| BackgroundCurrently,one of the characteristics of the HIV epidemic in China is that sexual transmission is becoming the main mode for the spread of HIV,Among the 50,000 estimated new infections during 2007,heterosexual transmission was 44.7 per cent. Factors contributing to this anticipated growth of the epidemic include the nation's growing number of internal floating population.Behavior changing is the most important way to reduce the spread of HIV.Behavioral and social science theory provides a platform to understand why people engage in health-risk behavior and why they adopt health-protective behavior to promote healthy life.It suggests five stages of behavior change,Intervention can be more effective if it is planned to match the stage of readiness to change behavior.Given the number of estimated 147.35 million migrants and the scope of public health challenge,prompt response to reduce future HIV/STI-related sexual risk behavior among floating population is of great importance.ObjectivesThis study aimed to identify the prevalence of HIV/STD related partner-specific sexual risk behaviours and condom use behaviors among heterosexual floating population in dongguan city,to increase our understanding of the characteristics and reasons why they engage in these behaviours,.and to get insight into the factors that influence their condom use behavior-changing so as to explore the ideas for strategy development and interventions for HIV/STI prevention.MethodsA cross-sectional study was conducted among floating population working in five occupational clusters,including construction-,restaurant and hotel-,entertainment-, and factory-based industry and casual laborers in one of the largest destination city of Chinese floating populations floating into,Dongguan.Qualitative method on the basis of semi structured in-depth individual interviews and quantitative method based on questionnaire investigation were used respectively to abtain relevant information. Interview outline was guided by a theoretical foundation,the stages of change model which imply that different strategies or approaches are necessary for individuals who are in different stages of change and it is important to identify factors that are associated with the various stages of change so that interventions can be tailored accordingly.Health care doctors from local hospital served as facilitators for the recruitment process.Two convenience samples of 25 and 1108 participants were respectively recruited from their work sites and community venues.Study subjects were categorized according to their condom use behavior change stages,which including precontemplation,contemplation,preparation,action,and maintenance.Epidata3.0 and SPSS12.0 software were used for quantitative data enter and analysis.Interviews were analyzed using a content analysis approach which was conducted by coding transcripts of audio-taped interviews and comparing and synthesizing code output across participants and sub-groups for key domains of interest.Thematic narratives were then developed per each of the study sub-groups.ResultsThree categories of partner-type were studied:commercial(e.g.prostitute's selling sex and client's buying sex):casual(e.g.,one-night stand,multiple partners);steady [e.g,live-in partner other than spouse(premarital boyfriend or girlfriend extramarital steady relationship),spouse];Selling sex and spouse are not included in the qualitative study,and multiple partners and extramarital primary relationship are not included in the quantitative study.1.HIV/STD-related sexual risk behavior as far as partners are concerned Sexual behaviors with each category of partner-type were identified common among our informants and their surrounding people;Findings from quantitative survey data showed that,in the past one year 4.2%of participants had had commercial sexual behaviors,7.1%of participants had had casual sexual behaviors,and 9.9%of single participants had had premarital live-in sexual behaviors.However,the occurrences of these risk sexual behaviors varied across different occupation sub-groups(χ~2=32.57,42.11,25.48,P <0.001) with some kind of behavior prevalent among some sub-population.Participants who had paid for sex in the past one year were predominantly male construction workers and casual laborers with the prevalence of 9.6%and 6.3% respectively;the prevalence of casual sexual behaviors was the highest among workers from entertainment places,with male workers 39.4%and female 13.1%;For unmarried respondents,the prevelances of having live-in sexual relationship among among female entertainment workers and among female restaurant workers were 20.0%and 7.7%respectively.2.Attitudes towards sexual risk behavior and the contexts regarding risky sexRespondents did not object to "pre-marital sex" or "prostitution"."Looks like every man want to visit commercial sex workers".For many young migrants,Cohabitating with a girlfriend or boyfriend is a common practice among their peers.The physiological needs or yearning for intimate relationships,the seems- to- be social norms and values that sexuality became a communicative approach or entertainment way between people in working environment or among circle of friends were cited as the main reasons for floating population's choice of risky sexuality. Many informants reported frustrations and distress burden as a result of their sexuality. Several respondents identified the spread of sex industry,male floating population's having more disposable income away from home than before and not being satisfied with only one women as other reasons.3.Partner-specific condom use behavior and behavior-changing stagesMen were more likely to report using condoms with a commercial partner than with a non-commercial partner,(commercial vs.,non-commercial,80.0%vs.55.9%, respectively;%=5.59,P=0.018).In comparison,women were more likely to report using condoms with a casual partner than with a steady partner(77.4%vs.53.9%, respectively;χ~2=4.18,P=0.041)80.0%male respondents and 63.6%female respondents had used a condom during the most recent commercial sexual encounter.But the proportions of consistent condom use during commercial sexual behaviors in the past one year were 64.7%and 30.0% respectively. Male respondents were significantly less likely to use a condom during the most recent sexual encounter with a casual partner than female respondents(55.1% vs.77.4%,respectively;χ~2=4.09,P=0.04).As for the frequency of condom use with casual partners in the past one year,18.4%reported never,more than half reported sometimes,and just 25.0%reported every time.Male respondents were significantly less likely to use a condom during the most recent sexual encounter with a regular partner than female respondents(21.9% vs.30.9%,respectively;χ~2=4.91,P=0.027).Participants were significantly less likely to use a condom during the most recent sexual encounter with spouse than with a premarital regular partner(21.8%vs.55.1%,respectively;χ~2=26.23,P=0.000).All the interview participants who had paid for sex(male clients of sex worker) are in the condom use preparation and later stages,with two thirds of them in the maintenance or action stage.Interviewees with casual parters are in the condom use contemplation and upper stages,with half of them in the maintenance stage. Interviewees with regular(non-marital) parters are almost all in the two extreme condom use stages,precomtemplation stage and maintenance stage,with nearly half of them in the precomtemplation stage who had no intention to change their condom use behaviors.4.Factors associated with stage of change for condom useFor interviewees who were in the later stages of change to adopt condom use behaviors or used condom consistently with some type of partner,some of them had had used a condom at first intercourse with that type of partner,and some of them experienced a behavior-changing process.Respondents in later stages of change tended to have a higher level of perceived susceptibility to STDs/HIV infection or unplanned pregnancy,and stated more reevaluation of self-image,especialy the sense of responsibility to one's family,to one's partner and to oneself when compared with those in the early stages of change. They believed the advantages out-weighed the disadvantages of condom use and showed great self efficacy to resist unsafe sexual behavior temptations while those in earlier stages showed lower self-efficacy and little reevaluation of self-image,and had low levels of concern about HIV/STIs,if not having no concern at all.For women,the additional usage of helping relationships to discuss prevention methods with peer also influenced their condom use behavior.ConclusionThe results of this study indicate that,in many respects,floating population in Dongguan city were typical of those in China,with a mixture of correct and incorrect knowledge about HIV and sexually transmitted infections,with great sexual desire and potential partners and are sexually active.Furthermore,a significant sub-group reported having had high risk sexual behaviours that place themselves or others at risk for HIV/STIs infection or unintended pregnancy by having multiple sex partners, casual partners,premarital and extramarital sex or participating in commercial sexual behaviors,and by having unprotected sex or inconsistent condom use,particularly in the context of their non-commercial and non-marital relationships.So floating population is the priority population for HIV/STD control and prevention.Many risk factors associated with mobile life style compounded by their changing cultures have multiplied the vulnerability of the floating population.The context of and reasons for their risky sexual behaviours include the sexual desire,the negative emotions of feeling agnosing and boring,participating in the positive social occasions of parties and entertainments which are likely to induce sexual behaviors,and the yearning for intimate relationships.The findings suggest an urgent need for the whole society to care about the life and psychological health of floating population,to enrich their sparetime,to strengthen their connections with families and to promote healthy attitudes towards sex,love and social norms.Factors influencing their condom use behaviors include perceived susceptibility to HIV/STD and pregnancy,sense of responsibility related reevaluation of self-image, the decision balance and self efficacy to condom use.Comprehensive education and intervention approaches are suggested to improve floating population's understanding of sexual health risks,to emphasize the double protection effects of condom use,to advocate sexual responsibility and condom use as well as provide them with necessary behavioral and communication skills.Accordingly,HIV prevention interventions must reach floating population both in the cities of destination and in the rural areas of origin.A multi-component approach to prevention,including programmes based on schools health education,work place participation and community health services mechanism,is of great importance. |
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