Study On Sexual Risk Behaviors Of Four Targeted Populations For HIV/AIDS Prevention

BackgroundRecent studies offer significant evidence showing that the epidemic of acquired immune deficiency syndrome(AIDS) is still serious all over the world.Human immunodeficiency virus(HIV) infection/AIDS is still a major global public health and social problem since the first AIDS case was identified in 1981.During the past three decades,it has demonstrated that behavioral intervention is the most effective strategy for AIDS/HIV control and prevention.It is reported that almost 75%of the HIV infection and AIDS has spread via sexual contact.Thus,indiscriminate sexual behavior is a serious risk to overall health and well-being.Sexual risk behavior can be described as any sexual practices that result in sexually transmitted infections,including HIV/AIDS.From the available epidemiological data on sexual risk behavior across the globe, some subgroups are to be considered as the main focus of HIV/AIDS prevention and control because of their exposure to high risk sexual behaviors,such as female commercial sexual workers(FSWs),patients with sexually-transmitted diseases(STDs),drug users,and migrant rural workers.Greater efforts must be made to conduct research of sexual risk behavior and promote behavioral intervention among these high-risk populations.Many of available studies in China have not clearly defined sexual risk behavior and not all types of sexual risk behaviors were investigated, and there are few studies that linked sexual risk behaviors and multidimensional factors. ObjectivesThis study describes the prevalence of sexual risk behavior among selected groups,which include female commercial sexual workers (FSWs),patients with sexually-transmitted diseases(STDs),drug users, and migrant rural workers,and drug users,and its multidimensional determinants.Specific objectives include:1.To describe the demographic characteristics,population-specific behavior characteristics,sexual attitudes and STD/HIV/AIDS-related knowledge among the four groups.2.To understand the prevalence of all types of sexual risk behaviors and to understand the distribution of these behaviors among the four groups.3.To assess the sexual permissiveness among the four main populations by the scale of sexual permissiveness(SSP),which is composed from overseas quantificational measurements.4.To assess the level of risk of sexual practices,which are based upon the partner's infection status and the sexual practices which oneself employed.5.To identify risk factors,which include demographic characteristics,population- specific behavior characteristics,sexual attitudes,and related knowledge among the four groups.6.To provide scientific advice for promoting sexual risk behavioral intervention and preventing and controlling HIV/AIDS.MethodsThe design of the study is cross-sectional,in which 21 entertainment establishments in a district of Changsha City,the STD clinic of a polyclinic of Changsha City,a community which had almost 2500 migrant rural workers,and two enforced detoxification institutions in Changsha City are set as primary sampling units.Then,through targeted and facility-based sampling,associate with cluster sampling randomly, face-to-face interviews were carried out among the total of 961 samples were investigated by a self-designed structured questionnaire. The questionnaire was designed to include the items related to the following four domains:1.A questionnaire about background information used by the four groups.The content includes socio-demographic characteristics(e.g.,age, gender,and marital status) and population-specific behavior characteristics(e.g.,the age when FSWs begin their commercial sexual behavior,the health-seeking behavior of patients with STDs,the frequency of returning home for migrant rural workers,and the durg abuse characteristics of drug users.)2.A questionnaire about sexual behaviors was used for four groups, and the recall time that be stetted in the past year.The items related to sexual practices include the prevalence of all kinds of sexual risk behaviors,the number of sexual partners,the frequency of the sexual behavior,the partner's HIV infection risk status,and the frequency of condom use in sexual intercourse with different partners.3.The scale of sexual permissiveness,which is used to assess the sexual permissiveness of the four groups.4.A questionnaire about STDs and HIV/AIDS knowledge.Results1.With the criterion of each samples,210 FSWs were investigated, 172 finished the interview,response rates were 81.9%(172/210),and 140 samples of FSWs were successfully investigated.300 STD outpatients were investigated,and 212 finished the interview,response rates were 70.7%(212/300),and 200 samples of STD outpatients were successfully investigated.328 rural migrant workers were investigated,268 outpatients finished the interview,response rates were 81.7%(268/328), and 250 samples of rural migrant workers were successfully investigated. 314 drug users in two enforced detoxification institutions were investigated,309 finished the interview,response rates were 98.4% (309/314),and 309 samples of drug user were successfully investigated. Totally,961 samples that come from four target groups were interviewed, and 899 samples were successfully investigated.2.In the past year,the prevalence of all of types sexual risk behaviors among the four groups occurred as follows:2.1 In 140 FSWs sampled,the prevalence of unprotected sexual behavior with the commercial sexual partners was 42.5%(54/127).The prevalence of non-commercial sexual behavior was 87.1%(122/140), including 43.4%(53/122) casual sexual behavior.2.2 96.0%(192/200) of the STD patient sampled had regular sexual relationships,and 22.0%(44/200) of them had more than one regular partner.The prevalences of casual sexual behavior,commercial sexual behavior,and multiple partners sexual behavior were 26.5%(53/200), 40.5%(81/200),and 62.0%(124/200),respectively.And 39.5% (79/200) had sex with both commercial and non-commercial partners.2.3 238(95.2%) of the rural migrant workers sampled had regular sexual relationships,and 1.6%(4/250) of them had more than one regular partner.The prevalences of casual sexual behavior,commercial sexual behavior,and multiple partners sexual behavior were 4.1%(10/250), 10.0%(25/250),13.2%(33/250),) respectively.And 8.0(20/250) had sex with both commercial and non-commercial partners.2.4 279(90.3%) of the drug users sampled had regular sexual relationships,and 27.5%(85/309) of them had more than one regular partners.The prevalence of casual sexual behavior,commercial sexual behavior,and multiple partners sexual behavior were 38.2%(118/309), 25.9%(80/309),62.8%(194/309),respectively.And 8.0%(20/250) had sex with both commercial and non-commercial partners.The prevalence of homosexual behavior was 5.2%(16/309).3.Excluding FSWs sampled,the remaining third of the groups assessment of their total partner's HIV infection risk status resulted as below:3.1 22.7%of STD patients sampled reported their partners had no HIV infection risk,and 46 people(23.0%)sampled reported their partners had 'â… ' hierarchy in the level of risk,74 people(37.0%)sampled reported their partners had 'â…¡'hierarchy in the level of risk.3.2 84.0%of migrant rural workers sampled reported their partners had no HIV infection risk,and 16 people(6.9%) sampled reported their partners had 'â… ' hierarchy in the level of risk,24 people(9.6%) sampled reported their partners had 'â…¡'hierarchy in the level of risk.3.3 22.7%of drug users sampled reported their partners had no HIV infection risk,and 68 people(22.0%)sampled reported their partners had 'â… ' hierarchy in the level of risk,171 people(55.3%) sampled reported their partners had 'â…¡'hierarchy in the level of risk.4.Excluding FSWs sampled,the remaining third of the groups assessed their own levels of sexual risk behaviors resulted as below:4.1 52.5%of STD patients sampled reported there was no risk of their own sexual behavior,and the remaining 95(47.5%) sampled were 'â… ' hierarchy or higher. 4.2 89.2%of migrant rural workers sampled reported there was no risk of their own sexual behavior,and the remaining 27(10.8%) sampled were 'â… ' hierarchy or higher.4.3 18.1%of drug users sampled reported there was no risk of their own sexual behavior,and the remaining 243(81.9%) sampled were 'â… ' hierarchy or higher.5.The assessment of the sexual permissiveness of the four sampling groups shows that 72.9%of the FSWs,53.5%of the STD patients,50.0 %of the migrant rural workers,and 52.1%of the drug users sampled had the median scores of the scale of sexual permissiveness.The median scores of knowledge that related with STDs and HIV/AIDS for FSWs, STD patients,migrant rural workers,and drug users sampled were 13(P₂₅ = 11,P₇₅ =14),18(P₂₅ = 15,P₇₅ =21,17(P₂₅ = 15,P₇₅ =19) and 18(P₂₅ = 15,P₇₅ =20),respectively.6.The results of multiple logistic regression analyses are presented as below:6.1 Multiple logistic regression showed that having an unstable marital status(OR=3.087,95%CI=1.148-8.301) and coming from a rural area(OR=2.639,95%CI=1.410-4.941) were risk factors for FSWs sampled having unprotected intercourse with the commercial sexual partners.6.2 Male gender(OR=12.280,95%CI=5.419-27.854) was a risk factor while beginning the sexual debut two years older(OR=0.702, 95%CI=0.520-0.947) was the protective factor for STD patients sampled partners higher in the level of risk hierarchy.Multiple logistic regression showed that male gender(OR=4.764, 95%CI=2.027-11.200),having unstable marital status(OR=2.533, 95%CI=1.057-6.068),and high openness of sexual permissiveness (OR=2.563,95%CI=1.177-5.464) continued to be the three most important factors in predicting sexual risk behaviors for STD patients sampled.Beginning their debut later was the most protective factor for STD patients sampled sexual risk behaviors(OR=0.621 (95%CI=0.439-0.877).There is no significant association between level of knowledge that related STD/AIDS or population-specific characteristics with sexual risk behaviors.6.3 Multiple logistic regression showed that male gender (OR=5.882,95%CI=3.223-19.163),having unstable marital status (OR=5.517,95%CI=2.918-12.466),and high openness of sexual permissiveness(OR=3.397,95%CI=1.609-7.185) were the risk factors in predicting sexual risk behaviors for migrant rural workers sampled while beginning their debut two years older was the most protective factor for migrant rural workers' partners sampled who are higher in the level of risk hierarchy(OR=0.598,95%CI=0.427-0.813).Multiple logistic regression showed that having unstable marital status(OR=7.059,95%CI=2.892-17.230) and high openness of sexual permissiveness(OR=6.985,95%CI=1.481-32.939) continued to be the two most important factors in predicting sexual risk behaviors for migrant rural workers sampled.Beginning the sexual debut two years older was the protective factor for STD patients sampled sexual risk behaviors (OR=0.553,95%CI=0.316-0.968).There is no significant association between level of knowledge related to STD/AIDS or population-specific characteristics with sexual risk behaviors.6.4 Multiple logistic regression showed that having unstable marital status(OR=2.219,95%CI=1.328-3.629,male gender (OR=0.376,95%CI=0.204-0.696),not having a history of STDs (OR=0.226,95%CI=0.095-0.540),and the history of injection drug use (OR=0.494,95%CI=0.262-0.931) were the protective factors for drug users sampled partners higher level in the risk hierarchy.Multiple logistic regression showed that being from a rural area (OR=2.268,95%CI=1.039-4.953),having unstable marital status (OR=1.982,95%CI=1.001-3.924),and high openness of sexual permissiveness(OR=2.730,95%CI=1.415-5.266) continued to be the three most important factors in predicting sexual risk behaviors for drug user sampled.Beginning their sexual debut was the protective factor for STD patients sampled sexual risk behaviors(OR=0.553, 95%CI=0.316-0.968).There is no significant association between the level of knowledge related to STD/HIV/AIDS or population-specific characteristics with sexual risk behaviors.Conclusions:1.Sexual risk behavior was relatively common in the four main population groups.To modify the sexually risk behavior of these four groups is very important to prevent and control HIV transmission and the spread among general population.2.The dominant pattern of sexual risk behavior was a combination of commercial and non-commercial sex,the most common was in the FSW sampled,next was patients with STDs,and the lowest was the migrant rural population.As a result of these behaviors,these groups form a 'bridging population' for STD/HIV transmission in the social sexual network.We should intervene to control the transmission and spread of HIV/AIDS in local areas.3.The evaluation method for the risk scale of sexual behavior could directly express the apparent situation of sexual risk behavior in the groups with HIV infection and could differentiate the severe degree and distribution among the different population groups.Also,it could serve as a reference index for the surveillance of the sexual risk behavior in the main groups.4.According to multiple analyses,having stable married status was the main protection factor associated with sexual risk behavior in the four main groups.Sexual attitude with high opening degree was the main factor for the appearance of sexual risk behavior in the patients with STDs,as well as in the groups of migrant rural workers and drug users. There was no significant correlation between the level of knowledge and the appearance of sexual risk behavior in the four main groups.5.Commercial and non-commercial sexual risk behaviors were commonly seen in FSWs working in entertainment establishments.6.In general,among the four main groups,drug users was the group with the highest risk of sexual behavior.We should intervene on the sexual risk behavior of drug users as well as on the sharing of needles, especially paying attention to their unstable married status,history of sexually-transmitted disease infection,and history of injection drug use.