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Original article
Vulnerabilities, health needs and predictors of high-risk sexual behaviour among female adolescent sex workers in Kunming, China
  1. Xu-Dong Zhang1,
  2. Marleen Temmerman1,
  3. Yan Li2,
  4. Wei Luo3,
  5. Stanley Luchters1,4,5
  1. 1International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
  2. 2School of Public Health, Kunming Medical University, Kunming, Yunnan, China
  3. 3STI Unit, Kunming Center for Disease Control, Kunming, Yunnan, China
  4. 4Centre for International Health, Burnet Institute, Melbourne, Victoria. Australia
  5. 5Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine,Monash University, Australia
  1. Correspondence to Xu-Dong Zhang, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, P3 B-9000, Ghent 650500, Belgium; stella_zxd{at}


Objectives This study assessed social and behavioural predictors for sexual risk taking and sexually transmitted infections (STIs) including HIV among adolescent female sex workers (FSWs) from Kunming, China. Additionally, health services needs and use were assessed.

Methods A cross-sectional survey was conducted in 2010. Using snowball and convenience sampling, self-identified FSWs were recruited from four urban areas in Kunming. Women consenting to participate were administered a semi-structured questionnaire by trained interviewers identified from local peer-support organisations. Following interview, a gynaecological examination and biological sampling to identify potential STIs were undertaken. Descriptive and multivariable logistic regression analyses were performed.

Results Adolescent FSWs had a mean age of 18.2 years and reported numerous non-paying sexual partners with very low rate of consistent condom use (22.2%). Half (50.3%) the respondents had sex while feeling drunk at least once in the past week, of whom 56.4% did not use condom protection. STI prevalence was high overall (30.4%) among this group. Younger age, early sexual debut, being isolated from schools and family, short duration in sex work, and use of illicit drugs were found to be strong predictors for unprotected sex and presence of an STI. Conversely, having access to condom promotion, free HIV counselling and testing, and peer education were associated with less unprotected sex. The majority reported a need for health knowledge, free condoms and low-cost STI diagnosis and treatment.

Conclusions There is an urgent need to improve coverage, accessibility and efficiency of existing interventions targeting adolescent FSWs.

  • Adolescent
  • HIV
  • Prostitution
  • China
  • Sexual Behaviour

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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