Three Cross-sectional Studies Of HIV Prevalence And Related Factors Among Male Clients Of Female Sex Workers In Kaiyuan, Yunnan

Background:Commercial sex behavior has become more and more important in HIV transmission than before as sex gradually takes the place of drug injection to be the main route of HIV transmission. Studies have shown that HIV/STIs prevalence rates are higher in male clients of female sex workers(FSWs) than in other male population, and men who patronize FSWs often have more non-commercial sex partners than others. However, studies on HIV/STIs infection and transmission among clients are limited. Therefore, researches on HIV/STIs prevalence and factors among clients are significant for AIDS control and prevention in China.Objectives:To investigate HIV and HSV-2 prevalence among male clients, and to explore related factors of HIV and HSV-2 infection among this population; To explore the accuracy of HIV tests results of condom semen samples collected by FSWs which are used to replace blood samples of sexual partners of FSWs (clients and regular partners of FSWs), and its related factors.Methods:Three cross-sectional studies were conducted form April 2008 to May 2009, and each study took 1 month. Clients were recruited by outreach workers. Questionnaires were administrated through face-to-face interview, which include socio-demographic characteristics, related knowledge and attitude of HIV/STIs, health seeking behavior, sexual behavior and illegal drug use history. Blood samples were collected for HIV, HSV-2 and syphilis tests. In the third study, male sexual partners were recruited by FSWs, and their condom semen samples for HIV tests were collected by FSWs. Both FSWs and their sexual partners participated the questionnaire survey and provided blood samples.Results:In the three cross-sectional studies,315,314 and 334 clients were recruited respectively. (1)In the three cross-sectional studies, HIV prevalence rates were 6.0%(19/315), 8.0%(25/314) and 17.4%(58/334) in each study, and its increasing trend was statistically significant(P＜0.0001); HIV prevalence rates among clients who used illegal drug were 38.1%(8/21),40.0%(12/30) and 55.1%(43/78) in each study, but its increasing trend was not statistically significant(P=0.0953); HIV prevalence rates among clients who didn't use illegal drug were 3.7%(11/294),4.6%(13/284)和5.9%(15/256), but its increasing trend was also not statistically significant(P=0.2426). HSV-2 prevalence rates among clients were 27.8%(86/309),22.7%(71/313)和27.5%(92/334), but its trend was not statistically significant(P=0.9633); Syphilis prevalence rates among clients were 3.5%(11/315), 1.3%(4/314) and 1.8%(6/334), but its trend was also not statistically significant(P=0.1455). (2) In multivariate logistic analysis, the factors associated with HIV infection were illegal drug users (VS non-drug users, OR=14.3,95%CI 4.8-42.5) in the first study; Having regular partner at present (VS having no regular partner at present, OR=0.4,95%CI 0.1-0.9), illegal drug users (VS non-drug users, OR=11.1,95%CI 3.9-31.8), being infected with HSV-2 (VS being not infected with HSV-2, OR=7.4,95%CI 2.8-19.6) in the second study; Injection drug users (VS other clients, OR=35.8,95%CI 10.5-121.4), being infected with HSV-2 (VS being not infected with HSV-2, OR=11.2,95%CI 3.3-38.3) in the third study. (3) Among clients who participated at least two surveys in the three cross-sectional studies, cumulative new infection rate of HIV was 1.77%(2/113). (4) In the third survey,100 male sexual partners(57 clients,43 regular partners of FSWs) were recruited by 54 FSWs,100 condom semen samples were collected. Based on blood sample HIV tests results as'golden standard', the sensitivity rate of condom semen sample HIV tests results was 100% for both clients and regular partners, but specificity rates of them were 85% among clients and 91% among regular partners respectively. In univariate logistic analysis, related factors of false positive of condom semen samples from male sexual partners of FSWs were, sharing needles in drug injection(VS other FSWs, OR=5.630,95%CI 1.066-29.728) among FSWs, being a father(VS not being a father, OR=6.273,95%CI 1.447-27.190) among male sexual partners of FSWs.Conclusion:(1) There are high HIV and HSV-2 prevalence rates among clients in Kaiyuan, Yunnan; Using illegal drug and being infected with HSV-2 were two risk factors of HIV infection among clients; The rates of condom use with FSWs and regular sexual partners were low and some clients had multi non-commercial sex partners as well as using illegal drug. Therefore, clients are a'bridge population'who transmit HIV between high risk people (FSWs, illegal drug users) and general people (their regular sexual partners and other non-commercial sex partners). Accordingly, it is urgent to conduct deeper and more comprehensive health education and behavior intervention to extend and increase condom use among clients of FSW, and provide methadone maintenance treatment(MMT) and clean needle exchange especially among clients who use illegal drugs. Strengthen STIs surveillance while strengthen HIV surveillance, and provide standardized treatment for clients infected with STIs in time to reduce their risks of HIV/STIs transmission and infection. (2) Condom semen samples from male sexual partners collected by FSWs which are used to replace blood samples for HIV tests may overestimate HIV prevalence rate among this population because condom semen samples from HIV-negative sexual partners might be contaminate by vaginal secretions of HIV-positive FSWs as they didn't use condom correctly and completely during sexual intercourse. Thus, before asking FSWs to collect condom semen samples for HIV tests, education and training of using condom correctly should be conducted among FSWs to reduce and avoid false positive caused by contamination.