The Study Of The Intervention Coverage And Its Related Influencing Factors Among The Street-based Sex Workers In Two Counties Of Yunnan Province

BackgroundHeterosexual transmission has become one of the driving forces of the spread of HIV/AIDS in China. Commercial sex workers are the major bridging population for transmission, among whom street-based sex workers (SSWs) are the most vulnerable to HIV/AIDS. However, there is limited literature on the characteristics of interventions targeting SSWs and the extent of intervention coverage. Evidence-based research is therefore needed to better understand ongoing interventions, so as to ensure effective implementation.Objective1. To understand the HIV/AIDS risks SSWs are exposed to, and the interventions targeted at them.2. To estimate the number of SSWs, and then evaluate the extent of intervention coverage.3. To identify the associated factors influencing intervention coverage.MethodsTwo counties are selected in Yunnan province as study sites. Both qualitative and quantitative methodologies were employed in the field investigation. Qualitative methodologies used included participant observation and in-depth interviews to understand the sex trade environment and up to 45 participants (SSWs, peer-educators, clients, CDC staff, local citizens and policemen) were surveyed. Quantitative methodologies used included a census to estimate the number of local SSWs. Meanwhile a structured questionnaire was designed for SSWs in order to obtain information on their HIV/AIDS related risk behaviors and the intervention services they received. Through qualitative methodologies, the extent of intervention coverage was evaluated. Through quantitative methodologies, the associated factors influencing intervention coverage were identified.All qualitative data were coded, sorted and conceptualized by Nvivo 7. 0 software. Deductive analysis was then applied based on the descriptive analysis. The quantitative data were inputted into a database established using Epidata 3.0 software, and analyzed using SPSS 13. 0 software.Results1. Local SSWs have a wide range of ages, are poorly educated and are highly mobile. Their sexual transactions are free of external control, resulting in dramatic high frequencies and low transaction prices. Condom use and its importance are not properly understood and drug abuse was sometimes reported. HIV positive rates among participants were 3.3% and 20.93% in Linxiang and Luxi respectively. The majority of clients were migrant labors. The interventions and health services SSWs received included out-reach services, peer-education, AIDS/STD testing and STD treatment, etc, which were primarily implemented by the local CDC,2. It was estimated there were 108 and 155 street-based sex workers in Linxiang and Luxi respectively. In Linxiang, the intervention covered 2/3 of localities where SSWs found clients, 83. 33% of temporary rental accommodation, and 65.74% of the target population. In Luxi, the intervention covered the only location where SSWs found clients, 28.39% of temporary rental accommodation, and 25.81% of the target-population.3. The major factors associated with influencing the intervention coverage included: the intervention capacity of local agencies, peer-education, the characteristics of SSWs and cross-sector government cooperation. Properly identifying the distribution and size of the local SSWs population, emphasizing on the intervention of the targeted population, supporting peer educators and strengthening communication with the local PSB (Public Security Bureau) were positive factors for good intervention coverage. Neglecting the importance of interventions among the target population by local agencies, the lack of capacity of peer educators, free control of sex transaction and misunderstanding of intervention services among SSWs were negative factors affecting intervention coverage.Conclusions1. Intervention coverage of SSWs is too low to effectively prevent HIV/AIDS transmission.2. Immediate efforts should be made to; improve coverage of interventions targeted at SSWs; develop out-reach services based from STD clinics; and establish an intervention evaluation system in order to guarantee long term effectiveness.