Psychological wellbeing and HIV risk behaviors among female sex workers in China

Background. Literature has documented the association between psychological wellbeing and HIV risks, but such studies are limited among female sex workers (FSWs) worldwide. Data on this area are particularly limited among FSWs in China, where millions of FSWs are playing an important role in HIV epidemic in the world's most populous country.;Aims. (1) Investigate present knowledge on behavioral studies of FSWs in China, and identify the gaps in literature. (2) Examine risk factors associated with FSWs' suicidal ideation and attempts. (3) Explore the relationship between depressive symptoms and FSWs' condom use with clients (both consistent use and proper use).;Methods. Study 1: A systematic review of the English literature published before October 2005 regarding FSWs in China. Study 2: Both bivariate and multivariate analysis of data (N=454) drawn from baseline assessment of a community-based HIV/STD voluntary counseling and testing (VCT) intervention trial in Guangxi, China. Study 3: Both bivariate and multivariate analysis of data drawn from follow-up assessment of Guangxi VCT study (N=278).;Results. Systematic literature review of published English literature on FSWs in China found that FSWs were at high risk of HIV infection and transmission and there was limited data regarding their psychological wellbeing and its relationship with HIV risk behaviors. Of 454 FSWs recruited from entertainment establishments, about 14% had suicidal ideation and 8% had suicidal attempt in the past 6 months. Both individual characteristics and relationship factors such as alcohol intoxication, reasons for entering commercial sex, experience of sexual coercion, and having stable sexual partners were associated with their suicidal behaviors. Of 278 FSWs from whom data on depressive symptoms were available, 62% had clinically significant depressive symptoms (CES-D total score ≥16). After controlling potential confounders, data indicated that women with high level of depressive symptoms were less likely to use condoms consistently (aOR=0.52, 95%CI=0.29–0.92) or use condoms properly (aOR=0.44, 95%CI=0.20–0.99).;Conclusions. These results suggest that FSWs in China have poor psychological wellbeing with high rates of suicidal behaviors and depression. Their mental health problems are associated with HIV-related sexual risk. Health education and promotion efforts among FSWs in China need to take into consideration their level of psychological distress.