Acceptability To Oral Pre-exposure Prophylaxis For HIV Prevention And Associated Factors And Features Among Community Female Sex Workers

[Objectives]:1.To analyze the status of HIV/Syphilis infection,the related behaviors, HIV/AIDS knowledge and awareness, and to understand the epidemic trend in order to provide basis for making strategies of control and prevention.2.To study the acceptability and associated factors to oral pre-exposure prophylaxis for HIV prevention among FSWs, and to understand the market demand of oral pre-exposure prophylaxis.[Methods]The study combined a qualitative and quantitative study. In the quantitative study, a cross-sectional survey was employed and 277 FSWs were recruited using stratified cluster sampling. High, middle-and-low grade entertainment were involved(bath center and nightclub were classified as high grade; KTV and guesthouse and hotel were classified as middle grade; roadside restaurants and salon were classified as low grade). The trained interviewers interviewed the FSWs and filled in the questionnaires anonymously after gained the consent of FSWs. Blood samples were collected to test for HIV and syphilis antibody.Information on demographic characteristics, HIV related knowledge,attitudes sexual behaviors, history of sexually transmitted infection, history of drug use, and PrEP acceptability score were collected using standard questionnaire. The scale contains 12 items:8 indicators provided information on formulation, mode and dose,color and smell, privacy;4 indicators provided information on efficacy, pharmacology, side effects. The Likert-type four-point scale indicated satisfactory reliability, as revealed by alpha coefficient(α=0.858), in the condition of the golden standard based on "intend to use future" with showing virtual drug. Epidata version 3.1 software was used for data input and management and SPSS version 19.0 software was used for data analysis. Quantitative data was analyzed using univariate and then further multivariate logistic[Results]1.6 FSWs were recruited for qualitative study.A total of 277 FSWs were recruited for quantitative study,including 81 from A town,43 form B town,63 from C town,90 from D town, alternatively including 29 from low grade settings,91 from middle grade settings,157 from high grade settings. The average age of the participants was 23 years; 60.6% of them were single 9.4% married,27.4% cohabited,2.5% divorced or separated; 91.0% of FSWs migrated from other provinces, majority(20.8%) is Guangxi province; majority(94.2%) had junior high school education or above; majority(57.4%) over one year local work experience.2.18.4% FSWs perceived the risk of HIV infection. The study showed that the proportion of awareness of HIV/AIDS knowledge was 69.0%,the score on HIV transmission route knowledge was 1.63±0.95 (x±s),the score on HIV non-transmission route knowledge was4.23±1.27 (x±s);218(78.7%) participants used condoms for their last commercial sex; 223(80.5%) FSWs had commercial sex trades last week,; the number of clients during the lastweek range from 0 to 19, with an average of 4.75±5.30(x±s); 146(52.7%) FSWs had both regular partners and commercial partners; 22(7.9%) had experienced violence duting the last 6 months; 131 (47.3%) FSWs used contraceptive or drugs for venereal diseases; 63 (22.8%) FSWs had a history of drug addiction; 244 (88.1%) FSWs had a history of alcohol addiction, 39 (14.1%) of whom were alcohol dependence; 27 (9.7%) FSWs had ever been diagnosed with a STD; 137 (49.5%) FSWs accepted more than one intervention service.3.There were 0 HIV infected case,22 cases with syphilis antibody positive. The syphilis prevalence was 1.08%(3/277)4.None of 277 FSWs had ever heard of PrEP. The proportion of acceptability to PrEP was 72.2%. The mean score on drug characteristic was 2.71±0.76 (x±s), and the mean score on pharmacology was 2.83±0.83 (x±s).Univariate analysis indicated that the acceptability varied by the sites grade, marital status, income, awareness of HIV, perceived risk of HIV infection, knowledge of HIV, no condom use for the last commercial sex, having clients last week, number of clients last week, frequency of condom use last month, having had contraceptive or drugs for venereal diseases, having been diagnosed with a STD, scores on pharmacology,free of charge. Logistic regression analysis showed that being from high-grade entertainment place(X3), being married or cohabited (X4) inconsistent condom use (X13),scores on pharmacology (X17),free for charge (X18) were associated with acceptability to PrEP, and the prediction model was p(1)=1/[1+e-(-4.979-1.223x3+0.782x4+0.922x13+2.707x17+0.124x18)]. Majority of interviewees believed that they would like to accept PrEP with characteristics of tablet, low dose, colorful, efficiency, minor side effects.5.210 (75.8%) FSWs intended to use PrEP if free for charge,193 (69.7%) FSWs would pay for money,87(31.4%) FSWs would rather choose no more than 5 yuan. The proportion of acceptability to PrEP was 72.2%(200/277),187(93.5%) FSWs hope use drug under the guidance, and 195 (97.5%) FSWs would recommend PrEP to other peers.[Conclusion]1. The proportion of awareness of HIV knowledge among FSWs was 69.0%,the percentage of condom use for their last commercial sex trade was 78.7%,the proportion being covered by intervention services was 49.5%.2. HIV/Syphilis prevalence in ZhongShan city was still low.3. The proportion of acceptability to PrEP among FSWs was high. Factors including being from high- grade entertainment place, being married or cohabited, inconsistent condom use, scores on pharmacology, free for charge were associated with acceptability4. PrEP will be an important adjunct to the HIV prevention service, and market foreground is vastitude.