ORIGINAL ARTICLE

Decreasing STD incidence and increasing condom use among Chinese sex workers following a short term intervention: a prospective cohort study

S Ma^1,3, N H T M Dukers¹, A van den Hoek¹, F Yuliang², C Zhiheng², F Jiangting², Z Lina² and Z Xiuxing²

¹ Cluster Infectious Diseases, Municipal Health Service, Amsterdam, Netherlands
² Maternal and Neonatal Hospital, Guangzhou, China
³ Gansu Provincial Anti-Epidemic Station, Gansu, China

Correspondence to:
Correspondence to:
Nicole H T M Dukers, Municipal Health Service, Cluster Infectious Diseases, Nieuwe Achtergracht 100, 1018 WT Amsterdam, Netherlands;
ndukers{at}gggd.amsterdam.nl

Objective: To describe the impact of a repeating behavioural intervention focused on preventive education and provision of STD testing and treatment services to female sex workers.

Methods: A prospective cohort study of 966 sex workers (first of its kind in China) was conducted in Guangzhou from March 1998 to October 1999. At each visit information was collected on sexual behaviour, condom use and knowledge about HIV transmission and condom use, education was given, STD were diagnosed, and treatment was provided free of charge. We evaluated trends in condom use, knowledge about HIV transmission and condom use, and STD incidences. Generalised estimating equations were applied to control for repeated measurements.

Results: The proportion of consistent condom use increased from the intake through the third follow up visit (from 30% to 81%), as well as the proportion of having good knowledge on HIV transmission (4.3% to 98.6%) and condom use (23.6% to 79.3%). The incidence of gonorrhoea, trichomoniasis, and chlamydia decreased over each follow up visit; from 17.5/100 person years (PY), 22.4/100PY, 65.9/100PY at the first follow up visit to 5.1/100PY, 3.0/100PY, 16.1/100PY at the third follow up visit, for each STD respectively.

Conclusions: STD care and prevention programmes targeting sex workers are feasible in China and, more importantly, intervention consisting of prevention education and STD care is likely to reduce unprotected sexual behaviour and STD incidence in this group at high risk for HIV and other STD infection.

Keywords: sexually transmitted diseases; condom use; cohort study; sex worker; China; intervention programme

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