Abstract
We evaluated a two-phase HIV/STIs prevention intervention for female sex workers in a resource-limited rural town in Hainan Province, China. The primary intervention strategy, conducted from 1997 to 2000, was a condom promotion campaign conducted through outreach to sex workers. Four serial cross-sectional surveys were carried out before and after the intervention. Over a period of 2 years, reported condom use during the most recent sexual encounter increased from about 50% to more than 70%; and condom use in more than 50% of sexual acts during the past 6 months increased from less than 40% to near 80% of respondents. Controlling for education, ethnicity and age, reading of educational materials (our intervention variable) was a significant contributor to a higher knowledge score, motivation to use condoms, and reported condom use. This study demonstrates that outreach to female sex workers, if appropriately tailored to local settings, can increase condom use in a resource-limited rural area.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Asamoah-Adu, A., Weir, S., Pappoe, M., Kanlisi, N., Neequaye, A., & Lamptey, P. (1994). Evaluation of a targeted AIDS prevention intervention to increase condom use among prostitutes in Ghana. AIDS, 8, 239–246.
Bhave, G., Lindan, C. P., Hudes, E. S., Desai, S., Wagle, U., Tripathi, S. P., & Mandel, J. S. (1995). Impact of an intervention on HIV, sexually transmitted diseases, and condom use among sex workers in Bombay, India. AIDS, 9(suppl), S21–S30.
Chen, X., Gong, X., Liang, G., & Zhang, G. (2000). Epidemiologic trends of sexually transmitted diseases in China. Sexually Transmitted Diseases, 27(3), 139–142.
China Ministry of Health (1998) Press release on HIV/AIDS Update in China, 5 November 1998.
China Ministry of Health (2005). HIV/AIDS Update in China. November 2005.
China Ministry of Health, Joint United Nations Programmes on HIV/AIDS and World Health Organization (2006). 2005 Update on the HIV/AIDS Epidemic and Response in China. Beijing. January 24, 2006.
China State Council AIDS Committee and UN Theme Group on HIV/AIDS in China (2004). A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China. Beijing.
Ford, K., Wirawan, D. N., Fajans, P., Meliawan, P., MacDonald, K., & Thorpe, L. (1996). Behavioral intervention for reduction of sexually transmitted diseases/HIV transmission among female commercial sex workers and clients in Bali, Indonesia. AIDS, 10, 213–222.
Ford, K., Wirawan, D. N., Reed, B., Muliawan, P., & Wolfe, R. (2002). The Bali STD/AIDS Study—Evaluation of an intervention for sex workers. Sexually Transmited Diseases, 29(1), 50–58.
Hanenberg, R. S., Rojanapithayakorn, W., Kunasol, P., & Sokal, D. C. (1994). Impact of Thailand’s HIV program as indicated by the decline of sexually transmitted diseases. Lancet, 344, 243–245.
Hershatter, G. (1997). Dangerous pleasures—Prostitution and modernity in twentieth-century Shanghai. Berkeley: University of California Press.
Laga, M., Alary, M., Nzila, N., Manoka, A. T., Tuliza, M., Behets, F., Goeman, J., St Louis, M., & Piot, P. (1994). Condom promotion, sexually transmitted diseases treatment, and declining incidence of HIV-1 infection in female Zairian sex workers. Lancet, 344, 246–248.
Liao, S. (1998). HIV in China: epidemiology and risk factors. AIDS, 12(suppl): S19–S25.
Liao, S., Schensul, J., & Wolffers, I. (2003). Sex-related health risks and implications for intervention with hospitality women in Hainan, China. AIDS Education & Prevention, 15(2), 109–121.
Ma, S., Dukers, N. H. T. M., van den Hoek, A., Yuliang, F., Zhiheng, C., Jiangting, F., Lina, Z., & Xiuxing, Z. (2002). Decreasing STD incidence and increasing condom use among Chinese sex workers following a short term intervention: a prospective cohort study. Sexually Transmited Infections, 78, 110–114.
National Center for STD and Leprosy Control (1996). STDs Epidemiology in China—1991–1995. In G. Y. Ye (Ed.), Diagnosis, treatment and prevention of sexually transmitted diseases – Proceedings of the National Workshop on STDs (pp. 564–568). Guangdong: Guangdong Science and Technology Publishing House.
Pan, S. M. (1999). Reality and absurdity – underground sex industry in China. Beijing: Qun Yan Publishing House.
Rojanapithayakorn, W., & Hanenberg, R. S. (1996). The 100% condom promotion in Thailand. AIDS, 10, 1–7.
Walden, V. M., Mwangulube, K., & Makhumula-Nkhoma, P. (1999). Measuring the impact of a behaviour change intervention for commercial sex workers and their potential clients in Malawi. Health Education Research, 14, 545–554.
Ward, H. (2002). Short term intervention are not enough—sex work and health in the free market (editorials). Sexually Transmited Infections, 78, 80–81.
Wong, M. L., Chan, R., & Koh, D. (2004). Long-term effects of condom promotion programs for vaginal and oral sex on sexually transmitted infections among sex workers in Singpore. AIDS, 18, 1195–1199.
Acknowledgment
We thank the World Bank, the Norwegian government and Novib in the Netherlands for providing financial and technical support for this project; Dr. Jean Schensul from the Institute of Community Research, Hartford, Connecticut, USA, for sharing her knowledge and research experience with us; and the UCSF Center for AIDS Prevention Studies, USA, for supporting the preparation of this manuscript. We particularly acknowledge the tremendous contribution of the project staff at different levels, and the support of county and township governments of the study site.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liao, SS., He, QY., Choi, KH. et al. Working to Prevent HIV/STIs Among Women in the Sex Industry in a Rural Town of Hainan, China. AIDS Behav 10 (Suppl 1), 35–45 (2006). https://doi.org/10.1007/s10461-006-9143-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-006-9143-1