Research On Sexual Risk Behaviors Of HIV Positive Clients Of Female Sex Workers And Their Associated Factors

ObjectionsTo understand the current sexual risk behavior of HIV-positive clients of female sex workers(CFSWs) in Hengyang City and Changsha City; to explore attitudes toward extramarital sex behavior and reasons for extramarital sex behavior and unsafe sex behavior among HIV-positive CFSWs in past 6 months.Participants and Methods1. ParticipantsHIV-positive CFSWs: infecting HIV by commercial sexual behavior, don’t have the history of homosexual behavior and selling blood, report having had sex with female sex workers(FSWs) before HIV diagnosis, and denied the possibility of their spouses transmit HIV to them.2. MethodsThis study combined the quantitative cross-sectional survey using face-to-face interview(FTFI) and semi-structure qualitative interview. HIV-positive CFSWs aged 18 and over and diagnosed with HIV more than 6 months were recruited from ARTs and CDCs in Hengyang City and Changsha City of Hunan Province. FTFI was used to collect social demographics, HIV related knowledge, sex behavior, condom use and so on. Frequency and Chi-square was used to describe social demographics, HIV related knowledge and current sexual behavior. Univariate and multivariate Logistic regression were used to analyze influential factors of sexual behaviors and condom use. Qualitative study was semi-structure in-depth interview, 32 HIV-positive CFSWs and 3-HIV related health workers were interviewed. The in-depth interview was designed to explore attitudes towards extramarital sexual behavior and reasons for extramarital sexual behavior. After transcribed, ATLAS.ti5.0 was used to code, integrate and analyze the qualitative data.Results1. Cross-sectional survey378 HIV-positive CFSWs were recruited and 327 completed finished the questionnaire investigation(response rate is 86.5%). Of them, 97 came from Changsha City(ART recruited 80, CDC recruited 17), 230 came from Hengyang(ART recruited 165, CDC recruited 65). The median age was 45.0 years(IOQ: 37.0-57.0), 58.4%(191/327) were married, 56.9%(186/327) were below middle school, 52.3%(171/327) were farmers or immigrant labors. The mean age for sex behavior was 22.6 years and the mean age for marriage was 25.2 years old.84.1%(275/327) of participants was receiving ART. 31.8%(104/327) the latest CD4 was more than 350 per cubic meter.In past 6 months, 41.6%(136/327), 20.8%(68/327), 9.2%(30/327) of the participants had sex with regular sexual partners, commercial sexual partners and casual sexual partners respectively. In past 6 months, consistent condom use with regular sexual partners, commercial sexual partners and casual sexual partners were 64.0%(87/136), 47.1%(32/68), 43.3%(13/30) respectively. The latest condom use with regular sexual partners, commercial sexual partners and casual sexual partners were 74.3%(101/136), 64.7%(44/68), 60.0%(18/30). The proportion of consistent condom use with regular sexual partners was higher than that with commercial and casual sexual partners in past 6 months, and the difference had statistical significance.2. Qulitative study32 HIV-positive CFSWs and 3 HIV-related health workers were interviewed in this study. The majority of participants were married, middle school and below. In the 6 months, 8 participants reported having sex with commercial or casual sexual partners. Reasons for extramarital sex behavior of HIV positive CFSWs after knowing their HIV infection status including: physiological and psychological need, open social atmosphere and social morality, pressure from companions, considering extramarital sex behavior is separated from family responsibility, regular sexual partners are HIV negative, experiences of social discrimination hindering the seeking for a regular sexual partner and alcohol. Condoms reduce sex pleasure, sexual partners are HIV positive, don’t have the responsibility to protect commercial or casual sexual partners, lack of HIV co-infection knowledge and potential psychology torevenge others are reasons for unsafe sex after knowing their HIV positive status.ConclusionsHIV-positive CFSWs continued to have unsafe sexual behaviors after knowing their HIV status, but condom use rates with different sexual partners were different. Condom use rates with commercial or casual sexual partners were lower than regular sexual partners. These findings urge effective intervention targeting this group not only emphasizing the consistent condom use with couples but also with other sexual partners; the initial epidemiological investigation and during the following up services of PLHIV, their social responsibility and obligation to protect others from HIV infection.