Journal of Urban Health

, Volume 87, Issue 2, pp 292–303

Condom Use with Female Sex Workers among Male Clients in Sichuan Province, China: The Role of Interpersonal and Venue-Level Factors

  • Cui Yang
  • Carl Latkin
  • Rongsheng Luan
  • Kenrad Nelson
Article

Abstract

Commercial sex work has re-emerged as a widespread industry since China started economic reforms in the 1980s. This study examined the role of interpersonal and venue-level factors in commercial sex male clients' (CSMCs) condom use with female sex workers (FSWs) in China. Given the heterogeneity of commercial sex industry in China, this study also aimed to explore how these factors function differently by social ranks of commercial sex work frequented by CSMCs. A cross-sectional survey was conducted with 601 CSMCs in Sichuan province, China. Human immunodeficiency virus (HIV) prevalence in this sample was 1.7%. In addition to the individual characteristics, interpersonal factor was measured by the frequency of FSWs taking the initiative in condom use and providing condoms. Venue-level factor was assessed by the frequency of the managers of commercial sex venues communicating condom use policies and the frequency of condom availability in commercial sex venues. The primary behavioral outcome was consistent condom use with FSWs. Multivariate logistic regression models revealed that consistent condom use with FSWs was significantly associated with interpersonal (adjusted odds ratio (AOR), 1.62; 95% confidence interval (CI), 1.38, 1.90) and venue-level factors (AOR, 1.98; 95% CI, 1.40, 2.80). Moreover, the associations between interpersonal and venue-level factors and consistent condom use were moderated by social ranks of commercial sex work frequented by the male clients. The present study findings underscore the need for comprehensive HIV prevention approaches that integrate individual, interpersonal, and venue-level factors to reduce HIV risk behaviors among CSMCs in China.

Keywords

Commercial sex male clients Interpersonal factors Venue-level factors Condom use HIV China 

References

  1. 1.
    China Ministry of Health, UNAIDS, WHO. 2007 Update on the HIV/AIDS Epidemic and Response in China. Beijing: China Ministry of Health; 2007.Google Scholar
  2. 2.
    Anderson AF, Qingsi Z, Hua X, Jianfeng B. China's floating population and the potential for HIV transmission: a social-behavioural perspective. AIDS Care. 2003;15:177–185.CrossRefPubMedGoogle Scholar
  3. 3.
    Ruan Y, Cao X, Qian HZ, et al. Syphilis among female sex workers in southwestern China: potential for HIV transmission. Sex Transm Dis. 2006;33:719–723.CrossRefPubMedGoogle Scholar
  4. 4.
    Rogers SJ, Ying L, Xin YT, Fung K, Kaufman J. Reaching and identifying the STD/HIV risk of sex workers in Beijing. AIDS Educ Prev. 2002;14:217–227.CrossRefPubMedGoogle Scholar
  5. 5.
    van den Hoek A, Fu YL, Dukers NHTM, et al. High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: potential for fast spread of HIV. AIDS. 2001;15:753–759.CrossRefPubMedGoogle Scholar
  6. 6.
    Hong Y, Li X. Behavioral studies of female sex workers in China: a literature review and recommendation for future research. AIDS Behav. 2008;12:623–636.CrossRefPubMedGoogle Scholar
  7. 7.
    Hesketh T, Zhang J, Qiang DJ. HIV knowledge and risk behavior of female sex workers in Yunnan Province, China: potential as bridging groups to the general population. AIDS Care. 2005;17:958–966.CrossRefPubMedGoogle Scholar
  8. 8.
    Huang YY, Henderson GE, Pan SM, Cohen MS. HIV/AIDS risk among brothel-based female sex workers in China: assessing the terms, content, and knowledge of sex work. Sex Transm Dis. 2004;31:695–700.CrossRefPubMedGoogle Scholar
  9. 9.
    Wang H, Chen RY, Ding G, et al. Prevalence and predictors of HIV infection among female sex workers in Kaiyuan City, Yunnan Province, China. Int J Infect Dis. 2009;13:162–169.CrossRefPubMedGoogle Scholar
  10. 10.
    Murray L, Moreno L, Rosario S, Ellen J, Sweat M, Kerrigan D. The role of relationship intimacy in consistent condom use among female sex workers and their regular paying partners in the Dominican Republic. AIDS Behav. 2007;11:463–470.CrossRefPubMedGoogle Scholar
  11. 11.
    Xu JJ, Wang N, Lu L, et al. HIV and STIs in clients and female sex workers in mining regions of Gejiu City, China. Sex Transm Dis. 2008;35:558–565.CrossRefPubMedGoogle Scholar
  12. 12.
    Zhang Y, Wu Z, Liu W. Risk factors of condom use among clients of commercial sex workers in saunas and beauty parlors in Beihai city. Prev Med Trib. 2006;12:32–33.Google Scholar
  13. 13.
    Chen C, Li B, Liu D, Li C, Pei Z. Condom use in commercial sex workers and clients among incarcerated sex workers and STD clinic attendees in Jinan, Shandong province. Chin J Sex Transm Infect. 2003;3:1–8.Google Scholar
  14. 14.
    Wang B, Li X, Stanton B, Fang X, Lin D, Mao R. HIV-related risk behaviors and history of sexually transmitted diseases among male migrants who patronize commercial sex in China. Sex Transm Dis. 2007;34:1–8.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Parish WL, Laumann EO, Cohen MS, et al. Population-based study of chlamydial infection in China: a hidden epidemic. JAMA. 2003;289:1265–1273.CrossRefPubMedGoogle Scholar
  16. 16.
    Lowndes CM, Alary M, Gnintoungbe CA, et al. Management of sexually transmitted diseases and HIV prevention in men at high risk: targeting clients and non-paying sexual partners of female sex workers in Benin. AIDS. 2000;14:2523–2534.CrossRefPubMedGoogle Scholar
  17. 17.
    Carael M, Slaymaker E, Lyerla R, Sarkar S. Clients of sex workers in different regions of the world: hard to count. Sex Transm Infect. 2006;82(Suppl 3):iii26–iii33.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Gil VE, Wang MS, Anderson AF, Lin GM, Wu ZO. Prostitutes, prostitution and STD/HIV transmission in mainland China. Soc Sci Med. 1996;42:141–152.CrossRefPubMedGoogle Scholar
  19. 19.
    Rojanapithayakorn W, Hanenberg R. The 100% condom program in Thailand. AIDS. 1996;10:1–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Rojanapithayakorn W. The 100% condom use programme in Asia. Reprod Health Matters. 2006;14:41–52.CrossRefPubMedGoogle Scholar
  21. 21.
    Zhongdan C, Schilling RF, Shanbo W, Caiyan C, Wang Z, Jianguo S. The 100% condom use program: a demonstration in Wuhan, China. Eval Program Plann. 2008;31:10–21.CrossRefPubMedGoogle Scholar
  22. 22.
    Kerrigan D, Ellen JM, Moreno L, et al. Environmental-structural factors significantly associated with consistent condom use among female sex workers in the Dominican Republic. AIDS. 2003;17:415–423.CrossRefPubMedGoogle Scholar
  23. 23.
    Sweat MD, Denison JA. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS. 1995;9(Suppl A):S251–S257.PubMedGoogle Scholar
  24. 24.
    Hong Y, Fang XY, Li XM, Liu Y, Li MQ. Environmental support and HIV prevention behaviors among female sex workers in China. Sex Transm Dis. 2008;35:662–667.CrossRefPubMedGoogle Scholar
  25. 25.
    Yang H, Li X, Stanton B, et al. Condom use among female sex workers in China: role of gatekeepers. Sex Transm Dis. 2005;32:572–580.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Wang B, Li XM, McGuire J, Kamali V, Fang XY, Stanton B. Understanding the dynamics of condom use among female sex workers in China. Sex Transm Dis. 2009;36:134–140.CrossRefPubMedGoogle Scholar
  27. 27.
    Oladosu M. Consistent condom use dynamics among sex workers in Central America: 1997-2000. J Biosoc Sci. 2005;37:435–457.CrossRefPubMedGoogle Scholar
  28. 28.
    Morisky DE, Tiglao TV, Sneed CD, et al. The effects of establishment practices, knowledge and attitudes on condom use among Filipina sex workers. AIDS Care. 1998;10:213–220.CrossRefPubMedGoogle Scholar
  29. 29.
    Morisky DE, Pena M, Tiglao TV, Liu KY. The impact of the work environment on condom use among female bar workers in the Philippines. Health Educ Behav. 2002;29:461–472.CrossRefPubMedGoogle Scholar
  30. 30.
    Luan RS, Zeng YL, Fan L, et al. A study on acquired immune deficiency syndrome related behaviors in male clients of female sex workers. Zhonghua Liu Xing Bing Xue Za Zhi. 2005;26:101–105.PubMedGoogle Scholar
  31. 31.
    Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19(Suppl 2):S67–S72.CrossRefPubMedGoogle Scholar
  32. 32.
    Liang KY, Zeger SL, Qaqish B. Multivariate regression analysis using generalized linear models. J Roy Stat Soc. 1992;B:3–40.Google Scholar
  33. 33.
    Waite LJ. Does marriage matter? Demography. 1995;32:483–507.CrossRefPubMedGoogle Scholar
  34. 34.
    Tucker JD, Henderson GE, Wang TF, et al. Surplus men, sex work, and the spread of HIV in China. AIDS. 2005;19:539–547.CrossRefPubMedGoogle Scholar
  35. 35.
    Choi S, Holroyd E. The influence of power, poverty and agency in the negotiation of condom use for female sex workers in mainland China. Cult Health Sex. 2007;9:489–503.CrossRefPubMedGoogle Scholar
  36. 36.
    Yang C, Latkin C, Liu P, Nelson K, Wang C, Luan R. A qualitative study on commercial sex behaviors among male clients in Sichuan province, China. AIDS Care. 2009; in press.Google Scholar
  37. 37.
    Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44:174–199.CrossRefGoogle Scholar
  38. 38.
    McKnight C, Jarlais DD, Bramson H, et al. Respondent-driven sampling in a study of drug users in New York City: notes from the field. J Urban Health. 2006;83:I54–I59.CrossRefPubMedGoogle Scholar
  39. 39.
    Wang J, Carlson RG, Falck RS, Siegal HA, Rahman A, Li L. Respondent-driven sampling to recruit MDMA users: a methodological assessment. Drug Alcohol Depend. 2005;78:147–157.CrossRefPubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2010

Authors and Affiliations

  • Cui Yang
    • 1
  • Carl Latkin
    • 1
  • Rongsheng Luan
    • 2
  • Kenrad Nelson
    • 1
  1. 1.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Sichuan University West China School of Public HealthChengduChina

Personalised recommendations