Influencing Factors Of Condoms Use And Corresponding Analysis Of The Sources Of Social Support Among Older Female Sex Workers In Qingdao

BackgroundHeterosexual contact has become the main transmission way of HIV/AIDS in China since 2007.The National AIDS/STDs report showed that the proportion of new cases with heterosexual contact infection has risen from 38.9%in 2007 to 67.9%in 2017.In the case of heterosexual transmission,the age group(≥50 years old)rose from 19.3%in 2008 to 36.1%in 2014.Studies have shown that the majority of elderly people infected with HIV in China(age≥50)had history of sexual behavior with older female sex workers(OFSWs),so OFSWs are important subjects for research and intervention.Condom use of female sex workers(FSWs)has always been the focus of research and intervention.The Previous research explored influencing factors of condoms use from the perspective of FSWs,such as low level of FSWs,lack of persuasion,lack of HIV/AIDS testing,multiple sexual partners,etc.The most important reason was sexual partners refused to use.Whether from the perspective of FSWs or sexual partners can not fully explain why FSWs used condoms with some partners,but do not use condoms with other partners.Therefore,this paper uses two-level of logistic regression to study both OFSWs and sexual partners at the same time,and comprehensively analyzed and explored the influencing factors of condom use among OFSWs.Due to professional reasons,OFSWs has a different social network structure with the general population.For OFSWs,social networks are vectors that promote the spread of HIV/STDs,but are potential ways to prevent the spread of HIV/STDs,such as social support networks.Prior study has shown that greater emotional and material support can reduce the probability of unsafe sex of OFSWs,therefore comprehensive and detailed analysis the source and support of OFSWs’ social support(material support and emotional support)and comparison social support sources of different characteristics of OFSWs,to help us to better understand the community of OFSWs social support network,to found the main source of social support and potential social support of OFSWs.Two provide new ideas and directions for the discovery intervention subjects and intervention works.Objectives1 To explore the use of condoms between OFSWs with different sexual partners in Qingdao,the two-levels logistic regression model combined with OFSWs level and sexual partners level was used to analyze the influencing factors.2 To display the material support,emotional support and support strength of OFSWs from 11 kinds of social support sources through the corresponding analysis chart of the corresponding analysis.To compare the social support of OFSWs with different characteristics.To provide theoretical and data support for the discovery of intervention objects and proposing of interventions measures.MethodsIn this study,respondent-driven sampling(RDS)was used to recruit OFSWs in Qingdao from March to June 2014.The computerized personal interviewing(CAPI)was used to obtain information of OFSWs,including general demographic characteristics,sex work-related information,syphilis biology detection information,sexual network information,and social support networks information.The two levels logistic regression model was used to analyze the influencing factors of condom use from OFSWs level and their sexual partners’ level.Corresponding analysis was used to show the material support and emotional support of OFSWs and the social support of different OFSWs.Results1 The characteristics of OFSWsA total of 420 OFSWs were recruited in this study,with an average age of(42.6±6.3)years,most of them were Han ethnics,divorced or widowed,were migrants(without registered household in Qingdao),with junior middle school or lower education.There were 133 OFSWs(31.7%)living alone;86.4%OFSWs’monthly income accounted for more than 50%of the total monthly income of the family;76.90%began to engage in sex work when they were at the age of 30 or older;42.14%engaged in sex work industry for economic reasons,17.14%for divorce/widowed.66.7%knew the knowledge about AIDS transmission;91.90%received AIDS service help;the attitude towards condom using was(10.83 ±2.22)points;97.4%agreed with that condom is the most effective way to prevent STDs/AIDS;75%self reported having HIV testing;18.33%self reported using drugs;47.62%reported suffering violence nearly six months;73.81%self reported using condom in their last commercial sex behavior,33.33%reported having consistent condoms use in every commercial transaction during last month;the main reasons for not using condoms with the guests in the last commercial transaction included refusing to use,giving more money,could not erection and regular customers.Previous syphilis prevalence rate of OFSWs was 29.8%,syphilis prevalence rate was 8.6%.2 Influencing factors of condom useInformation of 2100 network members was obtained by asking OFSWs.The percentage of condom use was different among different sexual partners of OFSWs(t=4.77,P=0.001).Two levels of logistic model analysis showed that,OFSWs with junior middle school education level(OR=1.448,95%CI:1.053-1.990),high school education level or above(OR=2.309,95%CI:1.242--4.291),approving prevention function of condom(OR=2.001,95%CI:1.271-3.152)had higher rate of condom use.OFSWs with higher score of attitude on condom use(OR=0.80,95%CI:0.750-0.853),syphilis infections in the past(OR=0.668,95%CI:0.487-0.917)had lower rate of condom use.For sexual partners,the rate of condom use among OFSWs’regular and general partners were higher than that of OFSWs’ boyfriends(OR=13.807,95%CI:7.614～25.036;OR=25.974,95%CI:13.810～48.852).Sexual partners having sexual behavior on salon、sauna、dancing halls and other places of entertainment(OR=0.50,95%CI:0.37～0.67)had higher rate of condom use.3 OFSWs’ social networks and supportFrom this study,we concluded that the largest proportion of the social support network members of OFSWs were peer friends,the second largest proportion was non-peer friends.This study divided social support into material support and emotional support,and the material support of OFSWs was greater than emotional support.Through the corresponding analysis chart,we found that the most reliable source of material support for OFSWs were boyfriend,other family member,non-family member relatives and non-peer friends,that were relatives and non-peer friends;the most reliable source of emotional support for OFSWs were other family members,boyfriend without commercial sex,peer friends;The closest and most trusted person of OFSWs were boyfriends and other family members;and the least intimate and trusting was boss.Through the t/F test,the social support of OFSWs with junior high school and above education was greater than that of primary school and lower.Social support of OFSWs working in public entertainment places was greater than that of non-fixed places.Social support of OFSWs with non-drug using was greater than that of drug using,and social support of OFSWs with condoms using in commercial sexual behavior was greater than that of no used,with statistical difference.Through the corresponding analysis,we can see that the social support sources of OFSWs with junior high school and above education level and working in non-fixed places were mainly non-peer friends.The social support sources of OFSWs who did not use condoms and drugs were mainly commercial partners(regular and commercial Boyfriend);the social support source of OFSWs with primary school and the lower education level and working in public entertainments were mainly peer friends.Conclusions and suggestions1 OFSWs are mainly Han nationality,divorced/widowed,foreign household registration,with junior high school and lower education level in Qingdao.Most of the OFSWs are forced to enter the sex work industry for economic reasons after the age of 30,and the vast majority of OFSWs are the main source of income for their family.Condom use of OFSWs is still low,and consistent condom use in the last month is much lower than last condom use,so it is important to strengthen the awareness of OFSWs that only consistent condoms use can prevent HIV/AIDS transmission.2 OFSWs’ condom use is affected by both theirself and their partners.In the future prevention and control work,OFSWs and their partners should be intervened at the same time,focusing on OFSWs with lower education level,working in not-fixed places,previously infected syphilis and boyfriend,regular customers of OFSWs.3 The main composition members of OFSWs’ social support network were peer friends and non-peer friends,but most reliable source of social support of OFSWs are husbands,no commercial sex boyfriends,other family members,and peer friends are potential social supporters,OFSWs are least trusting and closing to boss.Strengthening OFSWs’ relationship with bosses and peer friends will be an important intervention measures.Commercial partners(regular and commercial sex boyfriends)are the main social support source for OFSWs with using drugs,non-use condoms.Commercial partners are the main bridge population for AIDS/STDs transmission,so commercial partners(regular and commercial sex boyfriend)are the main intervention population in the future prevention of AIDS/STDs spread.Taking measures to change the use of condoms between OFSWs and different partners,strengthening self-awareness will be the focus of the work.