OBJECTIVES:
This
study addresses the lack of empirical studies about the epidemic of syphilis
among middle-aged female sex workers (FSWs). The objectives of this study were
to investigate prevalence of syphilis, and its potential risk factors among
middle-aged FSWs in China.
DESIGN:
A
cross-sectional study with respondent-driven sampling (RDS).
SETTING:
A
multisite study conducted at three Chinese cites (Nanning, Hefei, and Qingdao)
with different levels of sexually transmitted diseases in 2014.
PARTICIPANTS:
1245
middle-aged female sex workers who were over 35 years old (about 400 per study
site).
MAIN OUTCOME MEASURES:
Unprotected
commercial sex, and syphilis and HIV infection were biologically tested and
measured.
RESULTS:
The
RDS-adjusted prevalence of active syphilis was 17.3% in Hefei, 9.9% in Qingdao,
and 5.4% in Nanning. The RDS-adjusted prevalence of prevalent syphilis was
between 6.8% and 33.6% in the three cities. The proportion of unprotected sex
in the past 48 h verified by the prostate-specific antigen test (PSA) was
between 27.8% and 42.4%. Multiple log-binomial regression analyses indicate
that middle-aged FSWs who had 5 or more clients in the past week prior to
interviews and engaged in unprotected sex were more likely to be active
syphilitic cases. Middle-aged FSWs who had rural residency were less likely to
be active syphilitic cases.
CONCLUSIONS:
In
contrast with previous studies that reported low prevalence of syphilis and
high prevalence of protected sex among FSWs in China, both the prevalence of
syphilis and unprotected sex were high among middle-aged FSWs. Evidence-based
intervention programmes should be developed and evaluated among this vulnerable
population in China and other countries with similar settings.
Below: Location of the three study sites (Qingdao, Hefei, and Nanning)
1Department of Epidemiology and Biostatistics, School
of Public Health, University of Maryland, College Park, Maryland, USA.
2Department of Epidemiology and Biostatistics, College
of Public Health, Temple University, Philadelphia, Pennsylvania, USA.
3Department of Community Health Sciences, UCLA Fielding
School of Public Health, Los Angeles, California, USA.
4Department of AIDS/STD Prevention, Nanning Center for
Disease Control and Prevention, Nanning, Guangxi, China.
5Department of AIDS/STD Prevention, Hefei Center for
Disease Control and Prevention, Hefei, Anhui, China.
6Department of Epidemiology, School of Public Health,
Shandong University, Jinan, Shandon, China.
BMJ Open. 2016 May 10;6(5):e010420. doi:
10.1136/bmjopen-2015-010420.
