HIV Infection Rate Of Low - Grade Sex Workers And Their Acceptability To Interventions

Part I:HIV prevalence among low-fee Female Sex WorkersObjective:This part aims to assess HIV prevalence and characteristics among low-fee FSWs from different venues, and find associated factors with highest HIV infection.Methods:A cross-sectional study was carried out in Guangxi (Liuzhou city and Pingnan County), and Hunan (Zhangjiajie city and Jianghua County) from November2012to January2013. A face-to-face structured questionnaire interview and blood collection for HIV/Syphilis testing were accomplished. HIV testing strategy of high-risk population was employed, namely sequential testing using ELISA twice (one is with high sensitivity and the other is with high specificity). Current syphilis infection was confirmed provided that positive results are presented from both TPPA and RPR; Descriptive analysis, Chi-square test and Logistic regression model were utilized for data analysis.Results:a. HIV prevalenceA total of385participants were included(response rate-66%).The overall HIV prevalence is2.5%. The participants were categorized as organized and freelance low-fee FSWs according to different characteristics of venues. HIV prevalence is0.5%among organized low-fee FSWs versus5.0%among freelance low-fee FSWs (P＜0.0001); The overall ssyphilis prevalence is10.4%. Syphilis prevalence is2.0%among organized low-fee FSWs versus19.9%among freelance low-fee FSWs(χ2=33.112, P＜0.0001).b. Characteristics——Socio-demographic characteristicsThere were43.6%of organized low-fee FSWs and75.1%freelance low-fee FSWs aged more than35years old (x2=39.209, P＜0.0001);69.9%of organized low-fee FSWs and76.8%freelance low-fee FSWs were in marriage (χ2=2.153, P=0.113);57.8%of organized low-fee FSWs received prirnary school education or less while75.1%of freelance low-fee FSWs did(x2=12.779, P=0.005);52.2%of organized low-fee FSWs and65.2%freelance low-fee FSWs were with non-local household registration(x2=6.902, P=0.009). ——Knowledge of HIV/STD, HIV testing in the past yearThere were10.3%of organized low-fee FSWs having not heard of STD while21.0%of freelance low-fee FSWs have not(χ2=8.642, P=0.004); The proportion of knowledge score<6is30.4%and43.1%among organized and freelance low-fee FSWs respectively; Both of the proportion of self-recognized STD syndromes and HIV testing in the past year were not different between them.——Work-related informationThere were37.7%and48.6%of organized and freelance low-fee FSWs working as a FSW for more than2years (χ2=4.630, P=0.031); The proportion of clients number>5per day is25.0%among organized low-fee FSWs while39.8%among freelance low-fee FSWs (χ2=9.635, P=0.002);33.8%of organized low-fee FSWs estimated the average age of their clients was more than50years, while68.5%of freelance low-fee FSWs did (χ2=46.152, P＜0.0001); the price charged less than30RMB was distributed as36.3%and64.6%among organized and freelance low-fee FSWs respectively (χ2=30.870, P＜0.0001).——Sex behaviors and drug useThe rate of consistent condom use with regular clients in the past30days was44.1%and27.7%among organized and freelance low-fee FSWs respectively(χ2=5.923P=0.015); in addition,this rate with strange clients was52.5%among organized low-fee FSWs while32.6%among freelance low-fee FSWs (χ2=15.414, P＜0.0001); There are no injection drug users in the past6months among both groups.Conclusions:Freelance low-fee FSWs showed different HIV prevalence and characteristics compared with organized. Older age, longer time as a FSW, particular clients may contribute to their higher HIV prevalence. Targeted intervention strategies like improved negotiation of male condom use with clients, enlargement of HIV testing, early initiation of Anti-retroviral treatment, and exploration of female condoms and pre-exposure prophylaxis can be considered. Part Ⅱ:The acceptability of prevention strategies among low-fee Female Sex WorkersObjective:a) To compare Female Condom (FC) acceptability between organized and freelance low-fee FSWs, inform which sub-group have higher acceptability of FC and associated factors.b) To compare the acceptability of Pre-exposure Prophylaxis (PrEP) between organized and freelance low-fee FSWs, inform which sub-group has higher acceptability and associated factors.Methods:acceptability of FC——Willingness to use FCIt was conducted simultaneously with part I. Study sitesand sample size remained the same. The questions of FC willingness were added in the same questionnaire.——Rate of usage and acceptability after attemptsFrom June to November2013, a follow-up study of FC was accomplished in three study sites (Liuzhou, Pingnan and Zhangjiajie). At baseline, a face-to-face questionnaire was completed and every participant got10FCs; after one month, a follow-up survey consisting of a face-to-face questionnaire and used package counting was conducted.b) acceptability of PrEP——Willingness to participate in PrEPIt was conducted simultaneously with part I. Study sites and sample size remained the same. The questions of PrEP willingness are added in the same questionnaire.——Adherence to PrEPFrom June to November2013, adherence study was carried out in three sites (Liuzhou, Pingnan and Zhangjiajie). Informed consent, physical exam were accomplished before the participants began to take the drug. Follow-up visits were performed per15days and lasted for3months.Results:acceptability of FC——Willingness to use FC112(65.9%) out of204organized low-fee FSWs had used FC compared with116(64.4%) out of181freelance low-fee FSWs had(x2=2.517, P=0.067).——The rate of usage and acceptability after attempts A total of312participants (118freelance low-fee FSWs and194organized low-fee FSWs) were distributed with FC. All of the participants retained in the one-month follow-up survey. Overall,115(97.4) freelance low-fee FSWs had used FC while158(81.4%) organized low-fee FSWs had(x2=17.204,P<0.0001);30.5%of freelance low-fee FSWs had used FC with strange clients, while42.8%of organized low-fee FSWs had (x2=4.686, P=0.030);94.8%of freelance low-fee FSWs had used FC with regular clients while62.7%of organized low-fee FSWs had(χ2=38.594, P=0.030);Among participants who had used FC,66(57.4%)freelance low-fee FSWs and50(31.6%) organized low-fee FSWs would like to use FC in future(χ2=18.054, P＜0.0001).b) Acceptability of PrEP——Willingness to participate in PrEP114(55.9%) organized low-fee FSWs would like to participate in PrEP while125(69.1%) organized low-fee FSWs would(x2=7.705, P=0.008).——Adherence to PrEPA total of85participants were included. The overall retention rate is58.8%. Thirty two (72.7%) freelance low-fee FSWs retained while18(43.9%) organized low-fee FSWs did(χ2=7.396, P=0.0070).In terms of crude dose missed rate, the overall rate in the first visit was30%(40%among organized low-fee FSWs versus20%among freelance low-fee FSWs, x2-3.829, P=0.050). As the follow-up time increases, there is no difference of dose missed rate between them; In terms of adjusted dose missed rate, the overall rate in the first visit was20%(25%among organized low-fee FSWs versus15%among freelance low-fee FSWs, χ2=16.994, P＜0.001), there is no significance of adjusted dose missed rate either in the first visit or the followed visits between them.Conclusions:Freelance low-fee FSWs can be considered as priority population to whom we can distribute FC among low-fee FSWs.Identifyinging the sites where they gathered, highlighting FC use with regular clients and reinforcing FC training should be considered into distribution strategies.Freelance low-fee FSWs can be considered as priority participants in potential research exploring the effectiveness of PrEP among low-fee FSWs. The selection of drug, eligible criteria of participants, the measurement of adherence and surveillance for side effects should be considered comprehensively.