Determinants of condom use with female sex workers among male clients in Sichuan Province, China

Background. This dissertation examined determinants of HIV-related sexual behaviors among commercial sex male clients (CSMCs) in Sichuan Province, China, and assessed HIV-related peer norms, interpersonal and venue-level determinants associated with their consistent condom use with female sex workers (FSWs).;Method. Data of a cross-sectional study were collected from 601 participants Analysis included exploratory statistics and logistic regression accounting for clustered data.;Results. The review of existing published studies of CSMCs in China and globally revealed that much of research on CSMCs available to date has primarily addressed individual-level determinants, but has rarely examined the role of social and contextual determinants that may place this population at high risk of HIV infection or transmission. Multivariate logistic regression results indicated that male clients who perceived that peers supported and engaged in pro-condom behaviors were significantly more likely to consistently use condoms with FSWs. In addition, peer approval of condom use and HIV-related communication with peers were significantly associated with sexual behaviors among male clients who visited FSWs with friends, but not among those who visited FSWs alone. We also found consistent condom use among CSMCs was associated with FSWs taking the initiative in condom use and providing condoms, and condom availability and policy in commercial sex venues. Moreover, interpersonal factor was independently associated with consistent condom use among male clients who visited FSWs working in low rank of commercial sex industry, but not among those visiting FSWs in mid- or high-rank commercial sex venues. In addition, venue-level factor was associated with consistent condom use among male clients visiting FSWs in mid- and high-rank commercial sex venues, but not among those who visited FSWs working in low rank of commercial sex industry.;Conclusions. The results reveal that peer norms are significantly associated with male clients' commercial sexual behaviors, and suggest that future research should take into account the forms of social interaction that stimulate the communication and norm formation. The present study findings also highlight the heterogeneity of commercial sex in China and emphasize a need for ecological approaches connected with female sex workers, and male clients, and commercial sex managers.