Risk Behaviours among Female Sex Workers in China: A Systematic Review and Data Synthesis

Abstract

BackgroundCommercial sex is one of the major modes of HIV transmission in China. Understanding HIV risk behaviours in female sex workers (FSW) is of great importance for prevention. This study aims to assess the magnitude and temporal changes of risk behaviours in Chinese FSW.MethodFive electronic databases were searched to identify peer-reviewed English and Chinese language articles published between January 2000 and December 2012 that reported risk behaviours among FSW in China, including condom use, HIV testing, and drug use. Linear regression and Spearman's rank correlation were used to examine temporal trends in these risk factors. The study followed PRISMA guidelines for meta-analyses and was registered in the PROSPERO database for systematic reviews.ResultsA total of 583 articles (44 English, 539 Chinese) investigating 594,583 Chinese FSW were included in this review. At last sex, condom use was highest with commercial partners (clients), increasing from 53.7% in 2000 to 84.9% in 2011. During this same time period, condom use increased with regular partners from 15.2% to 40.4% and with unspecified partners from 38.6% to 82.5%. Increasing trends were also found in the proportion of sampled FSW who reported testing for HIV in the past 12 months (from 3.2% in 2000 to 48.0% in 2011), while drug use behaviours decreased significantly from 10.9% to 2.6%.ConclusionDuring the first decade of 2000, Chinese FSWs’ self-reported risk behaviours have decreased significantly while HIV testing has increased. Further outreach and intervention efforts are needed to encourage condom use with regular partners, continue promotion of HIV testing, and provide resources for the most vulnerable FSW, particularly low tier FSW, who may have limited access to sexual health and prevention programs.

Sex with sweethearts: Exploring factors associated with inconsistent condom use among unmarried female entertainment workers in Cambodia

“…However, this study found that the rate of consistent condom use with sweethearts remains unacceptably low among FEWs (31.4% of those having sex with sweethearts in the past three months). This finding is in line with findings in several studies in other countries, which found that the rates of consistent condom use with regular, non-commercial partners are consistently lower than the rates in commercial relationships [30, 31]. In this situation, partners of FEWs may potentially become a bridging population for HIV/STI transmission [12, 13].…”

A systematic review and meta-analysis of the prevalence, trends, and geographical distribution of HIV among Chinese female sex workers (2000–2011): implications for preventing sexually transmitted HIV

“…54,55 Both government institutions and non-governmental organizations have strongly promoted condom use and HIV testing programmes, which have significantly improved condom use (from 53.7% to 84.9%) and HIV testing coverage (from 3.2% to 48.0%) over the period 2000-2011. 56 However, it is also possible that a lack of access to optimal treatment and delayed linkage to care in the early 2000s contributed to high death rates among the earlier-infected women, which would remove them from future prevalence estimates.…”

“…56 The disproportionately high HIV disease burden among FSWs in Southwest China is likely drug-related. The so-called 'Golden Triangle' is a well-known illicit drug manufacturing and trafficking region bordering Myanmar, Laos, Thailand, and Southwest China.…”

Treatment-seeking behaviour and barriers to service access for sexually transmitted diseases among men who have sex with men in China: a multicentre cross-sectional survey

“…The HIV prevalence among suspected STD-infected MSM was 16.7%, which was also higher than Chinese MSM in general (6.5%) [30] and Chinese FSWs (0.2%) [31], as reported in two recently published meta-analyses. This indicates that STD clinics and medical institutions at all levels ought to recommend HIV screening for suspected STD-infected MSM through provider-initiated HIV testing and counselling (PITC).…”