Differences in Risk Behaviours & HIV/STI Prevalence Between Low-Fee & Medium-Fee Female Sex Workers in Three Provinces in China

To better understand risk behaviours and factors associated with low-fee female sex workers (FSW) and support HIV/sexually transmitted infections (STI) epidemic control among this key population in China.

A cross-sectional study using convenience sampling to recruit 1487 eligible low-fee and medium-fee FSW was conducted in 2012 in three provinces. The participants were interviewed using a structured questionnaire and tested for HIV-1, herpes simplex virus (HSV)-2 and syphilis antibody. Log-binomial modelling was used to estimate prevalence ratios (PR) and examine factors associated with low-fee sex work.

Prevalence of HIV-1, syphilis and HSV-2 antibody positive were 0.5%, 4.8% and 27.8%, respectively. 

• Low-fee FSW were more likely to have HSV-2 infection, 
• but not more likely to have HIV-1 and syphilis infection compared with medium-fee FSW. 
• Compared with medium-fee FSW, low-fee FSW were 
• more likely to be ≥35 years of age, 
• engage in sex work ≥6 days/per week, 
• have ≥3 clients per day, 
• have clients decide condom use, 
• fail to persuade clients to use condoms, 
• express willingness to have unprotected sex in return for receipt of a higher fee, 
• have had genital symptoms in the past year and 
• have migrated from another city.

Low-fee FSW in China have unique risks for acquiring HIV/STI, in part due to greater economic pressures. Tailored interventions targeting low-fee FSW and incorporating their prevailing perception of HIV/STI risks and condom use negotiation challenges that they face are urgently needed.

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By: Han L1, Zhou C2, Li Z1, Poon AN1, Rou K2, Fuller S1, Li Y3, Shen L4, Kang D5, Huang L4, Liao M5, Fu X3, Shepard C1, Wu Z2, Bulterys M6.

• 1US Centers for Disease Control and Prevention (CDC) Global AIDS Programme (GAP), Beijing, China.
• 2National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
• 3Department of HIV/AIDS, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
• 4Department of HIV/AIDS/STD, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China.
• 5Shandong Provincial Center for Disease Control and Prevention, Jinan, China.
• 6US Centers for Disease Control and Prevention (CDC) Global AIDS Programme (GAP), Beijing, China Division of Global HIV/AIDS, Center for Global Health, CDC, Atlanta, Georgia, USA.  

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