Abstract
Commercial sex is believed to play a role in the steadily increasing heterosexual transmission of HIV in China, but little attention has been paid to female sex workers working in the entertainment industry. From October to December 2000, we conducted a cross-sectional survey of 482 women in Baise City, Guangxi Autonomous Region, bordering Yunnan Province. Although no participants had antibodies to HIV infection, 4% of study participants tested positive for markers for syphilis and 21% reported being diagnosed with sexually transmitted diseases in the past year. Women reported low rates of consistent condom use with customers (17%), a spouse or fiancé (9%), and casual partners (13%). A substantial proportion experienced condom failure (20% slippage and 13% breakage). Multivariate analyses found that consistent condom use with customers was related to multiple sexual partnerships, higher condom knowledge, and higher condom-use negotiation skills. Multiple sexual partnerships and higher condom-use negotiation skills predicted consistent condom use with casual partners, whereas higher condom-use negotiation skills did so for consistent condom use with a spouse or fiancé. Our data suggest the need for condom education, condom skills training, and the distribution of reliable condoms among female sex workers. HIV prevention efforts must target these women as well as their clients and sex partners to prevent the further spread of HIV to the general population in China.
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REFERENCES
Anonymous. (2001, July 31). Thirty percent of Chinese condoms not 'up to standard.' Agence France-Press.
Bhave, G., Lindan, C. P., Hudes, E. S., Desai, S., Wagle, U., Tripathi, S. P., and Mandel, J. S. (1995). Impact of an intervention on HIV, sexually transmitted diseases, and condom use among sex workers in Bombay, India. AIDS, 9(Supplement 1), S21-S30.
Chen, J., and Liu, W. (1998). An outbreak of HIV infection among drug users in Baise City of Guangxi Autonomous Regions, China. Unpublished data.
China Ministry of Health and UN Theme Group on HIV/AIDS in China. (1997). China responds to AIDS: HIV/AIDS situation and needs assessment report. Beijing: Ministry of Health.
Crofts, N., Costigan, G., Narayanan, P., Gray, J., Dorabjee, J., Langkham, B., Singh, M., Peak, A., Aquio, C., and Deany, P., for the Asian Harm Reduction Network. (1998). Harm reduction in Asia: A successful response to hidden epidemics. AIDS, 12(Supplement B), S109-S115.
Grady, W. R., and Tanfer,K. (1994). Condom breakage and slippage among men in the United States. Family Planning Perspectives, 26, 107–112.
Hilton, A., Thompson, R., Moore-Dempsey, L., and Janzen, R. G. (2001). Harm reduction theories and strategies for control of human immunodificiency virus: A review of the literature. Journal of Advanced Nursing, 33, 357–370.
Liu, W. (2001). Evaluation of an intervention designed to reduce risk behaviors among woman engaged in illegal commercial sex activities in frontier areas of Guangxi Province. Chinese Journal of STD/AIDS Prevention and Control, 7, 223–225.
Marin, B. V., Gómez, C. A., Tschann, J. M., and Gregorich, S. (1997). Condom use in unmarried Latino men: A test of cultural constructs. Health Psychology, 16, 458–467.
Mills, S., Benjarattanaporn, P., Bennett, A., Pattalung, R. N., Sundhagul, D., Trongsawad, P., Gregorich, S. E., Hearst, N., and Mandel, J. S. (1997). HIV risk behavioral surveillance in Bangkok, Thailand: Sexual behavior trends among eight population groups. AIDS, 11(Supplement 1), S43-S52.
Morris, M., Podehisita, C., Wawer, M. J., and Handcock, M. S. (1996). Bridge populations in the spread of HIV/AIDS in Thailand. AIDS, 10, 1265–1271.
Qu, S. (2001, April 16). National AIDS/HIV surveillance and current HIV epidemic status in China. Presented at the National Workshop on HIV/STI surveillance, Nanjing, China.
Spruyt, A., Steiner, M. J., Joanis, C., Glover, L. H., Piedrahita, C., Alvarado, G., Ramos R., Maglaya, C., and Cordero, M. (1998). Identifying condom users at risk for breakage and slippage: Findings from three international sites. American Journal of Public Health, 88, 239–244.
Thuy, N. T. T., Lindan, C. P., Hoan, N. X., Barclay, J., and Khiem, H. B. (2000). Sexual risk behavior of women in entertainment services. AIDS and Behavior, 4, 93–101.
van den Hoek, A., Fu, Y., Dukers, N. H., Chen, Z., Feng, J., Zhang, L., and Zhang, X. (2001). High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: Potential for fast spread of HIV. AIDS, 15, 753–759.
Weniger, B. G., Limpakarnjanarat, K., Ungchusak, K., Thanprasertsuk, S., Choopanya, K., Vanichseni, S., Uneklabh, T., Thongcharoen, P., and Wasi, C. (1991). The epidemiology of HIV infection and AIDS in Thailand. AIDS, 5, S71-S85.
Wu, Z. (2000). Preventing HIV infection among injection drug users in China. Unpublished manuscript.
Yu, E. S. H., Xie, Q., Zhang, K., Lu, P., and Chan, L. L. (1996). HIV infection and AIDS in China, 1985 through 1994. American Journal of Public Health, 86, 1116–1122.
Zhang, F. (2001, August 3). AIDS prevention efforts deepen. China Daily.
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Qu, S., Liu, W., Choi, KH. et al. The Potential for Rapid Sexual Transmission of HIV in China: Sexually Transmitted Diseases and Condom Failure Highly Prevalent Among Female Sex Workers. AIDS Behav 6, 267–275 (2002). https://doi.org/10.1023/A:1019848026130
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DOI: https://doi.org/10.1023/A:1019848026130