Psychological fears among low-paid female sex workers in southwest China and their implications for HIV prevention.

Shan Qiao,Bonita Stanton,Xiaoming Li,Zhenzhu Tang,Zhiyong Shen,Yuejiao Zhou,Chen Zhang,Hong Shang

doi:10.1371/journal.pone.0111012

Abstract

Commercial sex plays a critical role in rapidly increasing heterosexual transmission of HIV in China. Low-paid female sex workers (FSWs) are especially vulnerable to HIV/AIDS. Because of the illegality and stigma associated with sex work, FSWs may constantly live with fears in their daily life. Based on cross-sectional study of 794 low-paid FSWs in China we described their psychological fears related to commercial sex and examined the associations between fears and HIV-related behaviors. Fear of HIV infection was significantly associated with consistent use of condoms with clients. However, fear of breaching sex worker identity significantly prevented the FSWs from consistently using condoms with clients and taking HIV tests. Fear of being arrested by the police was positively associated with consistent use of condoms but negatively associated with accessing HIV prevention services. Our findings underlined the importance of examining the triadic interaction of behavioral, psychological and environmental factors in HIV prevention interventions among low-paid FSWs.

Highlights

Compared with other women of reproductive age, female sex workers (FSWs) are taking a disproportionately high burden of HIV infection due to biological, behavioral and structural risk factors [1]
Low-paid FSWs refer to the FSWs who usually work on the street or lower-tier commercial sex venues and charge much less for each sex trade [5]
It is interesting that the FSWs who expressed various fears were not always the most disadvantageous groups in terms of sociodemographic characteristics

Summary

Introduction

Compared with other women of reproductive age, female sex workers (FSWs) are taking a disproportionately high burden of HIV infection due to biological, behavioral and structural risk factors [1]. According to a recent meta-analysis among FSWs in low- and middle-income countries, the overall HIV prevalence is 11.8% with a pooled odds ratio of 13.5 for HIV infection [1]. Among this high-risk population, low-paid FSWs were especially vulnerable and marginalized due to their social-demographic characteristics [2], life history (e.g. child sexual abuse, adult sexual assault) [3], and working environment [4]. Existing studies found that low-paid FSWs face a high risk of sexually transmitted infections (STIs) [11,12] and HIV infection [13]. Drug dependence was associated with elevated rates of injection drug use and sexual risk behaviors among low-paid FSWs [18]

Methods

Results

Conclusion