What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China?

China's rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. 

This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. 

In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of sexually transmitted infections (STIs), having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. 

These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings.

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By:  Mantell JE¹, LeVasseur MT, Sun X, Zhou J, Mao J, Peng Y, Zhou F, DiCarlo AL, Kelvin EA.

¹ HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA.

Glob Public Health. 2015;10(8):947-67. doi: 10.1080/17441692.2015.1045918.

  

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Multiple Abortions and Sexually Transmitted Infections among Young Migrant Women Working in Entertainment Venues in China

We conducted a survey of 358 young migrant women working in entertainment venues in China to explore the prevalence of and factors associated with two indicators of sexual and reproductive health: (1) multiple abortions and (2) the dual risk of sexually transmitted infections (STI) and abortion history. 

One quarter (25.4 percent) of the women in this sample had multiple abortions during their lifetime and, of those with any abortion history, 18.3 percent had had an abortion outside of a regulated health clinic. 

One-third (33.0 percent) of the sample had had an STI during the past year, and approximately one-fourth (23.7 percent) of those women did not receive STI treatment in a public hospital. 

Approximately one-fourth (23.5 percent) of the sample reported both a history of abortion and an STI during the past year. Women with a history of multiple abortions had significantly lower income levels, were more likely to have sex with clients and with husbands, and tended more to use alcohol before sex. 

Women who experienced both abortion and STI risks were more likely to report having had unprotected sex, genitourinary tract infections symptoms, anxiety, illicit drug use, and suicidal ideation. 

Enhanced efforts are needed to improve reproductive and sexual health for female migrants in urban China, particularly those working in entertainment venues.

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By:  Dong Y1, Zhang H, Wang Y, Tao H, Xu S, Xia J, Huang W, He H, Zaller N, Operario D.

• 1 Department of Adolescent Health and Maternal and Child Health, School of Public Health , Anhui Medical University , Hefei , Anhui Province , China. 

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Factors Associated with Induced Abortion among Female Entertainment Workers: A Cross-Sectional Study in Cambodia

OBJECTIVE:

To explore risk factors associated with induced abortion among sexually active female entertainment workers (FEWs) in Cambodia.

PARTICIPANTS:

This study included 556 FEWs aged 18-47 years randomly selected from entertainment establishments in the two cities in 2014 using a two-stage cluster sampling method. Data were collected through face-to-face interviews using a structured questionnaire.

RESULTS:

Of the total sample, 45.6% reported currently using a contraceptive method with condom (42.4%) being the most common method, followed by pills (25.6%). One-fourth (25%) of the respondents reported having been pregnant at least once, and 21.4% reported having at least one induced abortion during the time working as a FEW. After controlling for other covariates in a multivariate logistic regression model, FEWs with a history of induced abortion remained significantly more likely to be currently working in a karaoke bar, to have worked longer as a FEW, to have had a greater number of sexual partners in the past 12 months, to be currently using a contraceptive method, to be able to find condoms when they needed them, and to report inconsistent condom use with non-commercial partners in the past 3 months.

CONCLUSIONS:

This study highlights the high rates of unwanted pregnancies that ended in induced abortions among FEWs in Cambodia. Access of FEWs to quality sexual and reproductive healthcare services is deemed a high priority. Integrated interventions to improve sexual and reproductive health among these vulnerable women should be tailored to reach the most-at-risk groups.

Full article at:  http://goo.gl/GIsphP

By:  Siyan Yi,1,2 Sovannary Tuot,1 Pheak Chhoun,1 Khuondyla Pal,1 Khimuy Tith,1 and Carinne Brody2

¹Research Center, KHANA, Phnom Penh, Cambodia

²Center for Global Health Research, Public Health Program, Touro University California, Vallejo, California, USA

Correspondence to Siyan Yi; Email: moc.rotcod@nayis

 

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The Impact of Healthcare Access on Knowledge and Willingness for HIV Testing in Chinese Female Entertainment Workers

Chinese female entertainment workers are at high risk for HIV. We assessed the impact of healthcare access on HIV knowledge, condom use, and their willingness to receive HIV testing. 

We surveyed 257 entertainment workers in a cross-sectional study. Demographic, knowledge, and behavioral risk factors were examined. Of 257 women, 107 (42.1 %) reported inconsistent condom use. Only 9 % had prior HIV testing. Their HIV knowledge was generally poor. Having access to healthcare, being able to obtain condoms, and managers providing health information were associated with consistent condom use (all P < 0.01). 

Having access to healthcare was related to previous HIV testing (P < 0.01). Our study showed that having a doctor and access to healthcare had positive effects on HIV knowledge and likelihood of condom use and previous HIV testing. 

Chinese medical providers can play a significant role in encouraging HIV testing and outreach in migrant women employed at entertainment venues.

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By: Sio TT1, Chang K, Jayakrishnan R, Amitai A, Xu H, Zaller ND, Fu JJ, Mayer KH, Wu LH.

• 1Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA, Sio.Terence@mayo.edu.  

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HIV Risk & Sexual Health among Female Migrants in China

Sexual behavior is the dominant mode of HIV transmission in China, and young female migrants are among the populations at highest risk. This article examines how HIV-related risk behaviors among female migrants might vary according to workplace settings. 

Participants were young female migrants recruited from three workplace settings-factories, restaurants and entertainment venues. In a cross-sectional survey, we assessed 457 participants' sociodemographic characteristics, HIV/AIDS-related knowledge, condom use knowledge, sexual behaviors, condom use behavior and reproductive health factors. Participants working in entertainment venues were significantly more likely than those working in factories and restaurants to report sexual behavior, unprotected sex, multiple pregnancy terminations and sexually transmitted infections (STI). 

However, participants working in factories and restaurants reported significantly lower levels of HIV/AIDS knowledge, condom use knowledge, condom use self-efficacy and history of HIV/AIDS counseling and testing. Independent correlates of unprotected sex included employment in an entertainment venue, abortion history and sexual self-efficacy. Independent correlates of STI or genitourinary tract infection included employment in an entertainment venue, abortion history, recent migration and recent unprotected sex. 

These findings indicate a need for sexual and reproductive health interventions prioritizing young female migrants, and call for programs that can be incorporated into different workplace settings.

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By: Huang W1, Dong Y1, Chen L1, Song D1, Wang J1, Tao H2, Zaller N3, Zhang H1, Operario D4.

• 1School of Public Health, Anhui Medical University, Anhui, China.
• 2Luyang District Center for Disease Control and Prevention, Hefei, Anhui Providence, China.
• 3Fay W. Boozman College of Public Health, University of Arkansas, Little Rock, AR, USA.
• 4School of Public Health, Brown University, 121 South Main Street, Providence, RI, USA don_operario@brown.edu.  

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A Systematic Review & Meta-Analysis of the Prevalence, Trends & Geographical Distribution of HIV among Chinese Female Sex Workers (2000-2011): Implications for Preventing Sexually Transmitted HIV

The aim of this meta-analysis was to investigate temporal and geographical trends in the HIV epidemic among female sex workers (FSWs) recruited from various venues in China.

Chinese and English peer-reviewed articles published between January 2000 and February 2013 were systematically searched. Standard meta-analysis methods were used to calculate the pooled HIV prevalence, in accordance with the PRISMA guidelines.

• The national HIV prevalence among FSWs declined from 0.74% in 2000-2002 to 0.40% in 2009-2011. 
• All Chinese regions demonstrated significant declines in HIV prevalence, apart from the East and South Central regions, in which the epidemics stabilized at low/moderate levels. 
• Despite a significant decline from 1.92% to 0.87% during 2000-2011, Southwest China still bore the greatest HIV disease burden. 
• Nationwide, FSWs recruited from detention centres had the highest HIV prevalence, followed by voluntary counselling and testing sites and entertainment venues. 
• The prevalences among FSWs in high-, middle-, and low-tier entertainment venues were 0.59%, 0.92%, and 1.10%, respectively. 
• High- and middle-tier FSWs had a significantly lower risk of HIV infection than lower-tier FSWs (high/low: odds ratio (OR) 0.48, 95% CI 0.40-0.59; middle/low: OR 0.49, 95% CI 0.37-0.66).

The HIV epidemic has shown a gradual declining or stabilizing trend among Chinese FSWs. Intervention efforts should be diverted to high-risk subgroups of FSWs, such as drug-using and low-tier FSWs.

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Below:  Estimated HIV prevalence among female sex workers across the six regions in China during 2000–2011

Below:  The six Chinese geographical regions. The number in each province represents the number of publications reporting HIV prevalence among female sex workers (n = 456). The number in brackets represents the total number of HIV prevalence estimates identified (n = 848).

By: Zhang L1, Chow EP1, Su S2, Yiu WL2, Zhang X3, Iu KI2, Tung K2, Zhao R3, Sun P3, Sun X3, Yuan L4, Muessig KE5, Tucker JD6, Jing J7.

• 1Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
• 2The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
• 3Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
• 4The School of Sociology and Population Studies, Remin University of China, Beijing, China.
• 5The University of North Carolina Project-China, Guangzhou, China; Department of Health Behavior, Gillings School of Global Public Health at the University of North Carolina, Chapel Hill, North Carolina, USA.
• 6The University of North Carolina Project-China, Guangzhou, China; London School of Hygiene and Tropical Medicine, London, UK.
• 7Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
• 
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Characteristics, Risk Behaviors & Factors Associated with Abortion among Female Entertainment Workers in Cambodia

Background

Linkages between HIV and reproductive health (RH) among female entertainment workers (EWs) have not been addressed well in most developing countries. In Cambodia, there has been considerable research on HIV epidemiology among EWs. However, there have been limited studies on RH and specifically factors related to abortion. We examine socio-behavioral characteristics, and RH practices as determinants of abortion among Cambodian EWs.

Methods

A survey was conducted in Siem Reap and Battambang and Phnom Penh provinces/city among EWs in September 2012. Trained female interviewers administered the survey to 595 EWs. Two-stage cluster sampling was used to select EWs. Bivariate associations were examined using chi-squares; univariate and multivariate logistic regression were used to assess factors independently associated with reporting having at least one abortion while working as an EW.

Results

Three-quarters (75 %) of EWs were sexually active, of which nearly one third reported at least one abortion while working as an EW. About 40 % of EWs reported recent an abortion in the past six months. Contraceptive use in the past year was low. Factors found to be independently associated with reporting a recent abortion included: ages 25–29 (OR = 2.2, 95 % CI: 1.2–4.0), living with spouse/cohabitated partner (OR = 2.2, 95 % CI: 1.1–4.2), longer duration of entertainment work (OR = 4.8, 95 % CI: 2.5–9.2), higher number of partners (OR = 4.4, 95 % CI: 2.2–8.7) and being a karaoke worker (OR = 2.2, 95 % CI: 1.1–4.4).

Conclusion

This study highlights a high proportion of EWs reporting abortion. While HIV vulnerability of EWs has been clearly established, broader RH needs have gone largely unrecognized and not prioritized. Though HIV/RH integrated initiatives have been introduced by the HIV program, challenges for EWs with multiple risks from professional and partners are profound. Therefore, there is an urgent need for practical programmatic approaches to help address their RH needs.

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