Healthcare professionals should work with gatekeepers to create a supportive local environment for condom use in sex work establishments. Gatekeepers need to clearly articulate their support for condom use to the FSWs. Training and skill acquisition regarding correct use of condoms among FSWs will be necessary.

High prevalence of syphilis and overlapped unprotected commercial sex and drug using behaviors among FSWs along a drug-trafficking route may suggest a potential for rapid spread of HIV from injection drug users to FSWs and then to the general population and underscore the urgency of preventive interventions to break the bridge of FSWs for HIV/sexually transmitted disease spread.

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This study evaluates the efficacy of cultural adaptation of a voluntary counseling and testing (VCT) intervention, in increasing condom use and decreasing rates of sexually transmitted diseases (STDs) among a group of female sex workers (FSWs) in Guangxi, China. This intervention is modeled after the "state-of-the-science" VCT program that was developed and evaluated by the Center for Disease Control and Prevention's Project RESPECT. Four hundred FSWs were assigned to either an intervention group receiving the VCT intervention or a control group receiving standard of care STD testing and treatment. Data were collected at baseline and 6 months postintervention. Outcome measures included HIV/STD related knowledge and perceptions, condom use, and history of STDs. Five common STDs were screened and tested through clinical examination and laboratory testing to serve as biomarkers. After controlling for potential confounders and baseline differences, the VCT intervention group was significantly higher than the control group in HIV/STD related knowledge (p < .0001) and consistent condom use with clients (odds ration [OR] = 2.23; 95% confidence interval [CI] = 1.26-3.96) at 6 months follow-up. In addition, the intervention group had a significantly lower infection rate of STDs than the control group at follow-up (OR = 0.44; 95% CI = 0.24-0.80). This quasi-experimental trial provides evidence that the brief VCT intervention, through appropriate cultural adaptation, can be efficacious in increasing condom use and reducing STD infection rate among FSWs in China.Data from both industrialized (Kamb, Fishbein, Douglas, Rhodes, & Rogers, 1998;RotheramBorus, Cabtwell, & Newman, 2000) and developing countries (Coates, et al., 2000;Merson, Dayton, & O'Reilly, 2000;Painter, 2001) suggest that culturally appropriate voluntary counseling and testing (VCT) programs are effective in facilitating a change toward safer sex behavior and in reducing HIV/STD (sexually transmitted disease) transmission. In a multisite international trial in three developing countries (Kenya, Tanzania, and Trinidad), Coates and colleagues (2000) suggested that pre and posttest HIV counseling is effective as a prevention strategy for both individuals and couples. Among the 3,000 individuals enrolled in the study, the rate of unprotected sex with nonprimary partners decreased more significantly among those who received VCT than those who received only basic health information. Among the 586 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript couples enrolled in the study, reduction of unprotected sex with enrolled partners was significantly greater among VCT groups than those who received health information alone.There has been considerable debate regarding effective ways to deliver HIV/STD counseling for promoting condom use and preventing incidental STD (Kamb et al., 1998;Rotheram-Borus et al., 2000). For the past decades, the standard for counseling has been the delivery of factbased didactic messages aimed at increasing cl...