Zhijun Li
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
| | - Chu Zhou
- National Centre for AIDS/STD Prevention and Control, Chinese Centre for Disease Control and Prevention , Beijing , People's Republic of China
| | - Yan Li
- Department of HIV/AIDS, Guangdong Provincial Centre for Disease Control and Prevention , Guangzhou , People's Republic of China
| | - Lu Huang
- Department of HIV/AIDS/STD, Guizhou Provincial Centre for Disease Control and Prevention , Guiyang , People's Republic of China
| | - Meizhen Liao
- Department of HIV/AIDS, Shandong Provincial Centre for Disease Control and Prevention , Jinan , People's Republic of China
| | - Colin Shepard
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
| | - Marc Bulterys
- United States Centers for Disease Control and Prevention (CDC) Global AIDS Program , Beijing , People's Republic of China
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Chang RC, Hail-Jares K, Zheng H, He N, Bouey JZH. Mitigating circumstances: A model-based analysis of associations between risk environment and infrequent condom use among Chinese street-based sex workers. PLoS One 2018; 13:e0195982. [PMID: 29763416 PMCID: PMC5953488 DOI: 10.1371/journal.pone.0195982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/03/2018] [Indexed: 12/01/2022] Open
Abstract
Background Little is known about how freelance street-based sex workers navigate condom use while soliciting. Traditional behavioural model may fail to account for the complex risk environment that most street-based sex workers work within. We examine first the association of self-efficacy and the infrequent condom use, then we investigated the roles of clients and venues frequented on this association. Method Using a purposive chain-referral sampling method, we surveyed 248 street-based sex workers in Shanghai. The survey focused on sex workers HIV risk factors, sex work patterns, HIV knowledge, and related HIV self-efficacy. Clients types and behaviours, and characteristics of the venues frequented by these commercial sex workers were also collected. We conducted a series of multiple logistic regression models to explore how the association between a sex worker’s self-efficacy with infrequent condom use change as client and venue characteristics were added to the models. Results We find that within the basic model, low self-efficacy was marginally associated with infrequent condom use (54.9% vs. 45.1%, AOR = 1.70, 95% CI = 0.95–3.03). As client- and venue- characteristics were added, the associations between self-efficacy and condom use were strengthened (AOR = 2.10 95% CI = 1.12–3.91 and 2.54 95% CI = 1.24–5.19 respectively). Those who reported middle-tiered income were more likely to report infrequent condom use compared to their peers of high income (AOR = 3.92 95% CI = 1.32–11.70) whereas such difference was not found between low income and high income sex workers. Visiting multiple venues and having migrant workers as clients were also associated with infrequent condom use. Conclusion Our findings suggest sex worker’s self-efficacy matters in their HIV risk behaviours only when environment characteristics were adjusted. Risk environment for street-based sex workers are complex. Programming addressing behavioural changes among female sex workers should adopt holistic, multilevel models with the consideration of risk environments.
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Affiliation(s)
- Ruth C. Chang
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington DC, United States of America
| | - Katie Hail-Jares
- Griffith Criminology Institute, Griffith University, Mt. Gravatt, Queensland, Australia
| | - Huang Zheng
- Shanghai CSW&MSM Center, Xinjian St., Shanghai, China
| | - Na He
- Department of Epidemiology, Fudan University, Wu Jiao Chang, Yang Pu Qu, Shanghai, China
| | - Jennifer Z. H. Bouey
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington DC, United States of America
- * E-mail:
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Latifi A, Merghati-Khoei E, Shojaeizadeh D, Nedjat S, Mehri A, Garmaroudi G. Theory-based interventions in STIs/HIV Prevention: A systematic review of the literature in Iran. Med J Islam Repub Iran 2017; 31:131. [PMID: 29951431 PMCID: PMC6014754 DOI: 10.14196/mjiri.31.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Indexed: 11/18/2022] Open
Abstract
Background: Various theory-based interventions (TBIs) have been done to prevent STI/HIV. The current study aimed at reviewing the TBIs for STI/HIV prevention in Iran. Methods: We systematically searched 6 English and Persian electronic databases to identify TBIs conducted for STI/HIV prevention in Iran. General searches were conducted using PubMed MeSH terms. Articles were included if they were interventional and conducted using models and theories, aimed at reducing the risk of STIs, were quasi-experimental or experimental, and if their full text was available. Results: Overall, 1042 studies were found. Finally, 13 original studies met our inclusion criteria. The findings indicated that HBM and TPB were the most frequently used theory/models. High school students and drug abusers were the most common target groups in the included studies. Conclusion: The results revealed that the majority of the conducted TBIs contained a methodological weakness. Conducting randomized controlled trials is needed to evaluate the effectiveness of the TBIs.
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Affiliation(s)
- Arman Latifi
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Ira
- Department of Health Education & Health Promotion, School of Public Health, Tehran University of Medical sciences, Tehran, Iran
| | - Effat Merghati-Khoei
- Iranian National Center of Addiction Studies (INCAS), Institution of Risk Behavior Reduction, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Shojaeizadeh
- Department of Health Education & Health Promotion, School of Public Health, Tehran University of Medical sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical sciences, Tehran, Iran
| | - Ali Mehri
- Department of Health Education, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Gholamreza Garmaroudi
- Department of Health Education & Health Promotion, School of Public Health, Tehran University of Medical sciences, Tehran, Iran
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Zeng H, Zhang L, Zhao Y, Liu H, Guo H, Wang Y, Zhang Z, Mao L. HIV prevention among street-based sex workers (SSWs) in Chongqing, China: interviews with SSWs, clients and healthcare providers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e173-e180. [PMID: 26294326 DOI: 10.1111/hsc.12266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 06/04/2023]
Abstract
Street-based female sex workers (SSWs) are subjected to a relatively high risk of HIV transmission, even higher than establishment-based female sex workers in China. However, very few HIV intervention programmes have targeted this particular group to date. Based in Southwest China, this study aims to identify perceived barriers, demands and suggestions on HIV prevention from the perspectives of SSWs, clients and healthcare providers in Chongqing. Face-to-face, in-depth interviews were conducted in July 2008 with 23 participants. They were recruited by purposive, convenience sampling and included 12 SSWs, 5 male clients, 4 government healthcare providers and 2 outreach workers from a community-based non-governmental organisation. Thematic analysis was used. SSWs were largely rural-to-urban migrants with a low socioeconomic status. Most of their clients shared a similar background. Both SSWs and their clients demonstrated a low awareness of HIV infection and a lack of understanding of effective preventive strategies. Financial hardships, lack of family support, fear of police arrest and stigma in relation to sex work were identified as SSWs' major barriers for accessing healthcare services. Both SSWs and their clients indicated an urgent demand for accessing adequate HIV prevention and care programmes. On the other hand, government organisations trying to provide services to this group have also encountered obstacles, specifically their limited ability to establish mutual trust. Programmes provided by community-based non-governmental organisation, however, were perceived to be more attractive. In conclusion, there remains a substantial gap between the need of adequate HIV prevention services for SSWs and their clients and what is currently available. Strengthening inter-sectoral collaboration, providing specifically tailored health services, actively involving SSW peers and their clients, and reducing stigma in the society are keys to meet this urgent demand by SSWs in China.
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Affiliation(s)
- Huan Zeng
- School of Public Health and Management, Chongqing Medical University, Chongqing, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Hui Liu
- Centre for Disease Control and Prevention, Yubei District, Chongqing, China
| | - Hang Guo
- Institute of Health Policy, College of Human Medicine, Michigan State University, Lansing, Michigan, USA
| | - Yang Wang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Zhen Zhang
- Centre for Disease Control and Prevention, Yuzhong District, Chongqing, China
| | - Limin Mao
- Center for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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11
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Davis A, Meyerson BE, Aghaulor B, Brown K, Watson A, Muessig KE, Yang L, Tucker JD. Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China. Int J Equity Health 2016; 15:170. [PMID: 27741947 PMCID: PMC5064915 DOI: 10.1186/s12939-016-0453-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China. METHODS In 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes. RESULTS Out of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants' lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals. CONCLUSION Ugandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.
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Affiliation(s)
- Alissa Davis
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality & Health, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Dr, Unit 15, New York, NY 10032 USA
- UNC-Project China, 2 Lujing Road, Guangzhou, China
| | - Beth E. Meyerson
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, 1025 E 7th St. Rm PH116, Bloomington, IN 47405 USA
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Bloomington, USA
| | - Blessing Aghaulor
- School of Medicine, University of North Carolina-Chapel Hill, 321 S Columbia Street, Chapel Hill, NC 27516 USA
| | - Katherine Brown
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, 505 Parnassus Avenue, Rm. 1483, San Francisco, CA 94143 USA
| | | | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 306 Rosenau, Campus Box 7440, Chapel Hill, NC 27599 USA
| | - Ligang Yang
- Guangdong Provincial STD Control Center, 2 Lujing Road, 11th Floor, Guangzhou, 510095 China
| | - Joseph D. Tucker
- UNC-Project China, 2 Lujing Road, Guangzhou, China
- School of Medicine, University of North Carolina-Chapel Hill, 321 S Columbia Street, Chapel Hill, NC 27516 USA
- Guangdong Provincial STD Control Center, 2 Lujing Road, 11th Floor, Guangzhou, 510095 China
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