Rapid Syphilis Testing Uptake for Female Sex Workers at Sex Venues in Southern China: Implications for Expanding Syphilis Screening

Xiang-Sheng Chen,Wan-Hui Wei,David C Mabey,Joseph D Tucker,Jing Li,Crystal Shen,Shui-Jie Huang,Guo-Gu Liu,Rosanna W Peeling,Hong-Chun Wang,Zheng-Jun Zhu,Yue-Ping Yin,Michelle Louise Gatton

doi:10.1371/journal.pone.0052579

Abstract

BackgroundAccessibility of syphilis testing services is critical in syphilis control programs for female sex workers (FSWs), but few FSWs attend public STI clinics or other testing sites. Introduction of free rapid syphilis testing (RST) into outreach programs for FSWs will help improve test uptake.MethodsCommercial sex venues were identified in two cities in South China. In cooperation with health advocacy organizations, health outreach teams from local public health or medical facilities approached all types of sex venues in study areas to offer free RST. Acceptability and uptake of RST among FSWs were evaluated.ResultsA total of 2812 FSWs were offered RST and 2670 (95.0%) accepted syphilis testing. 182 (6.8%) FSWs had a positive RST result among whom 136 (74.7%) were willing to attend an STD clinic for confirmatory testing and treatment. More than half (89, 66.4%) of those with syphilis were not willing to notify their sex partners. Multivariate logistic analysis showed that syphilis test uptake was associated with residing in Jiangmen (AOR, 1.78; 95% CI, 1.15–2.77), older age (AOR, 2.11, 95% CI, 1.17–3.79 for age of 31 years or above), and not working at a service venue (AOR, 1.60; 95% CI, 1.10–2.34).ConclusionsRST at sex venues is well accepted by FSWs when it is integrated into ongoing outreach services. Such programs provide excellent opportunities for expanding syphilis screening efforts among specific subgroups of FSW who are difficult to reach through clinic-based programs.

Highlights

Female sex workers (FSWs) in South China have a high prevalence of syphilis and an increasing burden of sexually transmitted HIV infection [1,2,3,4]
female sex workers (FSWs) in China may not be aware of their risk of syphilis infection because there are not any specific syphilis screening programs for this population, mistrust of local public health STD clinics about confidentiality and privacy protection, or fear of social stigma and condemnation [15]
Of the 2812 female sex workers who were offered on-site rapid syphilis testing (RST), 2670 accepted testing, giving an overall test uptake rate of 95.0%

Summary

Introduction

Female sex workers (FSWs) in South China have a high prevalence of syphilis and an increasing burden of sexually transmitted HIV infection [1,2,3,4]. Most FSWs do not attend public STD clinics, or the voluntary testing and counseling (VCT) sites where they can receive free syphilis and HIV testing [13,14]. FSWs in China may not be aware of their risk of syphilis infection because there are not any specific syphilis screening programs for this population, mistrust of local public health STD clinics about confidentiality and privacy protection, or fear of social stigma and condemnation [15]. Accessibility of syphilis testing services is critical in syphilis control programs for female sex workers (FSWs), but few FSWs attend public STI clinics or other testing sites. Introduction of free rapid syphilis testing (RST) into outreach programs for FSWs will help improve test uptake

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