Analysis On Sexual Behaviors Changing After The Notification Of Hiv Positive Testing Result And Effects Of Antiretroviral Therapy Among The HIV Positive Female Sex Workers

ObjectiveTo understand the sexual behavior changing among spouses/fixed partners and commerical sex partners of female sex workers（FSWs）after the notification of HIV positive testing result,analyze the epidemiological characteristics and effects of antiretroviral therapy（ART）among HIV positive FSWs who first received highly active antiretroviral therapy（HAART）,and provide effective intervention,treatment and management strategies for FSWs.Methods（1）We carried out a cross-sectional survey of HIV infection among FSWs at low-grade commercial sex venues in 2011.7936 questionnaires were done and 7936 samples were tested for HIV,149 HIV positive samples were idenfitied,the positive results were informed within 1 week.Three months later,the staff of National HIV Program provided the first follow-up activity for the HIV positive FSWs,completed the follow-up questionnaire.Comparison of sexual behaviors changing before and after the HIV positive result were delivery.（2）HIV interventions and testing among FSWs were carried out in various cities and counties in Guangxi.HIV positive FSWs were encouraged to take ART.The information of HIV positive FSWs who first received HAART in2012-2014 were collected,and matched with the National Comprehensive AIDS Prevention and Control Information System-ART Management database with name,ID number,et al,get access to the data of demographic characteristics,time of HIV confirmation,clinical staging,CD4 count,viral load and other laboratory test results,then statistical analysis were conducted.Results（1）Survey of sexual behavior changing after the notification of FSWs’HIV positive testing results:Of 131 positive FSWs,116 came from fixed venues（88.5%）,and their mean age was 36.8 year-old;ethnics of Han（51.1%）and Zhuang（32.1%）were the majority,married and cohabitation females accounted for 66.4%;primary and lower education accounted for 71.0%;69.5%of them were residents in Guangxi Province.After informing the positive results,22.9%positive FSWs completely lost contact;52.5%of sex workers continued to engage in commercial sex behaviours;24.8%received antiretroviral therapy.The percentage of condom use in every sex intercourse with clients in most recent month was 49.1%（26/53）before the notification while it increased to71.7%（38/53）after the notification,the difference was significant（P<0.05）.The number of commercial sex partners had reduced by 0.5,1.7,and 8.2 persons in one recent day,the most recent week,and the most recent month respectively after the notification,there was not significant changing between the comparisons（p>0.05）.（2）Effects of FSWs who first received highly active antiretroviral therapy（HAART）:A total of 226 HIV positive FSWs who first received HAART in Guangxi from 2012 to 2014,mainly from low-grade commercial sex venues（81.4%）,with an average age of 38.8（38.8±10.1）years old,married or cohabiting were 64.6%.the median time from HIV confirmed positive to the initiation of antiretroviral therapy was 25 days,the baseline median CD4⁺T310cell/μL（IQR:198.5～447.5）,higher CD4⁺T lymphocyte count were observed in people lived with HIV who had no clinical signs or symptoms in last3 months and who was in WHO clinical stage typeⅠ（P<0.05）.By December 31,2015,185 people（81.9%）were still adhered to ART,17（7.5%）were out of contact,16（7.1%）were drug withdrawal,7（3.1%）died.There were no AIDS related deaths.Since received HAART,the CD4⁺T cell count increased with duration of treatment,CD4⁺T cell count recovered rapidly in recent six months of HAART initiation,and kept stable after 12 months,the highest CD4⁺T cell count were observed in 18^th months of HAART initation,compared with the baseline result,207.5 cell/μL has been increased.A total of 31（17.3%）patients were virologic failure among 179 HIV positive FSWs who were in 6 to 41months’HAART duration,the cumulative incidence of virological failure was9.9/100 person-years（31/312.2）;148（82.7%）sustained viral suppression effectively,univariate analysis showed that the difference in the number of missed doses,HBV/HCV detection rate were significant,trend test shoued that the more doses missed,the higher probability of virological failure（P<0.01）would occurred.Multivariate logistic regression analysis showed,Compared with the 0 dose missing group,the virologic failure was 0.187 times higher in0-10 dose missed group,and 0.233 times higher in 11 doses and above missing group,the difference was significant（P<0.05）.Conclusions（1）Although the percentage of condom use had been increased,sexual intercourse with spouses/fix sex partners have been decreasing after the FSWs’HIV positive testing results has been informed,most FSWs in low-grade commercial sex venues continued to engage with the illegal commercial sexual activities,and the decreasing of number of commercial sex partners was not significantly.We suggest that a cooperation model need to be built up among multiple administration departments to intensify the information exchange,punishment and imprisonment as well as strengthened the care and assistance when it is necessary,to avoid further HIV transmission in the community.（2）Most HIV positive FSWs who received early antiretroviral therapy have rebuilt the immune system in a good recovery,and most of them were effectively sustained viral load suppression;however,missed doses would increase the risks of virological failure.We recommended a further enhancement of the adherence education of HAART and ART monitoring among FSWs.