This paper analyses barriers to consistent condom use in the context of transactional sex among female sex workers in mainland China. It reveals how differences in socioeconomic profile and organisational hierarchies amongst different groups of sex workers create different barriers to condom use. Data was collected by means of field observation of entertainment venues and in-depth interviews. Findings suggest that, compared with other sex workers, street-walkers are less likely to use condoms with their clients, hold highly disadvantaged socioeconomic profiles and work in isolation. Major barriers to condom use link to economic deprivation and threats of violence from clients. For the women working in entertainment venues, drunkenness of clients, pricing mechanisms and familiarity with clients pose barriers to condom use. Yet within all these constraints women are not powerless and instead find ways to exercise agency and gain personal protection and economic advantage. In the newly emerging China, both structural hierarchies of work and individual agency inform condom use by female sex workers. Future HIV intervention programmes need to take these factors into account in order to meet the needs of different groups of women sex workers.

The influence of power, poverty and agency in the negotiation of condom use for female sex workers in mainland China.

Commercial sex plays a critical role in the heterosexual transmission of HIV in China. This study reviews behavioral studies in English literature on female sex workers (FSWs) in China from 1990 to 2006. Existing studies indicate that FSWs in China are young, mobile, most of them have both commercial and non-commercial sex partners; they have low rates of consistent condom use and high rates of STD infection. Some FSWs are also engaged in drug abuse. There is a great variation of sexual practices and HIV risks among FSWs across different work settings. Limited numbers of intervention studies have reported positive effects on increasing condom use and/or decreasing STD infections. Literature gaps and lessons learned from existing studies are identified and future research needs are discussed. Future behavioral intervention programs need to be multi-faceted and incorporate environmental and structural factors for different groups of FSWs.

Behavioral studies of female sex workers in China: a literature review and recommendation for future research.

Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas.

Prevalence and predictors of HIV infection among female sex workers in Kaiyuan City, Yunnan Province, China.

A cross-sectional prevalence survey of sexually transmitted infections (STIs) was conducted among female sex workers (FSWs) in Kunming Yunnan Province China. A total of 505 FSWs participated in the survey. All eligible participants gave informed consent. Demographic behavioral and clinical information of the participants was gathered by direct structured interviews. Tampon swabs were collected to test for Chlamydia trachomatis Nesseria gonorrhoeae and Trichomonas vaginalis and serum specimens were collected to test for HIV antibody by enzyme-linked immunosorbent assay (ELISA) screening and Western blot confirmation syphilis with rapid plasma reagin (RPR) and T. pallidum hemagglutination (TPHA) confirmation and for HSV-2 antibodies with the HerpeSelect 2 ELISA. The most prevalent bacterial STI was Chlamydia trachomatis (58.6%) followed by Trichomonas vaginalis (43.2%) and Neisseria gonorrhoeae (37.8%). Three hundred twenty-seven (65.1%) sex workers had serologic evidence of exposure to HSV-2 infection. Ten percent were positive for HIV infection all injecting drug users (IDUs); and 9.5% had infection with syphilis. Comprehensive prevention and effective STI services for sex workers and their clients will be the key strategies to the control of STIs including HIV. Policies and prevention strategies for STI/HIV need to focus on high-risk subpopulations such as sex workers (particularly sex workers who inject drugs) and their clients. (authors)

Sexually transmitted infections among female sex workers in Yunnan, China.

The objective of this study was to investigate the prevalence and risk factors of syphilis infection among female sex workers in a southwestern Chinese city along a drug trafficking route. From December 2004 to January 2005 343 female sex workers (FSWs) were recruited through community outreach and peer referring. Confidential questionnaire interviews were administered to collect information on sexual and other sexually transmitted diseases/HIV risk behaviors. Cervical and blood samples were collected to test for syphilis and HIV antibodies and Neisseria gonorrhoeae infection; Condyloma acuminatum infection was diagnosed clinically. Of 343 FSWs 15.7% were infected with syphilis. The prevalence of HIV gonorrhea and C. acuminatum was 0.6% 2.0% and 1.5% respectively. The subtype of 2 HIV-1 infections was both CRF 07BC. Nearly 10% of FSWs reported using illicit drugs. Consistent use inconsistent use and never use of condoms with commercial sex clients in the last month were reported by 53.9% 38.5% and 7.6% FSWs respectively. Longer duration of sex work (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.08 -3.62) working at low-end establishments (OR = 2.03; 95% CI = 1.10 -3.76) and if primary sex partners had sex with other women in the past 6 months (OR = 2.06; 95% CI = 1.08 -3.91) were independently associated with syphilis infection. High prevalence of syphilis and overlapped unprotected commercial sex and drug using behaviors among FSWs along a drug-trafficking route may suggest a potential for rapid spread of HIV from injection drug users to FSWs and then to the general population and underscore the urgency of preventive interventions to break the bridge of FSWs for HIV/sexually transmitted disease spread. (authors)

Syphilis among female sex workers in southwestern China : Potential for HIV transmission

Objective
To estimate HIV prevalence among injecting drug users (IDUs) in a drug trafficking city in southwest Sichuan Province, China

/pdf/continued-spread-of-hiv-among-injecting-drug-users-in-5bj2nvb6zh.pdf

Continued spread of HIV among injecting drug users in southern Sichuan Province, China

Objective To study hepatitis C virus (HCV) transmission through different modes of
sharing injection equipment and sexual behavior among injecting drug users (IDUs) in Liangshan of Sichuan
province. Methods A community-based survey was conducted to investigate past and current demographic
data,injection equipment sharing patterns and sexual behavior of IDUs. Blood samples were also taken to
test for HCV. The survey was conducted between Nov 8 and Nov 29,2002. 379 subjects were screened
through outreach recruitment and peer informing. SPSS(11.5) was used for data analysis. Results HCV
prevalence was 71.0%(269/379). Needles or syringes sharing in the past three months and past syphilis
infection were strongly associaled with HCV transmission after univariate analysis using chi-square test.
Trend analysis indicated that HCV infection rate increased along with the increase of needles or syringes
sharing,sharing of rinse water and the number of peers sharing the equipments. Data from multivariate
logistic regression showed that sharing of needles or syringes and history of syphilis infection were
significantly associated with HCV transmission. No significant difference was found between HCV infection
and sexual behavior after univariate analysis using chi-square test. Conclusion Further sero-epidemiological
prospective cohort studies should be conducted to clarify the relationship between different modes of sharing
injection equipment, sexual behavior and HCV infection.

[Study on the relationship between hepatitis C virus infection and sharing injection equipment, sexual behavior among injecting drug users].

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Syphilis among female sex workers in southwestern China : Potential for HIV transmission

Continued spread of HIV among injecting drug users in southern Sichuan Province, China

[Study on the relationship between hepatitis C virus infection and sharing injection equipment, sexual behavior among injecting drug users].