A Study On The Situation Of Condom Negotiation And Effective Use Among Female Sex Workers In Two Counties Of Honghe Prefecture,Yunnan Province

Objective:To know the prevalence of violence and anal sex among FSW;To know the situation of effective condom use and explore the related factors of effective condom use among FSW;To know the situation of condom negotiation and explore the related factors of condom negotiation.Methods:Census method:to collect information on the distribution of sex workers activity sites and the baselines number of sex workers in Jianshui County and Mengzi County in Hani-Yi Autonomous Prefecture of Honghe;selected sites in middle-high-grade and low-grade sites by stratified random sampling(sampling ratio 50%)to verify the number of sex workers;And estimated the size of female sex workers.Based on the size estimation of the census method on the distribution of FSWs’activity sites,from April to June 2018,a cross-sectional survey method was adopted to investigate the characteristics of demographics,sexual behaviors,violence,condom negotiation and condom use of FSW who meet inclusion criteria and recruited based on entertainment venues.The description of the count data is based on the frequency distribution.The comparison of the frquency and ratio is based on the Chi-square test.The bivariate analysis and multivariate analysis are based on binary logistic regression or multinomial logistic regression.The statistical test level(a)is 0.05.Results:1.The estimated population size in Mengzi City and Jianshui County:The age of female sex workers in Mengzi City and Jianshui County is the range of 15-54 years old.The estimated population size of sex workers is 604-651 and 413-438,respectively,accounting for 0.49%(651/132 631)and 0.27%(434/161 544)of the female population in the corresponding age group in Mengzi City and Jianshui County.respectively.2.The prevalence of violence and anal sex among FSW:A total of 852 FSW,aged(24.29±8.44)years old,were recruited in the cross-sectional survey.687(80.6%)FSWs had regular sexual partners.In the last year,there were 25(2.9%)FSWs suffered violence initiated by clients and 18(2.6%,18/687)FSWs suffered violence initiated by regular sexual partners.In the past month,in addition to vaginal sex with clients,69(8.1%)also had oral sex with clients.There were 190(22.3%)FSWs encountered the clients who have anal sex requests and 5(0.6%)FSWs had anal sex with their clients,3 of which always use condom in anal sex.In addition to vaginal sex with regular sexual partners,73(10.6%)also had oral sex with regular sexual partners.7(1.0%)FSWs had anal sex with their regular sexual partners,2 of which always use condom in anal sex.3.The situation of effective condom use with sex partners among FSWs in past month:In the past month,there were 14(1.6%)FSWs who reported never use condom with clients,110(12.9%)FSWs who reported that sometimes used condoms with clients,32.7%(36/110)of them didn’t proper use condoms.728(85.5%)FSWs reported that always used condoms with clients 8.2%(60/728)of them didn’t proper use condoms.The proportion of sex workers who never condom use,noneffective condom use and effective condom use with clients were 1.6%(14 FSWs),20.0%(170 FSWs),and 78.4%(668 FSWs),respectively.In the last vaginal sex。there were 216(31.4%)FSWs who reported never use condom with regular sexual partners,306(44.6%,306/687)FSWs reported that sometimes used condoms with regular sexual partners.26.5%(81/306)ofthem didn’t proper use condoms.165(24.0%,165/687)FSWs reported that always used condoms with regular sexual partners.7.3%(12/165)of them didn’t proper use condoms.The proportion of sex workers who never condom use,noneffective condom use and effective condom use with regular sexual partners were 31.4%(216 FSWs),46.3%(318 FSWs).and 22.3%(153 FSWs),respectively.4.The situation of negotiation for condom use with sex partners among FSWs in past month:In past month,499 FSWs had negotiation f’or condom use with unwilling clients(58.6%),after negotiation.441 FSWs(88.4%)had consistent condom use in each sex with the clients.In past month,99 FSWs had negotiation for condom use with unwilling regular sex partners(14.4%),after negotiation,54 FSWs(54.5%)had consistent condom use in each sex with regular sex partners.Among the FSWs.266(53.3%)reported that they could say;"It is a mandatory requirement" to persuade their unwilling clients to use condoms.97(19.4%)reported that they could say "There was risk for infection" to persuade their unwilling clients to use condoms.115(23.1%)reported that they could say "It was a mandatory requirement and there was risk for infection" to persuade their unwilling clients to use condoms.21(4.2%)reported that they used other strategies.22(4.4%)felt that it was difficult to persuade clients to use condoms.5.The related factors of consistent condom use with clients after negotiation in past month:Multivariate Logistic regression analysis showed that compared with FSWs who felt difficult in persuading clients to use condoms,FSWs who felt moderate difficulty were more likely to have consistent condom use after negotiation(OR=4.00,95%CI:1.55～10.32)and FSWs who felt easy in persuading clients to use condoms were also more likely to have consistent condom use(OR=30.17,95%CI:3.22-282.44).Compared with FSWs used other strategies to persuade their clients to use condoms,FSWs who said it was a mandatory requirement were more likely to have consistent condom use after negotiation(OR=4.44,95%CI:1.41～14.01)and FSWs who said it was a mandatory requirement and there was risk for infection were also more likely to have consistent condom use(OR=5.52,95%CI:1.55～19.73)6.The related factors of effective condom use with clients after negotiation in past month:Multivariate Logistic regression analysis showed that compared with FSWs who felt difficult in persuading clients to use condoms,FSWs who felt moderate difficulty were more likely to have effective condom use after negotiation(OR=5.35,95%CI:2.23～12.81)and FSWs who felt easy in persuading clients to use condoms were also more likely to have effecctive condom use(OR=12.60,95%CI:3.35～47.39).7.The related factors of negotiation strategy with clients in past month:Multivariate Logistic regression analysis showed that compared with those aged<24 years,FSWs who aged≥24 years old were more likely to say "It was a mandatory requirement" to persuade their unwilling clients to use condoms(OR=1.85,95%CI:1.21～2.86).Compared with those who had a low awareness of infecting HIV,FSWs with a moderate awareness of infecting HIV were less likely to say "It was a mandatory requirement"(OR=0.42,95%CI:0.23～0.76).Compared with FSWs who felt difficult in persuading clients to use condoms,FSWs who felt moderate difficulty were more likely to say "It was a mandatory requirement"(OR=3.61,95%CI:1.48～8.84)and FSWs who felt easy were also more likely to say“It was a mandatory requirement"(OR=3.51,95%CI:1.16～10.66).Conclusion:Either with clients or regular sexual partners,the mainly sexual behavior of FSWs was vaginal sex,22.3%of FSWs who had encountered clients had a requirement of anal sex.The prevalence of client-initiated violence or regular sexual partners-initiated violence was in lower level.There were different levels of inability to use condom throughout the whole process among FSWs.Moreover,FSWs who self-reported sometimes use condoms were more likely to can not use condom throughout the whole process.Negotiation for condom use increased the rate of condom use in FSWs in sex with unwilling sexual partners.The using of negotiation strategy,especially the negotiation strategy of saying it is a mandatory requirement,could not guarantee the effective use of condoms after negotiation,but can improve the condom use rate after negotiation.