Burden of HIV and Syphilis: A Comparative Evaluation between Male Sex Workers and Non-Sex-Worker Men Who Have Sex with Men in Urban China

The increasing burden of sexually transmitted infections (STIs) including HIV and syphilis among male sex workers (MSWs) is a major global concern. The aim of our study was to evaluate the difference between MSWs and non-commercial MSMs in China.

During 2008-09, in a cross-sectional study, 2618 adult MSM were recruited through respondent-driven and snowball sampling from seven cities of China. Information regarding socio-demographics, risk behaviors, HIV-related knowledge and STI-related symptoms were collected and participants were tested for HIV and syphilis.

Among 2618 participating MSM, 9.97% sold sex to males. HIV prevalence was 7.45% (6.13% among MSWs and 7.59% among non-MSW MSM) and syphilis prevalence was 14.32% (10.73% for MSWs and 14.72% for non-MSW MSM). Compared to non-MSW MSM, MSWs were more likely to be younger, never married, less educated, heterosexual, less knowledgeable regarding HIV, experiencing symptoms of STI, engaging in condomless vaginal intercourse and less likely to engage in condomless anal intercourse.

High HIV and syphilis prevalence warranted urgent intervention targeting MSWs as a separate sentinel group for efficient surveillance owing to their different distribution from non-MSW MSM. Although male sex workers and non-commercial homosexuals have similar rates of HIV and syphilis, MSWs have different characteristics which should be considered in designing intervention programs targeting them.

Table 2

Factors correlated with male sex work (MSWs) in China, 2008–2009 (N = 2618).

Variables		Unadjusted Model			Adjusted model*
		OR	95% CI	P-value	AOR	95% CI	P-value
Age		0.91	0.89,0.93	<0.001	0.91	0.88,0.93	<0.001
Marital status	Ever marred	Ref			Ref
	Never married	3.52	2.31,5.37	<0.001	4.38	2.83,6.8	<0.001
Residence	Sampling city	Ref			Ref
	Some province of sampling city	2.78	2.00,3.88	<0.001	1.15	0.88,1.49	0.30
	Other provinces	3.31	2.40,4.54	<0.001	1.13	0.86,1.48	0.37
Education	Primary school or below	9.79	5.06,18.96	<0.001	13.41	6.60,27.24	<0.001
	Junior or senior high school	5.84	4.12,8.27	<0.001	6.96	4.77,10.14	<0.001
	College or above	Ref			Ref
Venue	Pub, Disco, Tearoom, or Club	5.53	4.01,7.61	<0.001	5.01	3.55,7.08	<0.001
	Spa or bathhouse	1.84	1.19,2.84	0.01	1.76	1.10,2.80	0.02
	Park or Public Restroom	2.60	1.74,3.89	<0.001	3.12	1.98,4.94	<0.001
	Internet	Ref			Ref
	Others	1.17	0.64,2.13	0.62	1.15	0.62,2.12	0.66
Sexual orientation	Homosexual	Ref			Ref
	Heterosexual	14.61	7.15,29.85	<0.001	13.04	6.08,27.95	<0.001
	Bisexual	1.23	0.93,1.62	0.14	1.07	0.80,1.43	0.67
	Undecided	1.51	0.88,2.60	0.13	1.69	0.96,2.97	0.07
Knowledge	No	Ref			Ref
	Yes	0.74	0.55,1.00	0.05	0.70	0.51,0.96	0.03
Received HIV related service	No	Ref			Ref
	Yes	1.08	0.81,1.42	0.61	1.13	0.84,1.52	0.43
STIs related symptoms in the last year	No	Ref			Ref
	Yes	1.87	1.28,2.71	<0.001	2.16	1.47,3.19	<0.001
CAI in last six months	No	Ref			Ref
	Yes	0.97	0.75,1.26	0.83	0.91	0.70,1.19	0.50
CAI during last anal intercourse	No	Ref			Ref
	Yes	0.57	0.42, 0.77	<0.001	0.62	0.46, 0.85	0.003
CVI	No	Ref
	Yes	1.85	1.39,2.47	<0.001	1.55	1.13, 2.11	0.006
HIV	Negative	Ref			Ref
	Positive	0.80	0.47,1.35	0.39	0.72	0.42,1.24	0.23
Syphilis	Negative	Ref			Ref
	Positive	0.70	0.46,1.05	0.08	0.66	0.43,1.01	0.05

Note: * Model adjusted for city (seven cities), monthly income (≤2000/2001-6000/≥6000 USD),), social network size (1, 2–10, above 10) and Race (han, others)

Full article at: http://goo.gl/M4drdF

By: Tang W1, Mahapatra T2, Liu F3, Fu G4, Yang B3, Tucker JD5, Zhao J6, Detels R2.

• 1Guangdong Provincial Center for Skin Diseases and STIs Control, No. 2 Lujing Road, Guangzhou, 510085, China; University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510085, China.
• 2Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America.
• 3Guangdong Provincial Center for Skin Diseases and STIs Control, No. 2 Lujing Road, Guangzhou, 510085, China.
• 4Jiangsu Provincial Central for Disease Prevention and Control, Nanjing, Jiangsu, China.
• 5University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510085, China.
• 6Monitoring and Evaluation Unit, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland. 

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