Abstract
ObjectivesTo assess the prevalence of human immunodeficiency virus (HIV) infection and the correlated risk factors among male clients of female sex workers (FSWs) in a Chinese–Vietnamese border region in Yunnan Province, China.MethodsA cross-sectional survey was conducted between 2014 and 2015 in Hekou County, Yunnan Province, China. Convenience sampling and snowball sampling methods were used to recruit male clients for a questionnaire survey to collect information on demographics, sexual behavior, and drug use. Blood and urine samples were collected for testing of HIV/sexually transmitted infections (STIs) and drug use. Multivariate logistic regression was used to examine factors correlated with HIV infection.ResultsOf 776 respondents who participated in the study, 721 (92.91%) were Chinese and 55 (7.09%) were Vietnamese. Overall HIV prevalence in male clients of FSWs was 2.06%, 128 (16.49%) were infected with HSV-2, and five (0.64%) tested syphilis-positive. Two-thirds (68.81%) of respondents reported always using condoms with FSWs, and 89.05% reported condom use in the last episode of commercial sex. Male clients from Vietnam were significantly more likely to take morphine (9.09%) compared with Chinese male clients of FSWs. Age ≥50 years (OR: 8.11, 95%CI: 1.26–52.16) and morphine positivity (OR: 7.35, 95%CI: 1.42–38.06) were associated with HIV infection in the multivariate logistic regression model.ConclusionThe relatively high proportion of male clients of FSWs who have numerous sexual partners and use condoms less frequently make them serve as important bridges for HIV transmission from FSWs to the low-risk general population. The positive association between morphine positivity and HIV infection confirmed illegal drug use as another important route for acquiring HIV infection in addition to sexual transmission, indicating that innovative interventions addressing both drug use and risky sexual behaviors are greatly required for male clients. Respondents aged ≥50 years have a higher risk of HIV infection, which emphasizes that older male clients of FSWs should be focused in future HIV prevention interventions in the border regions of China.
Highlights
Since 2007, sexual transmission has replaced intravenous drug use as the primary mode of human immunodeficiency virus (HIV) transmission in China [1,2]
The relatively high proportion of male clients of female sex workers (FSWs) who have numerous sexual partners and use condoms less frequently make them serve as important bridges for HIV transmission from FSWs to the low-risk general population
The positive association between morphine positivity and HIV infection confirmed illegal drug use as another important route for acquiring HIV infection in addition to sexual transmission, indicating that innovative interventions addressing both drug use and risky sexual behaviors are greatly required for male clients
Summary
Since 2007, sexual transmission has replaced intravenous drug use as the primary mode of human immunodeficiency virus (HIV) transmission in China [1,2]. During the first half of 2016, it was estimated that 66.3% of novel HIV infections in China were acquired through unprotected heterosexual intercourse, which was considerably higher than the 2007 estimate of 37.9% [3,4,5]. Pan S et al [8] concluded that approximately 6%–9% of male adults aged between 18 and 60 years have ever engaged in commercial sexual behaviors with FSWs in China. In 2012, McLaughlin et al [9] estimated through a meta-analysis that HIV prevalence among Chinese male clients of FSWs was 0.68%, which is more than ten times higher than the estimate for adults in the general population. The HIV prevalence estimate among male clients in southwest China is significantly higher than among those in other regions (2.54% vs 0.24%, P = 0.001)
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