Perceived HIV risks, types of sexually transmitted diseases, and discordant

infection status among low-tier female sex workers in China

(Roundtable Presentation)

Presenters: Shan Qiao, Chen Zhang, Xiaoming Li, Yuejiao Zhou, Wei Liu

Acknowledgement

Funding AgencyThe study was in part supported by NIH Research Grant

R01AA018090 by the National Institute for Alcohol Abuse and Alcoholism

Discordant infection status for an individual is defined as the discrepancy between biologically confirmed and self-reported sexually transmitted diseases (STD).

The awareness of their infection status is a key to modifying their sexual risk behaviors (Porter, Wall, & Evans 1993).

A literature gap exists in the global literature to examine the discordant infection status among high-risk populations (e.g., FSWs).

Background

Background Vulnerability of Low-tier FSWs in China

Personal Attributes

New arrivals from rural areas

The least knowledgeable on health risk of unprotected sex

Most desperate for financial survivals

Older age, less educated, lower SES

Work-Related Risks

Having little control over the sex practice with their clients

The least protected and often the main target of government crackdowns

Higher HIV/STD Prevalence

Facing higher and more severe risks in their life context (e.g., violence)

Existing Studies on Low-tier FSW in China

The low-tier FSW had highest prevalence of syphilis infection (9.7%, 95%CI: 8.3-11.1%), followed by the middle-tier (4.3%, 95%CI:3.6-5.0%), and higher-tier FSW (2.2%, 95%CI:1.6-2.9%)

Tucker et al. (2011)’s study indicated that the prominent syphilis epidemic among low-tier FSW with the prevalence estimate as high as 12.5% (IQR 4.1-20.1)

The prevalence of discordant infection status among the current sample

The current study aims to detect factors associated with discordant status among a sample of low-tier FSWs in China

Research Questions

A total of 907 FSWs were recruited from nine types of low-tier commercial sex venues in Guangxi, China.

FSWs who provided consented forms completed a self-administered cross-sectional survey on their demographic and behavioral information, as well as history of STD infection.

A blood sample for testing HIV, hepatitis C virus (HCV) and syphilis was also collected.

Method

Characteristics of low-tier FSW (N=907)

Low-tier FSW

The average age of FSWs in the current sample was 32.1 (14-68) years old

Majority of them cohabited with their partners and 43% of them had less than middle school education

Averagely, they have been working as sex workers for 24 months (SD=23.58)

The low-tier FSWs met 15 (SD=20.24) clients in the recent week and charged a price with 41 yuan (about 6 US dollars) (SD=21.18yuan) for each service

About 15% of them had clients more than 50 years old and 61% reported inconsistent condom use with clients last month.

In the current study, 16.0% of FSWs had discordant status with 7.8% of unrecognized STD infection and 8.2% of recovered cases.

More FSWs infected with gonorrhea (aOR=10.31, 95%CI=3.19, 33.29) and Chlamydia (aOR=21.41, 95%CI=3.74, 122.59) were likely to have discordant status compared to women with other types of STD (e.g., syphilis, genital herpes).

FSWs with higher perceived HIV risks were less likely to have discordant infection status (aOR=0.50, 95%CI=0.27, 0.94).

Results

The pervasive discordant status among the current sample underscored urgent needs to address this problem

Several specific STDs were more likely to be ignored by infected persons

Perceived HIV risk was a protective factor for discordant infection status among FSWs

Discussion

Socially desirable reporting and volunteer bias

Limited ability of generalizing the findings to other areas of China

Cross-sectional study design prevents us from making a causal conclusion between discordant status and its correlates

Limitation

Our findings reinforce the need for a multidimensional approach to HIV/STD preventions among this high-risk population

Resources and efforts are called for making the HIV testing and counseling service accessible and available without barriers

Effective educational outreach is needed

Empowerment-based interventions are needed among women in vulnerability

Implication

Questions