HIV, Syphilis, and Behavioral Risk Factors among Female Sex Workers before and after Implementation of Harm Reduction Programs in a High Drug-Using Area of China

Li Zhang,Hui Xing,Qianping Liu,Yunan Xu,Shu Liang,Hui Dong,Weixia Lu,Stephen W Pan,Yiming Shao,Benli Song,Yuhua Ruan,Yuntao Wu

doi:10.1371/journal.pone.0084950

Abstract

ObjectiveTo evaluate the impact of harm reduction programs on HIV and syphilis infection and related risk behaviors among female sex workers (FSWs) in a drug trafficking city in Southwest China.DesignBefore and after harm reduction program study.MethodsTwo cross-sectional surveys were conducted among FSWs before and after harm reduction programs were launched in Xichang city, Sichuan province. The first and second cross-sectional surveys were conducted in 2004 and 2010, respectively. Temporal changes in odds of HIV, syphilis, and behavioral risk factors were assessed by multivariable logistic regression while controlling for socio-demographics.ResultsThe 2004 and 2010 cross-sectional surveys recruited 343 and 404 FSWs, respectively. From 2004 to 2010, the odds of syphilis infection decreased by 35% and was of borderline statistical significance (AOR: 0.65, 95% CI: 0.41–1.03), while odds of HIV infection rose, but not significantly (AOR: 4.12, 95% CI: 0.76–22.45). Although odds of unprotected sex with primary sex partners did not significantly change over time (AOR: 0.96; 95% CI: 0.61–1.50), odds of unprotected sex with clients declined significantly and remarkably (AOR: 0.14, 95% CI: 0.09–0.21). Notably, the odds of reporting ≥10 new sex partners in the previous month increased by 37% (AOR: 1.37; 95% CI: 0.98–1.90).ConclusionsHarm reduction strategies may be an effective means of reducing unprotected sex with clients among FSWs. Future research is needed to better target both FSWs and IDUs and interrupt bridging networks for HIV transmission in high drug-using areas of China.

Highlights

Prior to 1949, syphilis was one of the most common sexually transmitted infections (STI) in China [1,2,3]
Harm reduction strategies may be an effective means of reducing unprotected sex with clients among female sex workers (FSWs)
The goal of the present study is to evaluate the impact of the ‘‘Four Frees and One Care’’ harm reduction programs on HIV and syphilis infection and related risk behaviors among female sex workers (FSWs) in a drug trafficking city in Southwest China

Summary

Introduction

Prior to 1949, syphilis was one of the most common sexually transmitted infections (STI) in China [1,2,3]. Since its adoption of free market economic policies in 1978, China has witnessed the rapid reemergence of global drug trafficking, abuse and addiction, commercial sex, and STIs. Due to rapid economic development, large income disparities, limited occupational opportunities for women, and changing notions of sexuality, it is estimated that the number of commercial sex workers nationwide increased 140-fold, from 25,000 to 3.5 million sex workers between the years 1985 and 2000 [6,7]. Due to rapid economic development, large income disparities, limited occupational opportunities for women, and changing notions of sexuality, it is estimated that the number of commercial sex workers nationwide increased 140-fold, from 25,000 to 3.5 million sex workers between the years 1985 and 2000 [6,7] During this same period, the annual reported cases of eight notified sexually transmitted diseases (STDs, including syphilis and HIV/AIDS) increased by 147-fold from 5,838 to 859,040 cases [8]. Syphilis and HIV accounted for over 10% of all reported STDs cases nationwide [9,10,11,12,13]

Methods

Results

Conclusion