The Potential for Rapid Sexual Transmission of HIV in China: Sexually Transmitted Diseases and Condom Failure Highly Prevalent Among Female Sex Workers

Abstract

Commercial sex is believed to play a role in the steadily increasing heterosexual transmission of HIV in China, but little attention has been paid to female sex workers working in the entertainment industry. From October to December 2000, we conducted a cross-sectional survey of 482 women in Baise City, Guangxi Autonomous Region, bordering Yunnan Province. Although no participants had antibodies to HIV infection, 4% of study participants tested positive for markers for syphilis and 21% reported being diagnosed with sexually transmitted diseases in the past year. Women reported low rates of consistent condom use with customers (17%), a spouse or fiance (9%), and casual partners (13%). A substantial proportion experienced condom failure (20% slippage and 13% breakage). Multivariate analyses found that consistent condom use with customers was related to multiple sexual partnerships, higher condom knowledge, and higher condom-use negotiation skills. Multiple sexual partnerships and higher condom-use negotiation skills predicted consistent condom use with casual partners, whereas higher condom-use negotiation skills did so for consistent condom use with a spouse or fiance. Our data suggest the need for condom education, condom skills training, and the distribution of reliable condoms among female sex workers. HIV prevention efforts must target these women as well as their clients and sex partners to prevent the further spread of HIV to the general population in China.