Abstract
BackgroundIn China, clients of female sex workers (CFSWs) have a low rate of condom use and a high prevalence of human immunodeficiency virus (HIV). However, little is known about the high-risk sexual behaviors of HIV-positive CFSWs.MethodsIn 2014, 327 CFSWs diagnosed with HIV for 6 months or longer completed a face-to-face questionnaire for a quantitative survey. In addition, 32 HIV-positive CFSWs were recruited to participate in in-depth interviews (18 participated in both, 14 participated in-depth interviews only) to explore reasons for extramarital sexual behaviors and inconsistent condom use. The quantitative data on sexual risk behaviors were analyzed using chi-square tests. Interviews were coded inductively for emerging themes.ResultsAmong the participants of the quantitative survey, 41.6% (136/327) had sex with regular sexual partners only in the past 6 months, of whom 64.0% (87/136) had consistent condom use; 27.5% (90/327) of the participants had sex with irregular sexual partners in the past 6 months, of which, 46.7% (42/90) had consistent condom use. The qualitative study suggested that HIV positive sero-status, willingness to protect their spouses or regular sexual partners, and lacking a sense of responsibility to protect their commercial and casual sexual partners, influence CFSWs’ sexual behaviors.ConclusionsHIV-positive CFSWs continue to practice unsafe sexual behaviors with regular and irregular partners after HIV diagnosis, but were more willing to protect their regular partners. Future interventions targeting HIV-positive CFSWs should not only be confined to sero-discordant couples, but also need to instill a sense of responsibility to protect the commercial and casual partners and reduce the number of concurrent partners.
Highlights
In China, clients of female sex workers (CFSWs) have a low rate of condom use and a high prevalence of human immunodeficiency virus (HIV)
For people living with HIV (PLHIV), improvements in health and quality of life due to anti-retroviral therapy (ART) have enabled many to engage in sexual activity [4, 5]
After analyzing the quantitative and qualitative data separately, we merged the results of the two strands to describe the sexual risk behavior of HIV positive CFSWs
Summary
In China, clients of female sex workers (CFSWs) have a low rate of condom use and a high prevalence of human immunodeficiency virus (HIV). Little is known about the high-risk sexual behaviors of HIV-positive CFSWs. In China, the sexual transmission of HIV is rapidly increasing [1, 2]. Heterosexual transmission accounted for 52.2% of the estimated new infections in 2011, compared to 11.3% prior to 2006 [3]. Behavioral interventions typically aim to prevent new infections among key affected populations, rather than focusing broadly on all PLHIV [1]. Owing to rapid changes in sexual behaviors and attitudes over the past three decades, extramarital sex and concurrent sexual relationships are increasingly common in China [8].
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