Study Of AIDS/STDs Epidemiology, Prevention And Intervention Among Construction Workers In Nanhui Area

Background:Rapid progress has been made in AIDS prevention and control, risk factors of AIDS are widely existed, this brings great difficulty for AIDS prevention and control. Increasing number of floating population enhance the possibilities of serious HIV spread.The construction workers are primarily males between the ages of 18-40. They face additional risks because of the migratory nature of their work that requires continuous movement of workers. Work-related mobility often significantly increases vulnerability to HIV infection. Some of the factors may increase the vulnerability of construction workers to HIV infection, such as:nature of work, lack of access to health care services for construction workers, increased sub-contracting trend, gender-male dominated sector and low knowledge about HIV and AIDS. Consequently, keep abreast of behavioral characteristics of construction workers, adopt effective intervention model, enhance awareness of HIV/AIDS knowledge and rate of condom use, reduce risk behavior are useful in AIDS control.Objects:1. Assess HIV/AIDS knowledge, attitudes, and risk behaviors of construction workers in Nanhui area.2. Evaluate the epidemiology and risk factors of HIV and STI.3. Generate necessary data which could be used to provide guidelines on designing and implementing appropriate HIV and AIDS intervention for construction workers.4. Evaluate the effects of AIDS prevention and controlMethods:This study was divided into 2 parts.All the subjects were recruited into this study to participate in three surveys, included the baseline survey and two follow-up. Blood samples and urine samples were collected from participants at baseline survey. Blood samples were tested for HIV, HSV-2 and syphilis while urine samples were for Chlamydia and gonorrhea. Two follow up were conducted every 3 months.PartⅡis for carrying out and evaluating intervention. Study participants were divided into three groups after the baseline survey:brochures were provided for the low level of intervention group; posters, display panel and DVD were provided for the medium level of intervention group except for brochures; face-to-face interview was provided for the high level of intervention group except for the formers.Results:1. Result of baseline survey(1)A11 the 657 construction workers worked at construction sites where were the assembly area of migrants in Nanhui area were young, middle-aged and sexually active, their average age were 38.9±10.1; 90.4% were male; most of them were low educated, those with junior high school education make up 56.2% of them; the majority of them were married,84.2% were in-married; their bunkhouses were simply constructed, and were with monotonous amusement.(2)Most migrants were at certain awareness of HIV/AIDS knowledge, they knew well in the ways of HIV transmitting (e.g. AIDS can be spread through the use of shared syringes (66.2%); AIDS can be spread through sexual behavior without condoms (72.1%);the more sexual partners, the higher risk of getting AIDS(73.1%);AIDS can be spread through vertical transmission(60.6%)), but they lacked in the knowledge of non-transmissible routes((e.g. AIDS can't be spread through eating(40.6%), sharing close stool(36.5%),coughing(30.9%),kissing(26.0%), mosquito bite(14.3%)).(3) Construction workers have discrimination against HIV/ADIS,72.9% thought HIV/AIDS were frightening, and 18.72% consider HIV/AIDS were unworthy of sympathy. They were gradually tolerant towards pre-marital and extra-marital sexual behavior,13.5% subscribe to extramarital sex among married men while 11.8% subscribe to this among married women.12.2% identifies with commercial activity; 7.2% thought men who have sex with men (MSM) is acceptable.(4) The proportions of condom use was low among construction workers, the consciousness of AIDS prevention became disjointed with relative behaviors.50.6% of the married construction workers never use condoms in sexual intercourse, only 7.4% of them use condoms consistently,70% of them thought it was unnecessary and 16.8% thought they felt nothing while using condoms.41.3%of the unmarried construction workers never use condoms in sexual intercourse, only 14.4% of them use consistently, most of them thought it was uncomfortable and 23.1% thought it a matter of indifference.(5) No one tested positive for HIV, while 2 tested positive for STIs (0.3%); 1 was tested for HSV positive; 2 were tested for Neisseria gonorrhoeae positive,13 e tested for Chlamydia positive (2.0%).2. Evaluation of intervention657 participants were enrolled at the baseline survey, of the 657,224 were in low level of intervention group,209 were in medium level of intervention group while 224 in high group; 72.3%(475/657) of them completed the first follow up study. Among them,154 were in low level of intervention group,152 were in medium level of intervention group while 169 in high group; 50.2%(330/475) of them completed the second follow up study. Among them,102 were in low level of intervention group,91 were in medium level of intervention group while 137 in high group.(1)The average score of low level of intervention group were 6.46±3.94,11.6±2.25,12.55±1.36 respectively for the three surveys, the average score of the two follow up were higher than baseline survey(P<0.01), the average score of the second follow up was higher than the first follow up(P<0.01). The HIV knowledge rate in two aspects after first follow up was higher than at the baseline (P<0.01), while there was no statistical significance in sex concepts among the participants in three surveys (P>0.01). There was statistical significance in the rate of condom use among married and unmarried in three surveys (P<0.01).(2)The average score of medium level of intervention group were 6.31±4.26,12.37±1.48,12.23±2 respectively for the three surveys, the average score of the two follow up were higher than baseline survey(P<0.01), the average score of the second follow up was higher than the first follow up(P<0.01). The attitude towards AIDS in one aspect after first follow up was higher than at the baseline (P<0.01), while the attitude towards AIDS in two aspects after second follow up was higher than at the baseline (P<0.01).There was no statistical significance in sex concepts among the participants in three surveys (P>0.01). There was statistical significance in the rate of condom use among unmarried in three surveys (P<0.01).(3)The average score of high level of intervention group were 7.05±4.35,12.65±1.43,12.4±1.76 respectively for the three surveys, the average score of the two follow up were higher than baseline survey(P<0.01), the average score of the second follow up was higher than the first follow up(P<0.01). The HIV knowledge in two aspects after first follow up was higher than at the baseline (P<0.01), while the HIV knowledge in four aspects after second follow up was higher than at the baseline (P<0.01). There was statistical significance in the rate of condom use among married in three surveys (P<0.01). There was statistical significance in the rate of condom use among unmarried in three surveys (P<0.01).(4)Comparison of three intervention methodsThree intervening methods play important role in enhancing the knowledge of AIDS. Statistical significance wasn't found between three intervention groups (P>0.01) during baseline survey. After intervention, the average score of high and medium level of intervention groups were higher than the low after first follow up (P<0.01). Statistical significance wasn't found between high level of intervention and medium groups. Statistical significance wasn't found between three intervention groups after second follow up (P>0.01), though the average score of three groups were all higher than before.Three intervening methods play positive role in changing the attitude towards AIDS. Statistical significance wasn't found between three intervention groups (P>0.01) during baseline survey. After the first intervention, statistical significance was found between high, medium level of intervention groups and low level. Statistical significance wasn't found between three intervention groups after second follow up (P<0.01), though the average score of three groups were all higher than before.Three intervening methods play certain role in changing AIDS behavior. There was no statistical significance in the rate of condom use among married after first follow up (P>0.01), while there was statistical significance in the rate of condom use among married after second follow up (P<0.01). Statistical significance was found in the rate of condom use among unmarried after first follow up (P<0.01).Conclusions:1. Three intervening methods proved notable effect in enhancing awareness of HIV/AIDS knowledge. Their attitude towards HIV/AIDS changed better after intervention.2. There wasn't obvious change in risk behaviors about AIDS after intervention, while knowledge and attitude changed evidently. There was statistical significance in the rate of condom use among married and unmarried in the high level of intervention group (p<0.01). 3. It is found that brochures, posters, display panel, DVD and face-to-face interview were of great use for enhancing awareness of HIV/AIDS knowledge and attitude.4. We find that the consciousness of AIDS prevention became disjointed with relative behaviors, study participants need profound intervention. A more effective behavior intervention model is needed not only for construction workers but also for population, in order to control the transmission and spread of HIV.