Ran Zhao

Vaginal Douching, Condom Use, and Sexually Transmitted Infections Among Chinese Female Sex Workers

Background and Objective: Vaginal douching has been hypothesized to increase a womans risk for human immunodeficiency virus (HIV) infection. However, data on the prevalence of this practice and its association with condom use and sexually transmitted infections (STIs) are limited. Study: A cross-sectional survey among 454 female sex workers (FSWs) in a Chinese county. Results: Vaginal douching was reported by 64.7% of the women. The prevalence of self-reported history of STI and that of current STI was 19.4% and 41.5%, respectively. Fifteen percent of the women reported consistent use of condoms with their clients and 8.4% with their regular partners. Vaginal douching was significantly associated with decreased use of condoms (with clients: OR = 0.31; with regular partner(s): OR = 0.22) and increased rate of self-reported STI history (OR = 1.95). However, there was no direct relation between douching and current STI. Over one third of the women believed that douching can prevent STI/HIV. Conclusion: Vaginal douching exposes FSWs to a high risk of STI/HIV. Medical professional and public health workers should correct womens misconception about the effectiveness of douching and discourage women from douching through educational activities.

Depressive symptoms and condom use with clients among female sex workers in China

This study examines the association between depressive symptoms and condom use with clients among 278 female sex workers (FSW) in Guangxi, China. About 62% of these FSW had a high level of depressive symptoms (CES-D total score >or=16). Multiple logistic regression analyses indicated that FSW with high level of depressive symptoms were less likely to use condoms consistently (aOR = 0.50, 95% CI: 0.28-0.89) or use condoms properly (aOR = 0.44, 95% CI: 0.20-0.99). The findings suggested that HIV prevention programs targeted at FSW should take into consideration the level of depression they experience.

Condom use and self-efficacy among female sex workers with steady partners in China

Abstract This study attempted to determine the association of self-efficacy with condom-use practice and to explore reasons of not using condoms among female sex workers (FSWs) with steady partners in China. Data from 309 establishment-based FSWs with steady partners in one Chinese county were collected through a cross-sectional study. Consistent condom use with steady partners was lower than with clients in entertainment establishments. Condom-use self-efficacy was positively associated with condom-use communication and condom-use frequency with clients but not with steady partners. It was positively associated with condom-use intention and skill with clients and steady partners. However, it was not associated with appropriate use of condoms. Significant differences of reasons about not using condom were also observed between the two partner types. The results may represent an important challenge to STD and HIV intervention programs aimed at achieving consistent condom use in FSWs. Health workers should focus on psychosocial factors affecting inconsistent condom use among FSWs with steady partners in China. In addition, intervention programs that can promote FSWs’ self-efficacy through condom-use skill training will still be necessary.

HIV/AIDS-related sexual risks and migratory status among female sex workers in a rural Chinese county

Abstract Currently, there are millions of female sex workers (FSWs) in China and these women play a critical role in the escalating HIV epidemic in the country. Existing studies revealed high mobility of this population, but data on the relationship of FSWs’ migratory status and their HIV/AIDS-related sexual risks are limited. A cross-sectional survey was administered among 454 FSWs in a rural county of Guangxi, China. Sexual risks and current infections of sexually transmitted disease (STD) were compared among local FSWs (i.e. those who were the county residents or from other parts of Guangxi) and those FSWs who migrated from outside Guangxi. Data reveal that local FSWs were younger, less educated and newer to the sex industry, and had more sexual risks and higher rates of STDs compared to migrant FSWs. This relationship remains significant after controlling for potential confounders. A higher level of sexual risks and STDs among local FSWs than migrant FSWs in the rural Chinese county suggests the need to examine the relationship between migratory status and HIV/AIDS-related risks within specific social and cultural contexts. The data also underscore an urgent need for culturally appropriate HIV/AIDS-prevention intervention efforts among FSWs in rural or less developed areas in China.

A Multilevel Analysis of Gatekeeper Characteristics and Consistent Condom Use Among Establishment-Based Female Sex Workers in Guangxi, China

Background: Multilevel analytical techniques are being applied in condom use research to ensure the validity of investigation on environmental/structural influences and clustered data from venue-based sampling. The literature contains reports of consistent associations between perceived gatekeeper support and condom use among entertainments establishment-based female sex workers (FSWs) in Guangxi, China. However, the clustering inherent in the data (FSWs being clustered within establishment) has not been accounted in most of the analyses. We used multilevel analyses to examine perceived features of gatekeepers and individual correlates of consistent condom use among FSWs and to validate the findings in the existing literature. Methods: We analyzed cross-sectional data from 318 FSWs from 29 entertainment establishments in Guangxi, China in 2004, with a minimum of 5 FSWs per establishment. The Hierarchical Linear Models program with Laplace estimation was used to estimate the parameters in models containing random effects and binary outcomes. Results: About 11.6% of women reported consistent condom use with clients. The intraclass correlation coefficient indicated 18.5% of the variance in condom use could be attributed to their similarity between FSWs within the same establishments. Womens perceived gatekeeper support and education remained positively associated with condom use (P < 0.05), after controlling for other individual characteristics and clustering. Conclusions: After adjusting for data clustering, perceived gatekeeper support remains associated with consistent condom use with clients among FSWs in China. The results imply that combined interventions to intervene both gatekeepers and individual FSW may effectively promote consistent condom use.

Factors Associated with Sexually Transmitted Infection Underreporting Among Female Sex Workers in China

OBJECTIVE To examine the underreporting of sexually transmitted infections (STI) (i.e., no STI by self-report but have at least one STI through biological testing or clinical examination) and factors associated with underreporting among female sex workers (FSWs) in China. METHODS A total of 454 FSWs were recruited from entertainment establishments in a rural county of Guangxi, China. Participants completed a self-administered survey about their demographic and working characteristics, history of STI (past or current infections), sexual history and practices, and HIV/STI-related knowledge and perceptions; 411 of the sample were also tested for syphilis, Neisseria gonorrheae, Chlamydia, Trichomonas, and genital warts. RESULTS About 18% (79 of 411) of the sample reported a history of STI (past or current infections). Biological testing or clinical examination revealed at least one STI (acute STI) for 42% (171 of 411) of the sample. Only 9% (37 of 411) of FSWs with acute STI reported an STI through self-report, which resulted in 33% (134 of 411) of FSWs who were considered underreporting their STI. STI underreporting was independently associated with younger age (adjusted odds ratio [aOR] 0.87, 95% confidence interval [CI] 0.76-0.99), a shorter duration of commercial sex (aOR 0.97, 95% CI 0.94-0.99), poorer knowledge of STI (aOR 0.81, 95% CI 0.70-0.94), and less sexual risks (aOR 0.52, 95% CI 0.41-0.66). CONCLUSIONS Underreporting of STI was prevalent in FSWs, especially among women with perceived lower STI risks. The underreporting might be largely due to their perception of low risks for STI and unawareness of STI symptoms (including asymptomatic STIs). Future studies of FSWs should identify those new in commercial sex with lower STI awareness and perceived risks and encourage them to seek timely and appropriate testing and treatment.

Can variation in HIV/STD-related risk be explained by individual SES? Findings from female sex workers in a rural Chinese county

Low socioeconomic status (SES) has been linked to HIV and sexually transmitted disease (STD) at a macro level because the majority of new cases of HIV infection in the world have been reported in underdeveloped or developing countries. However, empirical data on the relationship between individual SES and HIV/STD related risk have been mixed. Employing quantitative data from 454 female sex workers (FSWs), this study was designed to examine the profile of the study sample in terms of their individual SES, HIV/STD-related sexual risk across work locations with different social, cultural, and economic conditions; and to examine the relationship between work location and HIV-related risk behaviors, controlling for individual SES. We have shown in the current study that both SES and HIV/STD-related risk behaviors significantly differed by work location. However, the difference in individual SES was not sufficient to explain the difference of HIV/STD-related risk across the work locations. The findings underscore the need for effective prevention intervention efforts targeting FSWs in rural areas. Based on the findings, we also suggest that HIV/STD intervention efforts among FSWs should take the social and cultural contextual factors of their working environment (and sexual risks) into consideration.