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Differences in risk behaviours and HIV/STI prevalence between low-fee and medium-fee female sex workers in three provinces in China
  1. Lifeng Han1,
  2. Chu Zhou2,
  3. Zhijun Li1,
  4. Adrienne N Poon1,
  5. Keming Rou2,
  6. Serena Fuller1,
  7. Yan Li3,
  8. Limei Shen4,
  9. Dianmin Kang5,
  10. Lu Huang4,
  11. Meizhen Liao5,
  12. Xiaobing Fu3,
  13. Colin Shepard1,
  14. Zunyou Wu2,
  15. Marc Bulterys1,6
  1. 1US Centers for Disease Control and Prevention (CDC) Global AIDS Programme (GAP), Beijing, China
  2. 2National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  3. 3Department of HIV/AIDS, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
  4. 4Department of HIV/AIDS/STD, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
  5. 5Shandong Provincial Center for Disease Control and Prevention, Jinan, China
  6. 6Division of Global HIV/AIDS, Center for Global Health, CDC, Atlanta, Georgia, USA
  1. Correspondence to Dr Lifeng Han, U S Centers for Disease Control and Prevention (CDC) Global AIDS Programme, Suite 601- Dongwai Diplomatic office, 23 Dongzhimenwai Dajie, Beijing 100600, China; hlf{at}


Objectives To better understand risk behaviours and factors associated with low-fee female sex workers (FSW) and support HIV/sexually transmitted infections (STI) epidemic control among this key population in China.

Methods A cross-sectional study using convenience sampling to recruit 1487 eligible low-fee and medium-fee FSW was conducted in 2012 in three provinces. The participants were interviewed using a structured questionnaire and tested for HIV-1, herpes simplex virus (HSV)-2 and syphilis antibody. Log-binomial modelling was used to estimate prevalence ratios (PR) and examine factors associated with low-fee sex work.

Results Prevalence of HIV-1, syphilis and HSV-2 antibody positive were 0.5%, 4.8% and 27.8%, respectively. Low-fee FSW were more likely to have HSV-2 infection (adjusted prevalence ratio (APR)=1.3, 95% CI 1.1 to 1.7), but not more likely to have HIV-1 and syphilis infection compared with medium-fee FSW. Compared with medium-fee FSW, low-fee FSW were more likely to be ≥35 years of age (APR=2.1, 95% CI 1.3 to 3.6), engage in sex work ≥6 days/per week (APR=1.7, 95% CI 1.2 to 2.6), have ≥3 clients per day (APR=2.2, 95% CI 1.5 to 3.3), have clients decide condom use (APR=1.6, 95% CI 1.1 to 2.3), fail to persuade clients to use condoms (APR=1.6, 95% CI 1.1 to 2.6), express willingness to have unprotected sex in return for receipt of a higher fee (APR=1.8, 95% CI 1.2 to 2.8), have had genital symptoms in the past year (APR=1.4, 95% CI 1.1 to 1.8) and have migrated from another city.

Conclusions Low-fee FSW in China have unique risks for acquiring HIV/STI, in part due to greater economic pressures. Tailored interventions targeting low-fee FSW and incorporating their prevailing perception of HIV/STI risks and condom use negotiation challenges that they face are urgently needed.

  • HIV

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