HIV Prevalence and Risk Behaviors Among Male Clients of Female Sex Workers in Yunnan, China

Abstract

Objectives To assess the prevalence and risk factors of HIV among male clients of female sex workers in China. Methods Convenience sampling methods were used to recruit 315 clients using FSW-client and client-client networks. Subjects provided information on socio-demographic characteristics and sexual and drug behavior patterns. Blood samples were collected for HIV testing and urine samples for opiate testing. Results Overall HIV prevalence was 6.0%; among drug users it was 30.8%. 33.7% of respondents reported that they always use condoms in commercial sex and 63.5% that they used a condom in the last commercial sex episode. Drug use (OR: 6.1; 95% CI: 1.7–21.4) and lack of a regular sexual partner (OR: 6.3; 95% CI: 1.8–21.9) were significantly associated with HIV infection. Conclusions Clients of FSWs serve as potential bridges for HIV transmission from the high-risk FSWs to the low-risk general population, making them a key target for intervention. High HIV prevalence rates among clients in Kaiyuan is particularly alarming given their risk behavior patterns including high rates of partner exchange, low condom use rates, and drug using behaviors. Innovative interventions are needed to reduce the risk of HIV among clients and reduce the bridge of transmission to the general population.

Review of HIV and other sexually transmitted infections among female sex workers in China

“…Linkages between research, programmatic interventions, health services, and scale-up of successful pilots are urgently needed. Condom use rates of clients with FSW have been reported to be quite low (Jin et al, 2010;Parish et al, 2003), likely because social norms largely do not support their use. Many FSW may also hesitate to access health services even at specially tailored clinics due to stigma and confidentiality concerns (Wong & Wang, 2003).…”

HIV Infection, Sexual Behaviors, Sexual Networks, and Drug Use Among Rural Residents in Yunnan Province, China

“…For example, in 1996, Wu and colleagues found that nearly 20% of their study participants and 25% of the Jingpo minority in the study area had used drugs [21]. A recently reported study among male clients of female sex workers (FSWs) in the same province found that drug use was prevalent and significantly associated with HIV infection [7]. These observations indicate that drug use remains prevalent among males and rural ethnic minorities, especially the Jingpo minority in Yunnan, and continues to be an important driver of the HIV/AIDS epidemic in this region.…”

“…In addition, although the Dai and Jingpo minorities, respectively, constitute only 0.3 and 2.5% of Yunnan's population, they account for 7 and 9% of all new HIV infections [4]. Since these HIV prevalence rates are primarily derived from high-risk groups such as IDUs [5][6][7], little is known about the epidemic in the ''general population'' (especially in the Dai and Jingpo minority communities). These studies can provide only a limited understanding of HIV transmission since an individual's probability of infection or transmission is influenced by his/her position in social or behavioral networks [8], while the risk of epidemic at the population-level is influenced by network structures [9].…”

Understanding the diversity of male clients of sex workers in China and the implications for HIV prevention programmes

“…While HIV prevalence among FSWs remains below 1% in Chinese Centers for Disease Control and Prevention (CDC) sentinel sites, FSW biomarker studies in selected locales have found HIV prevalence up to 8% and estimates of STIs up to 91% (Xu et al 2008). Studies among FSWs' clients have found HIV prevalence up to 6% and STI prevalence up to 23% (Xu et al 2008, Jin et al 2010, Rou et al 2010, Yang et al 2010b). Our 2006 nationally representative data on men's self-reported FSW contact and STIs were consistent with these reports, demonstrating that 6% to 8% of men buy commercial sex and that unprotected commercial sex increased the likelihood of contracting STIs (Pan et al , 2011.…”

“…Our 2006 nationally representative data on men's self-reported FSW contact and STIs were consistent with these reports, demonstrating that 6% to 8% of men buy commercial sex and that unprotected commercial sex increased the likelihood of contracting STIs (Pan et al , 2011. Extensive FSW use by Chinese men from all social classes and the high prevalence of STIs among FSWs (Wang et al 2007, Xu et al 2008, Jin et al 2010) raises concern about the spread of STIs/HIV, especially in male clients, who are proving to be an important bridge population.…”