| BackgroudThe main AIDS/STDs infections cases were clustered at the age of 15 to 49 years for a long history, while in recent years the proportion of elderly (older than 50 years) shows a rapid growth in China. Having unprotected sex with older female sex workers (OFSWs) was considered as the primary transmission to the elderly. Making prevention and intervention strategies tailored for this population, and reducing their high-risk sexual behaviors is crucial to control the spread of AIDS/STDs among the elders, while there was few study focused on this population.ObjectiveThe study aimed to assess the feasibility of respondent-driven sampling (RDS) in recruiting OFSWs sample; To investigate the prevalence and risk factors of human immunodeficiency virus (HIV) and syphilis infection among this population; To validate the reliability of self-reported recent unprotected heterosexual behaviors; And to overview the status of social support on OFSWs and its influenced factors for a better understanding on the characteristics of their egocentric social support networks.MethodsThe cross-section study was conducted during March to June 2014. With the recommend of the native medical and health staffs,4 eligible OFSWs were selected as seeds, who recruited the respondents by RDS method. The study Collected information of social-demographic characteristics, sexual behaviors and social networks by face to face and one by one computer assisted personal interviewing (CAPI), and conducted biological detect to learn of the serum infection status of OFSWs. Log-binomial regress model was used to recognize the risk factors of the respondents related to their life time ever syphilis and structural equation model (SEM) was used to fitted test and estimation of the information-motivation-behavior models (1MB) and social networks model, so that to explore factors related to their condom use behaviors and factors related to the ratings of their social support.Results1.The characteristics of OFSWs in Qingdao city420 eligible respondents were recruited by the selected 4 seeds within 8 waves, whose median age was 42 years old (P25-P75:36-48 years old), and most of them were Han ethnic, without local cencus registers, with the middle school or lowers education, and were divorced or widowed. The awareness rate about the knowledge of AIDS/STDs in spreading and prevention was 66.7%; Most of OFSWs choose their commercial sex trade place as small hotels beside streets or their rent houses. Their average monthly income obtained from the sex trade was (7185±3563) Yuan, and in most case such income were the main resources of their family economy; 46.0% percent had their sex trade after the age of 35, and 54.3% had provided commercial sex serve over 5 years; 68.3% percent being female sex worker was driven by thought of economy; The ratio of consistent condom use was not high in their commercial sex behaviors,26.2% self reported didn’t use condom in their last sex trade before the survey, and 66.7% didn’t use condom in their every sex trade during the recent month before the survey; 18.3% admitted of having a drug use history, while all denied inject ways.2.The prevalence of AIDS/syphilis among the OFSWs in Qingdao city and its risk related factorsNo HIV positive cases was identified among all the participants, and 125 cases had prior, and among which 36 cases had current syphilis infection; And there wasn’t obvious cluster among the infectious cases; The RDS-adjusted lifetime prevalence of syphilis was 31.8% and the active prevalence was 9.1%. The result of multiple variable log-binomial regress showed that local census register (aPR=1.935,95%CI: 1.518～2.467), having commercial sex after the age of 35 years (aPR=1.542,95%CI: 1.224～1.941), the test of prostate specific antigen (PSA) was positive (aPR=1.346, 95%CI:1.010～1.794) and drug use history (aPR=1.876,95%CI:1.512-2.326) were factors positive related to their life time ever syphilis infection.3.Influencing factors of consistent condom use among OFSWsThe final IMB model shows that both the information and motivation can affect prevention behavior directly, and can affect it via behavioral skills indirectly also. Both motivation (direct effect:0.487, indirect effect:0.473) and behavioral skills (only direct effect:0.526) had a strong influence on prevention behavior, while the influence of information was slight (direct effect:-0.014, indirect effect:0.0009).4.Validate the reliability of self reported recent unprotected behaviorsRegard PSA test result as the golden criterion of whether the participants experienced unsafe sex exposure in the recent 48 hours, the sensitivity of the self report unsafe sex was 73.83%, and its specificity was 70.00%, the diagnostic index was 145.83% lower than the experimental index (170%). The prevalence ratio of unsafe sex of life time syphilis related to unsafe sex was 9.65% under estimated because of the misreport.5.The characteristic of social supportive networkThe result of bivariate log-binomial regress showed that both the average tangible (cPR=0.90,95%CI:0.85～0.95) and emotional (cPR=0.92,95%CI:0.88～ 0.95) social support ratings had a negative effect on unsafe sex.400 OFSWs nominated 1617 social supportive members, and their egocentric social network was on small size, namely (4.0±1.5), and female sex workers fellows accounted for the largest proportion (37.9%) among all the social ties.Characteristics of small size and non-relative relationships were seen more obviously among OFSWs without local registration. And the ratings of emotional support was significantly lower than the tangible support (P<0.05); Result of the SEM showed that homogeneity, joint strength and the network structure were significantly related to the ratings of average support. The total standard effects of which were 0.110,0.925, and -0.069 respectively. It seemed that homogeneity can affect the degree of support both directly and indirectly.Conclusions and suggestions1. Most of the OFSWs in Qingdao city didn’t have local cencus registers and were divorced or widowed, attained lower education, and began their sex trade work at their late 30s, and the rate of consistent condom use among them was not high. The AIDS prevalence was low among them, while where existed an relative serious syphilis prevalence, with local census register, having commercial sex after the age of 35 years, having unprotected commercial sexual behaviors and used to be a drug users were found to be risk indicate factors related to their life time syphilis infection, thus in the future prevent and treatments works for AIDS/STDs, should pay more attention on those with local cencus registers, began their sex trade at an relative older age, and had drug use history in this city.2. Both motivation and behavioral skills showed a quite strong positive effect to the protected sexual behaviors, while the perception about AIDS/STDs infection among the OFSWs were thin, and it didn’t take the roles of positive motivation, thus behavior intervention should strength their AIDS/STDs infections risk, and force the risk perception to be motivation that push them to take prevention measures. What more important is promoting their condom use negotiation skills, self efficiency of refuse unsafe sex, and their self control as well.3. Compared to other study, with the consideration of all potential factors, such as investigate skills and site, to get the participants’trust, the validation of self reported condom use had been improved, while the report result did not attain to ideal status still. Thus when conduct an survey involved in sensitive questions, and such information is crucial, investigators should try to reduce the worries of the participants that their real information may be let out as much as possible, take biological test if conditions permit at mean while, to increase the reliability of the study conclusion, and its feasibility.4. The higher ratings of emotional or tangible support the OFSWs received, the lesser possibility they had unsafe sexual behavioral. And the female sex workers fellows were the main composition of their social support network, thus in the future behavior intervention for controlling and preventing AIDS/STDs from OFSWs to general population, should not just focus on biological and medical matters, social psychology issues should take into consideration, strengthen the communication and organizations between OFSWs fellows, establish and improve the comprehensive and effective intervention strategies. |
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