Objective: This study investigated the consistency of condom use and the prevalence of self-reported sexually transmitted diseases (STD) among male Hong Kong commercial sex clients with respect to the geographical location of these transactions.
Design and methods: Male clients were identified via three independent, population-based surveys conducted in 1998, 1999, and 2001. A unique confidential telephone system was used to collect sensitive information.
Results: Respondents patronizing female sex workers (FSW) in 'mainland China only' or in 'mainland China and other places' were more likely to be inconsistent condom users (28 and 34%) than those patronizing FSW in 'Hong Kong only' (9.1%). A similar pattern was found for self-reported STD in the past 6 months (10.1, 8.1 and 1.0%, respectively). Patronizing FSW in mainland China was associated with a higher prevalence of self-reported STD (adjusted OR 4.16), independent of consistent condom use and other potential confounding factors, including calendar year of survey, age, educational attainment, HIV-related knowledge, perceived efficacy of condom use for HIV/AIDS prevention, number of female sex partners, and the presence of a regular female sex partner in the past 6 months. Clients who had commercial sex both in mainland China and Hong Kong were more likely to use condoms in Hong Kong than in mainland China (paired OR 4.67, < 0.05).
Conclusion: The geographical location of commercial sexual activity is related to the consistency of condom use, irrespective of the clients engaged in such activity. Prevention programmes need to be aware of how risk behaviour is dependent on local contexts.