Based on cross-sectional study of 794 low-paid FSWs in China we described their psychological fears related to commercial sex and examined the associations between fears and HIV-related behaviors. Fear of HIV infection was significantly associated with consistent use of condoms with clients. However, fear of breaching sex worker identity significantly prevented the FSWs from consistently using condoms with clients and taking HIV tests. Fear of being arrested by the police was positively associated with consistent use of condoms but negatively associated with accessing HIV prevention services.
Our findings underlined the importance of examining the triadic interaction of behavioral, psychological and environmental factors in HIV prevention interventions among low-paid FSWs.
Table 1
Summary of background characteristics among low-paid FSWs in China.
| N = 794 | Frequency (%) | Mean (SD) |
| Demographic factors | ||
| Age in years | 31.1(8.9) | |
| Ever married* | 506(64.1%) | |
| Guangxi residence* | 558(70.6%) | |
| Han-Ethnicity | 676(85.1%) | |
| Education < middle school | 324(40.8%) | |
| No. of people in household | 4.0(4.2) | |
| Annual household income | 14195.0(12132.9) | |
| Work-related factors | ||
| Length of working as sex workers ≥1year | 336(42.3%) | |
| Venue types | ||
| Feet massage salon | 75(9.40%) | |
| Hair salon | 332(41.8%) | |
| Roadside Restaurant | 137(17.2%) | |
| Mini-hotel | 71(9.0%) | |
| Other establishment-based venues | 63(7.9%)) | |
| Street-based | 116(14.6%) | |
| Age group of clients* | ||
| <30 | 47(5.9%) | |
| 30–50 | 635(80.3%) | |
| >50 | 109(13.8%) | |
| Charge per service (Yuan) | 39.6(17.8) | |
| No. of clients per week | 18.9(2.7) | |
| Income from sex work in past month (Yuan) | 1911.9(1254.2) | |
| Ever using drug | 26(3.3%) | |
| Eve being arrested by the police | 45(5.7%) | |
| HIV-related perceptions | ||
| High HIV awareness* | 502(63.3%) | |
| Low HIV susceptibility | 638(80.4%) | |
| Content of psychological fears | ||
| Fear of HIV infection | 482(60.7%) | |
| Fear of STIs | 403(50.8%) | |
| Fear of breaching sex worker identity | 356(47.7%) | |
| Fear of being arrested by the police | 317(39.9%) | |
| Fear of not getting paid by clients | 103(13.0%) | |
| Other fears | 8(1.4%) |
*Missing data was not included when we calculated the proportions.
Table 2
Correlations between fear and background characteristics among low-paid FSWs in China.
| Fear of HIV infection | Fear of STIs | Fear of breaching FSW identity | Fear of being arrested by the police | |||||
| No | Yes | No | Yes | No | Yes | No | Yes | |
| Demographic factors | ||||||||
| Age in years (Mean, SD) | 31.5(9.0) | 30.8(8.8) | 31.1(9.3) | 31.1(8.5) | 31.7(9.5) | 30.3(8.1)* | 30.7(8.7) | 31.9(9.2) |
| Ever married | 62.1% | 65.3% | 59.7% | 68.2%* | 63.7% | 64.4% | 61.9% | 67.2% |
| Guangxi residence | 70.0% | 71.0% | 71.6% | 69.7% | 73.1% | 68.0% | 72.4% | 68.0% |
| Han-Ethnicity | 88.8% | 82.8%* | 90.3% | 80.1%*** | 85.8% | 84.4% | 85.1% | 85.2% |
| Education < middle school | 62.5% | 57.1%* | 37.1% | 44.4%* | 58.6% | 59.9% | 63.1% | 53.3%** |
| No. of people in household (Mean, SD) | 4.2(4.1) | 4.0(4.4) | 3.9(3.0) | 4.2(5.1) | 4.6(4.9) | 3.5(3.2)*** | 4.3(4.5) | 3.6(3.9) |
| Annual household income(Yuan, Mean, SD) | 11741.6 (9929.9) | 15791.0 (13138.6)*** | 11421.9 (10829.3) | 16843.6 (12718.6)*** | 12228.4 (11551.7) | 16361.9 (12401.3)* | 12072.7 (11339.4) | 17422.8 (12598.2)* |
| Work-related factors | ||||||||
| Length of working as sex workers ≥1year | 36.9% | 45.9%*** | 37.1% | 47.4%** | 41.4% | 43.3% | 36.7% | 50.8%*** |
| Working in venues with less mobility (feet massage salons and hair salons) | 62.0% | 48.1%*** | 50.6% | 53.1% | 36.4% | 47.0%** | 55.8% | 46.1%** |
| Age group of clients (Year) | ||||||||
| <30 | 3.2% | 7.7% | 4.6% | 7.2% | 6.6% | 5.3% | 6.9% | 4.4% |
| 30-50 | 78.3% | 81.5% | 78.4% | 82.1% | 80.8% | 79.7% | 82.7% | 76.6% |
| >50 | 18.4% | 10.8%** | 17.0% | 10.7%* | 12.6% | 15.0% | 10.3% | 19.0%** |
| Charge per service (Yuan, Mean, SD) | 38.1(18.7) | 40.6(17.1) | 39.9(22.0) | 39.4(12.3) | 36.9(21.0) | 42.6(12.7)* | 38.1(20.4) | 41.8(12.5)* |
| No.of clients per week (Mean, SD) | 19.2(2.5) | 18.7(2.8) | 18.7(2.7) | 19.1(2.6) | 18.7(2.7) | 19.1(2.6)* | 19.1(2.6) | 18.6(2.7)* |
| income from sex work past month (Yuan, Mean, SD) | 1688.8 (872.7) | 2056.3 (1431.0)** | 1642.2 (1065.4) | 2173.5 (1364.7)*** | 1549.2 (887.5) | 2309.1 (1461.1)*** | 1795.1 (1001.4) | 2087.6 (1544.5)** |
| Ever using drug | 1.0% | 4.8%** | 2.8% | 3.7% | 4.8% | 1.6%*** | 1.7% | 5.7% |
| Eve being arrested by the police | 4.5% | 6.5% | 6.5% | 5.0% | 7.6% | 3.7%* | 5.5% | 6.0% |
| HIV-related perceptions | ||||||||
| High HIV awareness | 56.0% | 66.0%* | 64.4% | 62.3% | 65.8% | 60.6% | 61.6% | 65.8% |
| Low HIV susceptibility | 89.4% | 77.0%*** | 87.7% | 73.2%*** | 79.0% | 81.8% | 76.1% | 86.8%*** |
*p<.05, **p<.01, ***p<.001.
Full article at:
By:
1Prevention Research Center, Carman and Ann Adams Department of Pediatrics, School of Medicine, Wayne State University, Detroit, Michigan, United States of America
2Institute of Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
3Guangxi Center of Disease Control and Prevention, Guangxi, China
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