Epidemiological Survey Of AIDS Among Sex Workers In Xichang City, Sichuan Province

BackgroundFemale sex worker (FSW) are important bridge population of human immunodeficiency virus (HIV) transmitted from high risk population to general. The constitution ration of heterosexual transmission of acquired immune deficiency syndrome (AIDS) cases between2005and2009in China was11.3%,30.6%,38.9%,40.3%, and47.1%respectively, that present a rising trend year by year. Heterosexual transmission has become the major route of HIV transmission in China. Sexual transmission between spouse was accounted for one third of whole heterosexual transmission. The investigation shows, that there were at least6.4%male between20and64years old in China had experienced commercial sex with FSW. Therefore, it has important meaning to lower the prevalence of HIV of FSW in order to control the prevalence of general. With the sustain increase of HIV infection rate, the scheduled HIV test could be one of the key measures to control the prevalence of AIDS.HIV consulting and test could reduce the high risk behavior, and extending the coverage of the free HIV testing is beneficial for early diagnosis and promptly treated. However, there were few studies on the influence factors of HIV test among FSW in China. The documents about FSW in China mostly focus on analysis of surveillance data at present, but few reports about influence factors of HIV/syphilis. We therefore conducted a behavioral and serological survey of FSW in Xichang in order to access the prevalence and correlates of HIV testing and syphilis infection among FSW and the changes of related high risk behaviors, so as to provide valuable basis for establishing AIDS intervention measures.Objective1To understanding the prevalence of and factors associated with syphilis among FSW in Xichang.2To determine the prevalence of and factors associated with HIV testing in the past year among FSW in Xichang.3To assess the changes of high risk behaviors among FSW in Xichang by compare the data of2010and2004.MethodsA community-based survey was conducted to investigate demographic characteristics, sexual behaviors, condom use and drug use in FSW in voluntary counseling and testing (VCT) in Xichang Center for STD and Leprosy control. Blood samples were collected to test for HIV, syphilis, HBV and HCV. Using Epidata3.1to established database, two person input the data respectively then conduct consistency checks and modify the wrong information till the two database are complete coincident. We conducted descriptive statistical analysis, logistic regression analysis using SAS9.2software.Results404eligible FSW were recruited in May in2010. Among the FSW surveyed,11.6%(41/404)、12.3%(45/404)、12.8%(47/404)had unprotected sex behavior with their spouse, steady sex partners and clients respectively. The prevalence of HIV, syphilis, HBV and HCV was1.5%(6/404),12.1%(49/404),7.9%(32/404),1.2%(5/404) respectively. Multivariate logistic regression analysis showed that minority (adjusted odd ratio[AOR]3.1,95%confidence interval [CI]1.5-6.3). longer duration of sex work(AOR3.0,95%CI1.4-6.3) and having occupations other than sex work(AOR3.9,95%CI1.5-10.2) were independently associated with the risks of syphilis prevalence.Among the FSW surveyed,43.5%(177/404)of them ever had HIV test,35.15%(142/404) of them had ever participated in HIV testing in the last year. The result of multivariate logistic regression analysis showed that longer duration of sex work(AOR=3.0,95%CI:1.9-4.7), higher charge for one deal(AOR=2.1,95%CI:1.6-3.9), having more new sexual partners in the last month(AOR=1.65,95%CI:1.05-2.59), having no idea of where to test for HIV(AOR2.69,95%CI1.69-4.28) are the factors influencing the utilization of HIV test among FSW.47.8%(193/404) of them didn’t know where to have HIV test.91.58%(370/404) of them indicated that they would have HIV test if they learned where can do the free test for them in Xichang.Compared with FSW surveyed in2004, FSW investigated in2010were older(48.5%vs.40.5%, P=0.03), more minority(18.3%vs.12.0%, P=0.02), had high annual income(57.2%vs.29.2%, P<0.01), more from other province than Sichuan(15.1%vs.8.2%, P<0.01), less live in workplaces(46.3%vs.62.4%, P<0.01), less had. spouse or steady sex partners(45.0%vs.59.2%, P<0.01), higher age of the fist commercial sex(70.5%vs.63.0%, P=0.03), had longer duration of sex work(43.3%vs.35.3%, P=0.03). We used logistic regression to adjust for age, nationality, marital status, years of school completed and previous occupation before FSW, the results showed that compared with FSW surveyed in2004, FSW investigated in2010had larger number of sex trade with client in the last month(79.2%vs.70.9%, P<0.01), larger number of new sex partners in the last month(67.1%vs.54.0%, P<0.01),had low percentages of having unprotected sex with clients in the last month(9.4%vs.44.3%, P<0.01), lower percentages of ever use drug or methadone (1.7%vs.9.3%, P<0.01), and high average charge per sex trade(78.0%vs.66.5%,P<0.01),higher percentages of ever have an HIV test((53.8%vs.19.5%, P<0.01). Meanwhile, there was no significant difference among the FSW’ number of sex trade with spouse or steady sex partners, number of ever have unprotected sex with spouse or steady sex partners, infection of HIV and syphilis.ConclusionThe prevalence of syphilis was high among FSW in Xichang, it’s suggest that effective syphilis prevention and control progroms are urgently required, especially aim at FSW who were minority, longer duration of sex work or having occupations other than sex work. We need more information about risk factors of syphilis infection, and effective measures should be taken to control syphilis and other sexually transmitted diseases transmitted by this bridge population.The level of ever had HIV test and HIV testing in the last year were both low, and part of FSW had HIV test were not aware of their infection status. We should popularize AIDS knowledge, take anonymous or other more acceptable test methods and expanding advertising of free HIV test are the effect measures to raise the level of HIV test among FSW. Meanwhile, we should also encourage FSW to take HIV testing regularly, thus effectively control the spread of HIV in this population.Comparative data of two cross-sectional surveys showed that, although the unprotected sex with customers decline distinctly, the proportion of had unprotected sex with spouse or steady were still high. Meanwhile there was no significant difference of infection of HIV and syphilis between these two years. As to the great mobility and other factors caused the important bridge function, we should formulate more targeted intervention strategies and reinforce intervention efforts on the basis of high risk behavior changes.