Background The fast growing heterosexual transmission of HIV in China has drawn global attention. Millions of female sex workers (FSW) play a critical role in the escalating epidemic. Existing studies on FSW in China have typically used venue, income or venue to categorise FSW and none developed a data-driven typology based FSW's HIV risks.
Methods A cross-sectional survey was administered among 1022 FSW recruited from 60 different types of entertainment establishments or personal service sectors in southwest China. FSW's HIV risk was measured by a composite score of 12 items on condom use, HIV testing, STD infection, drug abuse. We used multiple regression and graphics to illustrate the relationship between the HIV risk and key FSW characteristics including age, working venue, and income.
Results Unlike previous studies that assumed a linear relationship between HIV risk and age or income, our data revealed that the relationships between HIV risk or income varied by venue. For example, older FSW in clubs or massage parlour reported lower level of HIV risks compared to their counterparts whereas older FSW in saner or KTV reported higher level of HIV risks; but age was not significantly associated with HIV risk for FSW working in hair salons or streets. Income was positively associated with HIV risks; however, the association reversed after the income reached 1500 ¥ ($225). None of the key variables such as age, income, or venue can predict HIV risks singularly; in addition, all three variables need to be integrated to devise the appropriate typology.
Conclusion Our study suggests that it was too simplistic to categorise FSW HIV risks by a single indicator; the interactions between individual and environmental factors underscored the importance of multiple indicators for typology. Interventions to reduce HIV risks in FSW in China could be more focused and targeted those at highest risks.