Investigation On STD/AIDS Related Knowledge, Attitude And Behavior Among Female Sex Workers Of Entertainment Places In Macau

ObjectivesSexually transmitted disease is a group of diseases that sexual contact is the main route of transmission.Eight kinds of sexually transmitted diseases which include syphilis,gonorrhea,genital herpes,condyloma acuminatum,chancroid, nongonococcal urethritis,lymphogranuloma venereal and AIDS are classified as a focus of prevention and treatment of sexually transmitted diseases in China.AIDS (Acquired Immune Deficiency Syndrome,AIDS) is caused by the human immunodeficiency virus.In addition to sexually transmitted route,the routes of transmission of AIDS are blood transmission and mother-to-child vertical transmission;AIDS mortality rate is up to 90%-100%.Nowadays,it is estimated that there are 32.2 millions AIDS-infected persons are alive.About 3/4 of HIV are infected through sexual transmission.The number of women infected with HIV is also increasing.To the end of 2008,the number of AIDS diagnosed is accumulated to more than 260,000 in China.Places of entertainment service are likely to become the hidden places of commercial sex trade or transaction of contact points in China.The people who provide sexual service are usually female workers in those places. Therefore,they would act as bridge population as well as high risk population as for AIDS epidemic if being engaged in commercial sex.In recent years,the sex industry is more prosperous than before because the economic,gambling and tourism industries are developing so fast.So the morbidity of AIDS is an upward trend in Macau.Up to the end of December 2008,a total of 410 HIV infections were reported in Macau,42 of HIV infected patients have progressed to AIDS.And the entertainment female sex workers are high risk population to spread STD/AIDS in Macau.So if we know their awareness attitudes and behavioral characteristics to STD/AIDS,we can provide the basis for intervention measures on STD/AIDS.MethodsPartipants is recruited from 6 clinics in Macau by cluster sampling,these 6 clinics are helping the female sex workers to carry out the vaginal exam and flushing regularly.After the participants completed the questionnaire independently,or by health care professionals to ask them one by one,I got 202 copies of valid questionnaires.Logistic regression model was used for multiple factors analysis by SPSS 11.5 statistical software. Results1) The ages of the female sex workers are 20-30 year old in this research and 89.6% are unmarried.They are higher educatied,senior secondary level and above accounted for about half of the proportion.The vast majority of them come from the other provinces of China and they are highly mobile.2) Their awareness on STD/AIDS is general.At the basic knowledge level,only 4.5%can answer correctly of all eight kinds of STD which is the focus of prevention and treatment of sexually transmitted diseases in our country,only 18.3%think the nongonococcal urethritis is STD and 4.4%still think AIDS is not a sexually transmitted disease.For the knowledge of the route of transmission of AIDS,only 42.6%know people will not be infected with HIV by mosquito's bite. In preventive knowledge,only 52%know that washing the vagina after sexual intercourse or to use anti-inflammatory drugs are not the prevention of sexually transmitted diseases / AIDS.This indicates that female sex workers are not aware of STD/AIDS comprehensively enough.3) A small number of female sex workers think that the prevention of STD/AIDS has nothing to do with me,it accounts for 17.8%,28.2%think that the STD/ AIDS" is very far away from me,This indicates that female sex workers are lack of awareness in being high risk population themselves.There are 15.8%female sex workers have ever been smoking or drug abuse.I also discovered that there are significant differences in the female sex workers who has the attitude of not using condom in getting extra pay are related to whether they have drug abuse history(X~2=4.01,P=0.045).The female sex workers in Macau are high risk population and they play important role in AIDS epidemic if being engaged in commercial sex.4) Although there are 89.6%female sex workers that use condoms in the last 3 meetings with the guests,there are only 75.7%female sex workers who resist to have sexual intercourse with the guests if they refuse to use condoms.Only 63.9% female sex workers convince the guests who do not want to use condoms.This indicates that part of female sex workers are not fully initiative in the use of condom at commercial sex.They also lack in ability to negotiate with the guests in the use of condom.5) Logistic regression analysis results show that the female sex workers who have positive attitude of not serving the guests if they refuse to use condoms (OR=10.191,95%CI:3.532～29.407)and those who suspect themselves suffering from STD / AIDS will go to see a doctor for relevant examinations(OR=5.239, 95%CI:1.259～2.795) have higher frequency of condom use.In addition,the poor awareness of AIDS is the risk factors not to use condoms.Conclusion1) Female sex workers in Macau do not have enough comprehensive awareness on STD/AIDS,and it will cause high risk behavior in leading to the infection of STD/AIDS.We have to carry out timely,extensive,in depth and enduring education and intervention against the female sex workers about STD/AIDS.2) We should strengthen the monitoring of sex workers who has drug abuse history and especially those with drug abuse by injection.And we should take targeted interventions to reduce the spread of AIDS by the female sex workers.3) We can increased our commercial sex condom usage and in the behavioral intervention that enhancing the faith of the important role of condom in the prevention of STD/AIDS with female sex workers continuously,increasing their condom use self-efficacy and initializing to increase the number of clients of educational and publicity activities and intervention work.4) We should strengthen our efforts to set up promotional education,condom use promotion and community intervention network as the main contents of the measures,and to improve STD/AIDS knowledge and awareness of disease prevention.We need to analyze the impact of factors of condom use from the social, economic and cultural factors,both factors involved in sexual activity,condom and other product characteristics.