Sexual Related Behaviors And STD Infections Among Female Sex Workers In Shanghai

【BACKGROUND】Increasing of epidemic of STD/AIDS in China has already aroused widespread concern inside or outside of China. The very importment one, among the control strategies of STD/AIDS, is to cut off the routes of transmission. In our country, with the STD/AIDS epidemic, sex workers have become the key to the spread of STD/ AIDS from high-risk groups to the general population, so it will play an important role in the control of STD/AIDS to effectively cut off the transmission through prostitution. Currently, in China female sex workers (FSWs) infected with HIV continues to rise, and the proportion of adhering to the use of condoms is still low, so the population still needed for effective intervention. Obtaining accurate, valid estimates of the characteristics, behaviors and disease prevalence to interventions among FSWs is critical in China due to the urgent need to limit the spread of HIV infections from this population group to the general population.【OBJECTIVES】To find out sexual related behaviors and STD infection status among female sex workers in Shanghai, in order to provide scientific evidence for later intervention project; to assess the effectiveness of Respondent Driven Sampling (RDS) to sample FSWs in Shanghai.【METHODS AND SUBJECTS】:We used the Respondent Driven Sampling approach to recruit 521 female sex workers in Shanghai for a cross-sectional survey. All respondents provided informed consent, anonymous interviews and a urine sample for assays of Chlamydia and Gonorrhea. Eligibility criteria for subjects were:aged 18 and above; exchanged sex for money in the past one month; currently worked or lived in Shanghai.【RESULTS】1. In this survey,84% of FSWs came from rural areas; 41% were unmarried; 80% graduated from middle school and the below. The average age of participants was 27 years old. Among them,89% had been pregnant,71% had abortion history, three-quarters needed to support others finacially. Compared to other tier workplaces, FSWs worked in KTV, sauna club, hotels and other high-tier workplaces were younger, mostly unmarried, with higher educational level; and FSWs who worked in Street, Park and other low-tier workplaces were older, and had a higher proportion of divorced/separated/widowed and lower educational standards.18% of participants used non-injection drugs, and the proportion using non-injection drugs among FSWs working in KTV/hotel/nightclub/hotel was the higest (38%).90% of participants had engaged in sex work no more than 4 years, and more than half engaged in sex work because of poverty or life stress. Their average monthly income was about 8,000 Yuan. Sauna parlor’s income was the highest (71% of FSWs’monthly income was above 10,000 Yuan), followed by KTV/hotel/nightclub/guesthouse, while street/park/disco/tearooms’income was the lowest.2. Sexual characteristics:The average age of first sexual intercourse was 19 years old, and the first sex of a quarter of participants occurred in 18 years old and previous. Approximately 56% of FSWs provided masturbation,41% provided penilingus, and all provided vaginal intercourse. The average number of partners that the participants reported was 20 (ranged 1～127) in the last month. partners’number of FSWs working in sauna parlor was the most (mean50), followed by hair salon/beauty parlor/foot massage/public bathroom/massage (mean 20), KTV/hotel/nightclub/ guesthouse and Street/Park/disco/tearoom (mean 10). In the past one month, about a third of FSWs had sexual intercourse with steady partners,93% with regular clients, 92% with one time clients, and 92% had two or more types of sexual partners.3. Condoms use:FSWs’condoms consistant use was negatively proportional to the closeness with sexual partners. With standy partners, regular clients and one time clients, the proportions of FSWs using condoms consistently were 24%,54% and 73% respectively. In multivariate analysis, from the rural, use of non-injection drugs, use of contraceptive measures (excluding condoms), the time engaged in sex work and the number of sexual partners were signicantly associated with consistent condom use with clients in the past one month. The proportion of FSWs using condom consistently with clients in sauna parlor was significantly higher than those in other types of workplaces. In addition, from the rural and use of contraceptive methods (excluding condoms) were signicantly associated with consistant condom use with standy partners. The main sources of condoms were stores and pharmacies, followed by the communities and the workplaces. Few reported to get condom from medical institutions or hotels.4. STD infections:In the past year,30% of participants had symptoms of STD infections, of which 28% had genital sores or unusual genital discharge and 7% had genital ulcers. Multivariate analysis showed:that from the rural, the time engaged in sex work, the number of sexual partners and condom consistant use were signficantly associated with STD infection. The proportion infected STD of FSWs in KTV/ nightclub/hotel/guesthouse was significantly higher than that in other types of workplaces. When symptoms of STD infections appeared, the main treatments of FSWs were to buy drugs themselves from pharmacies, to use spare medicine at home, and to go to the.formal medical institutions. About 30% of partcipants tested positive for Chlamydia or Gonorrhea,25% tested positive for Chlamydia,8% tested positive for Gonorrhea, and 2% tested positive for Chlamydia and Gonorrhoeae.5. Assess of the effectiveness of RDS to sample FSWs:This study proved that FSWs could be linked through social network, so RDS could be used to sample FSWs. The last sample have reached equilibrium in this survey, in other words, the sample’s characteristics have been independent of the characteristics of the seeds. The analysis of the final sample produced sample proportion estimate and population proportion estimate with differentials of between, but the differentials of the main characteristics were less than 0.05.【CONCLUSION】1. Although a lot of interventions were carried out among FSWs, the result of this study still indicated:STD infections among FSWs were serious, and the treatments were irregular. In addtion, FSWs had a large number of STD/AIDS high-risk behaviors such as a large number of sexual partners, many types of partners, a lower proportion of condom consistant use, a higher proportion of using non-injection drugs. So the effective interventions among FSWs are urgently needed to limit the spread of STD/ AIDS infections from this population group to the general population.2. FSWs from different workplaces were different in demographic characteristics, the characteristics of sex work, condom use and other characteristics. Therefore, to conduct targeted education and intervention activities in accordance with the characteristics of different workplaces may be highly effective.3. A representative sample could be got by using RDS.