Research On High-risk Behavior And HIV/STIs Infection Status Among Female Sex Workers Who Are In Low And Middle Places In Two Cities, Shandong Province

Objectives1. To obtain HIV/syphilis/HSV-2infection status and its influencing factorsamong female sex workers (FSWs) in Licheng and Decheng districts.2. To explore demographic characters, AIDS-related knowledge, condom usewith ordinary client or regular or fixed sexual partner and other high-risk behaviorssuch as drinking, smoking and drugging among FSWs who are in elementary andmiddle places.3. To analyze the HIV epidemic objectively in FSWs who are in low and middleplaces, so as to provide scientific basis for HIV prevention and control strategy.4. To consolidate the relationship between local CDC and proprietors, and build afoundation work smoothly for behavior intervention in the future.MethodsSelecting low and middle entertainment places to carry out a cross-sectionalsurvey among FSWs from May to August,2012. Adopting the method of multistagesampling (first stratified and then cluster sampling)to recruit subjects. Enteringentertainment place at the right time and choosing closed quiet room to sign a written informed consent, then using a self-designed questionnaire to investigate face-to faceand collect blood sample (each subject about5ml)for HIV antibody test, syphilisleptospira test and HSV-2antibody test. Survey data were recorded with EpiData3.1software and logical consistency checked with Excel. SPSS17.0software was appliedfor all statistical analyses.Results1. Of the583participants,50.9%were18-25years of age, the average age was27.34±6.73from18to60.53.9%were unmarried,58.7%coming from otherprovinces and60.4%from countryside, and64.3%were junior high school or lowerlevel.2. Of the participants,55.2%need procuress’help,67.4%need to provide fortheir family,68.1%were working6-7days a week,59.9%had2-3guests a day,32.4%provided the whole night services, and51.3%got3001-5000yuan RMB a month.3.80.8%of the participants had their first sex experience after18and45.1%started sex work from the age of20-24.62.6%had≥2years of sex workexperience,14.1%had anal sex, and52.8%had oral sex. The behavior of smokingand drinking was overflowed,52.5%were smoking, and up to83.2%were drinking.Only9person admitted having used new drugs.4. The participants knew more about transmission of AIDS, but knew less aboutnon-transmission. The rate of‘mosquito bites do not spread HIV’was59.4%and‘having dinner together with AIDS patients will not infect HIV’was71.9%.5. Of the269subjects who had fixed sexual partner, the rate of100%condomuse was17.1%,20.8%and27.9%respectively in the past year, the last month and thelatest week. Of the413subjects who had regular sex partner, the rate of100%condom use was33.4%,49.9%and61.55%respectively in the past year, the lastmonth and the latest week. Of the583subjects who had ordinary client, the rate of100%condom use was53.7%,59.2%and66.9%respectively in the past year, the last month and the latest week. With the time going, the rate of100%condom use with allsex partners showed obvious downtrend.The last month, the rate of100%condom use with ordinary client was higherthan that with regulars and fixed partner. With ordinary client: compared with Lichengdistrict, the FSWs in Decheng district had lower rate of100%condom use（OR=0.12，95%CI：0.08-0.20）. FSWs who need to provide for their family hadlower rate of condom use（OR=0.40，95%CI：0.25-0.64）and these who got51-200yuan RMB a deal had higher rate of condom use（OR=2.13，95%CI：1.38-3.30）. Withregular: compared with Licheng district, the FSWs in Decheng district also had lowerrate of100%condom use（OR=0.26，95%CI：0.17-0.40）. FSWs who got51-200yuanRMB a deal and got6point and more had higher rate of condom use（OR=2.17，95%CI：1.39-3.69; OR=1.73，95%CI：1.09-2.77）.6. The research contains583subjects, no HIV positive was found.35cases ofsyphilis, the positive rate of syphilis was6.0%, and108cases of HSV-2, the positiverate of HSV-2was18.5%. Stratified analysis showed that the positive rate of HSV-2in Licheng district (26.8%) was higher than that of Decheng district (10.1%).Through review and verification, we found that nearly80%subjects in two largeKTVs of Licheng district were infected by HSV-2. Logistic regression analysisshowed that the positive rate of syphilis in Decheng district was higher that ofLicheng district（OR=2.36，95%CI：1.13-4.92）and FSWs who began the firstcommercial sex before25years old had higher positive rate of HSV-2（OR=7.46，95%CI：3.29-16.90）.Conclusion1. FSWs who worked in low and middle places were mostly18-25years old,unmarried, and from other provinces. They had low levels of education; most ofthem were junior high school or lower level.2. Most FSWs need to provide for their family and FSWs working in low-gradeplaces had to work longer time, entertain more guests, but got less money. So, FSWsworking in low-grade places were more vulnerable to the threat of AIDS/STD. 3. FSWs with longer working life, especially the one intertwined with‘dequeue’and‘enqueue’had more dangerous sex behavior. Health education andcomprehensive behavior intervention should be implemented to change theirknowledge, awareness and behavior.4. The behavior of smoking and drinking was overflowed in FSWs. Whethersmoking or drinking would contribute to high-risk behavior need further study.5. The lack of knowledge on non-transmission of AIDS might lead to negativeemotion. Given that only37.6%FSWs ever had HIV testing in the last year, we had tostress the importance of ‘testing is prevention’.6. The sexual partners of FSWs were complex. When facing different partners,FSWs had different decisions in condom use. The rate of condom use with regularclients was higher than regulars, but lower than fixed sexual partner.It prompts thatwe should continue promoting the use of condom and improving FSWs’attitude andintention.7. The rate of condom use in FSWs who charged low in a single sex was lower.Stratified analysis showed that most of them were older, lower level of education andrecruited from the street-based venues. So, based on these characteristics oflow-grade place FSWs, we should make publicity items simpler and particularemphasis on improving the skill when negotiating condom use with clients.8. HSV-2appeared cross infection and outbreak in two KTVs of Licheng district.It prompts that the prevention and intervention of HIV in FSWs is a task whichbrooks no delay.9. In lower HIV epidemic areas, HIV antibody testing is not sensitive, HSV-2antibody detection may be a good indicators for sexually transmitted disease.