Evaluation On Effectiveness Of AIDS-related KABP Behavior Intervention Among Female Sexual Workers In Low-grade Venues In Shandong Province

Background:Currently, sexually transmission has become an important way for the epidemic of AIDS. Female sex workers is one of the highest susceptible population who can transmit HIV. While the comprehensive interventions for such population in some areas have been adopted, and get some successes, its intervention places were most limited in high or middle-grade venues, and target populations in low-grade venues were less involved. Compared with high-grade venues, low-grade female sex workers are generally older, lower education level, more fluid, less knowledge of AIDS prevention, less use condoms. It is always the difficulty and focus of intervention among AIDS high risk groups.In order to further promote the work of behavioral intervention, expand the coverage of AIDS interventions, and improve condom use rate and knowledge level of AIDS in commercial sex services, the Global Fund AIDS Project support to carry out behavior intervention in low-grade venues.Objective and Content:To understand the quantitative distribution, knowledge, attitude and behavior status related to AIDS among female sexual workers in low-grade venues from the AIDS Global Fund project counties in Shandong Province. To acquire target populations of HIV, syphilis, hepatitis B, hepatitis C infection and other infectious diseases To analyze factors influencing knowledge and behavior. Evaluation on effectiveness of behavior intervention through cross section study. So as to explore better policy strategies for HIV/AIDS prevention and provide scientific basis for health education, behavior intervention.Methods:This survey selected project areas which has been intervened as the intervention group and selected non-project areas which has not been intervened as the control group. A two-stage cluster sampling method were selected in intervention group and control group. Face to face questionnaire interviews were conducted among female sexual workers by skilled investigators who had been trained before Epidemiological scene investigations. Questionnaires were completed anonymously by the person being investigated independently. The intervention group regularly took some intervention including developing policy, distributing leaflet, issuing and using of condom, outreach activities, organizing health talks, peer education and providing counseling and testing, treatment services about sexually transmitted diseases based on local medical institutions, interventions. Epidata3.1 was used to establish a database and SPSS17.0 software was used for statistical analysis.Results1) information about demographic female sex workers's who worked in low-grade venuesThis survey investigated 1444 female sex workers in low-grade venues, of which washing feet-hair house /hair salon account for 50.6%, motel / mini- hotels account for 22.6%, mini- rental / mini- hotels account for 16.6%, hidden / family sex services shop / building site account for 10.1%. The Age range of female sexual workers was 15~49 years, average age was 26.3±6.36 years. In the intervention group, target populations were mainly came from the washing feet-hair house /hair salon which account for 52.5%, 47.9% of them aged between 15 and 24, 55.5% were unmarried, and education to middle school account for 61.2%.In the control group, female sex workers were also mainly came from the washing feet-hair house /hair salon which account for 49.5%, 47.4% of them aged between 15 and 24, 51.9% were unmarried, and education to middle school account for 65.4%.2)Compared intervention group with control group,Analysis on knowledge, attitude and behavior status related to AIDS among female sexual workers.AIDS knowledge, condom using rate, voluntary counseling and testing, acceptance of AIDS prevention intervention services of intervention group have significantly differences compared with control group of women sex workers in low-grade venues. In the intervention group, the rates of high rate about AIDS knowledge group(χ~2=119.63, P<0.01), consistent condom use for FSWs with regular partners in the last month(χ~2=218.39, P<0.01) / in the last three month (χ~2=213.44, P<0.01), voluntary counseling and testing(χ~2=265.31, P<0.01), awareness of HIV testing result (χ~2=10.29, P<0.01)and receiving intervention services(χ~2=122.78, P<0.01)were significantly higher than control group. Acceptance to HIV / AIDS in intervention group is significantly better than the control group(χ~2=165.26, P<0.01), 73.8% expressed that they willing to continue contacts with acquaintances who infect HIV, female sex workers with sexual history had more difficult to accept patients with HIV or AIDS. In the STD clinic, 93.3% would choose to specialist STD clinics, general hospitals, maternity and child care and other formal channels for treatment in the intervention group, it significantly higher than control group.3)The main factors that influencing condom useBy multivariate Logistic analysis, it shows that venue source, age, STD history are important factors which can influence condom use of the last month in the intervention group, while high age group and STD history are independent factors that increase safe sex behavior in last one/three month; venue source, marriage, HIV antibody test and STD history are important factors which can influence condom use of the last month in the intervention group. Unmarried, HIV antibody test are independent factors that increase safe sex behavio in last one/three month, while STD history are independent factors that decrease safe sex behavio in last one /three month.AIDS knowledge has no correlation with sex behavior in last one/three month, there is a serious runing adrift between knowledge and behavior. The main reason that female sex workers in the low-grade venues had not used condom in the commercial sex last time was guest unwillingness.4)The psychology of female sex workers in the low-grade venueThis research obtained 1163 valid psychology questionnaires, including 385 of of social support, 318 of questionnaires of self-rating depression scale, 460 of questionnaires of self-rating anxiety scale. As for the special social status, female sex workers in the low-grade venue need to face more psychological stress from society and worse psychological health. The support of social was lower than the national norm. 58.2% of female sex workers has emerged depression status. Depression and anxiety scores were significantly higher than the national average norm.Conclusion1)For AIDS-related knowledge, the intervention group was obvious better than the chontrol group; for the main source of AIDS-related knowledge, the intervention group was more diversification, and satisfied degree was more better.2)In the intervention group, the proportion of voluntary counseling and testing was significantly higher than the control group and the attitude toward AIDS patients also showed more understanding and tolerance. In the medical treatment, the ratio of intervention group who treated in regular hospitals was significantly higher than that of the control group.3)As for the proportion of using condoms in commercial sex of the intervention group, it was obvious higher than that of the control group, while the infection rate about syphilis and hepatitis B virus was lower, the intervention effect is obvious.4)In the psychological state, The social support of female sex workers in low--grade venue was lower than the mormal population, and there were different degree of depression and anxiety prevalence. They are vulnerable groups, and there are lots of instability risks, so it is necessary to give them the psychological support and humanistic care.