Clients Of Female Sex Workers Research Articles

Measuring HIV Acquisitions Among Partners of Key Populations: Estimates From HIV Transmission Dynamic Models.

Key populations (KPs), including female sex workers (FSWs), gay men and other men who have sex with men (MSM), people who inject drugs (PWID), and transgender women (TGW) experience disproportionate risks of HIV acquisition. The UNAIDS Global AIDS 2022 Update reported that one-quarter of all new HIV infections occurred among their non-KP sexual partners. However, this fraction relied on heuristics regarding the ratio of new infections that KPs transmitted to their non-KP partners to the new infections acquired among KPs (herein referred to as "infection ratios"). We recalculated these ratios using dynamic transmission models. One hundred seventy-eight settings (106 countries). Infection ratios for FSW, MSM, PWID, TGW, and clients of FSW were estimated from 12 models for 2020. Median model estimates of infection ratios were 0.7 (interquartile range: 0.5-1.0; n = 172 estimates) and 1.2 (0.8-1.8; n = 127) for acquisitions from FSW clients and transmissions from FSW to all their non-KP partners, respectively, which were comparable with the previous UNAIDS assumptions (0.2-1.5 across regions). Model estimates for female partners of MSM were 0.5 (0.2-0.8; n = 20) and 0.3 (0.2-0.4; n = 10) for partners of PWID across settings in Eastern and Southern Africa, lower than the corresponding UNAIDS assumptions (0.9 and 0.8, respectively). The few available model estimates for TGW were higher [5.1 (1.2-7.0; n = 8)] than the UNAIDS assumptions (0.1-0.3). Model estimates for non-FSW partners of FSW clients in Western and Central Africa were high (1.7; 1.0-2.3; n = 29). Ratios of new infections among non-KP partners relative to KP were high, confirming the importance of better addressing prevention and treatment needs among KP as central to reducing overall HIV incidence.

Barriers to HIV Testing among Clients of Female Sex Workers an Assessment of Ogoja Local Government Area

Frequent engagement of men in sexual encounters with female sex workers (FSWs) while not using condoms places them at high risk for Human Immunodeficiency Virus (HIV) infection. HIV testing has been noted to be among the necessary methods to stop HIV transmission and acquisition. However, it’s illustrious that not all men voluntarily test for Human Immunodeficiency Virus (HIV), take a look at how to stop Human immunodeficiency virus (HIV) transmission and/or acquisition. This study aimed to spot barriers to accessing Human immunodeficiency virus (HIV) testing services among men. World Health Organization square measure shoppers of female sex workers (clients) in Ogoja Cross River North, South-South Nigeria. A comprehensive search of recent literature uncovered a fancy array of social, Personal, and behavioural barriers, as well as knowledge/awareness of the Human immunodeficiency virus (HIV) infection’s existence, perception of human immunodeficiency (HIV) risk, stigma from care suppliers or family/partners/friends, distrust of care providers/systems. The purpose of this study is to explore possible barriers to HIV counseling and testing uptake among clients of Female Sex Workers in the Ogoja Local Government area of Cross River State, Nigeria, and to see possible ways of mitigating the barriers to epidemic control. This study was conducted in Ogoja Cross River State, Nigeria, with a sample size of 100 male clients of female sex workers, via random sampling technique through an online survey system known as Mwater for data collection. Frequency counts and percentages were used for data analysis. Vital findings of the study conclude: stigma and trust impact uptake of HIV test among male clients of female sex workers. Keywords: Acquired immunodeficiency syndromes, Barriers, Female sex workers, Human immunodeficiency virus, Human immunodeficiency virus testing, Male.

Application of the network scale-up method to estimate the sizes of key populations for HIV in Singapore using online surveys.

Singapore lacks robust data on the sizes of the key populations that are most at risk for HIV. Using the network scale-up method for hidden or hard-to-reach populations, we estimate the sizes of five key populations-male clients of female sex workers (MCFSW), men who have sex with men (MSM), female sex workers (FSW), people who inject drugs (PWID) and transgender people-and profile the ages and ethnicities of respondents with the high-risk contacts they report knowing. We conducted a cross-sectional online survey between March and May 2019 (n = 2802) using a network scale-up instrument previously developed for Singapore. Participants were recruited using an existing panel and online advertising, and the sample reweighted by age, sex, ethnicity and education attained to represent the general adult population. We built a Bayesian hierarchical model to estimate the sizes of the five key populations for HIV in Singapore. After adjustment, the sizes of the at-risk populations are estimated to be: 76,800 (95% credible interval [CI]: 64,200-91,800) MCFSW; 139,000 (95% CI: 120,000-160,000) MSM; 8030 (95% CI: 3980-16,200) FSW; 3470 (95% CI: 1540-7830) PWID and 18,000 (95% CI: 14,000-23,200) transgender people. Generally, men reported knowing more people in all the high-risk groups; older people reported knowing more MCFSW, FSW and transgender people; and younger people reported knowing more MSM. There was a bimodal effect of age on those who reported knowing more PWIDs: people in their 20s and 60s reported more contacts. This study demonstrates that a size estimation study of hidden populations is quickly and efficiently scalable through using online surveys in a socially conservative society, like Singapore, where key populations are stigmatized or criminalized. The approach may be suitable in other countries where stigma is prevalent and where barriers to surveillance and data collection are numerous.

Dual Mating Strategies Observed in Male Clients of Female Sex Workers

Humans have a complex and dynamic mating system, and there is evidence that our modern sexual preferences stem from evolutionary pressures. In the current paper we explore male use of a dual mating strategy: simultaneously pursuing both a long-term relationship (pair-bonding) as well as short-term, extra-pair copulations (variety-seeking). The primary constraint on such sexual pursuits is partner preferences, which can limit male behavior and hence cloud inferences about male preferences. The aim of this study was to investigate heterosexual male mating preferences when largely unconstrained by female partner preferences. In service of this goal, female full-service sex workers (N = 6) were surveyed on the traits and behaviors of their male clients (N = 516) and iterative cluster analysis was used to identify male mating typologies. Two clusters emerged: clients seeking a pair-bonding experience and clients seeking a variety experience. Results also suggested that romantically committed men were more likely to seek a variety experience than a relationship experience. We conclude that men desire both pair-bonding and sexual variety, and that their preference for one might be predicted by fulfilment of the other. These findings have implications for relationships, providing insight into motivations for male infidelity.

MPrEP+ study protocol: a prospective cohort study assessing the feasibility and acceptability of an HIV pre-exposure prophylaxis (PrEP) strategy for male clients of female sex workers in Kisumu, Kenya

IntroductionMale clients (MCs) are integral to sex work-driven HIV transmission dynamics as sexual partners of female sex worker (FSW). MCs contribute disproportionately to incident HIV globally and in sub-Saharan Africa,...

Predictors of HIV Among 1 Million Clients in High-Risk Male Populations in Tanzania

The World Health Organization identified men as an essential group to target with HIV testing and treatment strategies;: men who have sex with men (MSM) and male clients of female sex workers (CFSW) account for 35% of new HIV infections globally. Using a cross-sectional design from a community-based HIV prevention project in Tanzania (October 2015–September 2018) and multivariable logistic regression, we identified predictors of HIV seropositivity among men. Of 1,041,343 men on their initial visit to the project, 36,905 (3.5%) were MSM; 567,005 (54.5%) were CFSW; and 437,343 (42.0%) were other men living near hotspots (OMHA). Three predictors of HIV seropositivity emerged across all three groups: being uncircumcised, having sexually transmitted infection symptoms, and harmful drinking of alcohol before sex. Any reported form of gender-based violence among MSM and OMHA and inconsistent condom use among CFSW were associated with HIV seropositivity. These findings may inform community HIV strategies like self-testing, delivery of pre-exposure prophylaxis and antiretroviral therapy, and behavioral change communication targeting men at higher risk of infection.

HIV Testing Approaches to Optimize Prevention and Treatment for Key and Priority Populations in Malawi.

BackgroundDespite progress in improving antiretroviral therapy (ART) for people with HIV in Malawi, the burden of HIV infections and HIV treatment outcomes among key populations is suboptimal. Client-centered differentiated service delivery approaches may facilitate addressing HIV prevention and treatment needs of key populations in Malawi.MethodsDe-identified program data routinely collected as part of the LINKAGES project–Malawi were assembled from October 2017 to September 2019. HIV case finding was compared across different testing modalities for each population. Poisson regression was used to estimate the association between testing modalities and ART initiation.ResultsOf the 18 397 people included in analyses, 10 627 (58%) were female sex workers (FSWs), 2219 (12%) were men who have sex with men (MSM), and 4970 (27%) were clients of FSWs. HIV case finding varied by modality and population, with index testing and enhanced peer outreach demonstrating high yield despite reaching relatively few individuals. FSWs who tested positive through risk network referral testing were more likely to initiate ART within 30 days compared with those who tested positive through clinic-based testing (adjusted risk ratio [aRR], 1.50; 95% CI, 1.23–1.82). For MSM, index testing (aRR, 1.45; 95% CI, 1.06–2.00) and testing through a drop-in center (aRR, 1.82; 95% CI, 1.19–2.78) were associated with 30-day ART initiation.ConclusionsThese data suggest that differentiated HIV testing and outreach approaches tailored to the needs of different key populations may facilitate improved ART initiation in Malawi. Achieving 0 new infections by 2030 suggests the need to adapt treatment strategies given individual and structural barriers to treatment for key populations with HIV in high-prevalence settings.

Quantifying the Evolving Contribution of HIV Interventions and Key Populations to the HIV Epidemic in Yaoundé, Cameroon.

Key populations (KP) including men who have sex with men (MSM), female sex workers (FSW), and their clients are disproportionately affected by HIV in Sub-Saharan Africa. We estimated the evolving impact of past interventions and contribution of unmet HIV prevention/treatment needs of key populations and lower-risk groups to HIV transmission. Yaoundé, Cameroon. We parametrized and fitted a deterministic HIV transmission model to Yaoundé-specific demographic, behavioral, HIV, and intervention coverage data in a Bayesian framework. We estimated the fraction of incident HIV infections averted by condoms and antiretroviral therapy (ART) and the fraction of all infections over 10-year periods directly and indirectly attributable to sex within and between each risk group. Condom use and ART together may have averted 43% (95% uncertainty interval: 31-54) of incident infections over 1980-2018 and 72% (66-79) over 2009-2018. Most onward transmissions over 2009-2018 stemmed from sex between lower-risk individuals [47% (32-61)], clients [37% (23-51)], and MSM [35% (20-54)] with all their partners. The contribution of commercial sex decreased from 25% (8-49) over 1989-1998 to 8% (3-22) over 2009-2018, due to higher intervention coverage among FSW. Condom use and recent ART scale-up mitigated the HIV epidemic in Yaoundé and changed the contribution of different partnerships to onward transmission over time. Findings highlight the importance of prioritizing HIV prevention and treatment for MSM and clients of FSW whose unmet needs now contribute most to onward transmission, while maintaining services that successfully reduced transmissions in the context of commercial sex.

Awareness of and barriers to using non-occupational post-exposure prophylaxis among male clients of female sex workers in two cities of China: a qualitative study.

We conducted semi-structured in-depth interviews with 20 clients in two Chinese cities in 2018. Participants were recruited through purposive sampling. The content of the interviews was analysed using thematic content analysis in ATLAS.ti. Overall, just a minority of participants were aware of nPEP. A majority expressed willingness to use nPEP. Potential barriers to nPEP uptake and adherence included adverse drug reactions, price, concerns of drug efficacy, privacy issues, and forgetting to take the drugs. Almost all participants expressed the need to promote nPEP among clients. Participants suggested that the promotion of nPEP should be at hospitals, online, and be integrated with HIV/AIDS health education. Our findings suggested that nPEP guidelines should be formulated and implementation strategies should be developed to address barriers to uptake and adherence in order to successfully tap into the potential of nPEP as an effective HIV prevention tool.

Estimating the contribution of key populations towards HIV transmission in South Africa.

IntroductionIn generalized epidemic settings, there is insufficient understanding of how the unmet HIV prevention and treatment needs of key populations (KPs), such as female sex workers (FSWs) and men who have sex with men (MSM), contribute to HIV transmission. In such settings, it is typically assumed that HIV transmission is driven by the general population. We estimated the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa (SA).MethodsWe developed the “Key‐Pop Model”; a dynamic transmission model of HIV among FSWs, their clients, MSM, and the broader population in SA. The model was parameterized and calibrated using demographic, behavioural and epidemiological data from national household surveys and KP surveys. We estimated the contribution of commercial sex, sex between men and sex among heterosexual partnerships of different sub‐groups to HIV transmission over 2010 to 2019. We also estimated the efficiency (HIV infections averted per person‐year of intervention) and prevented fraction (% IA) over 10‐years from scaling‐up ART (to 81% coverage) in different sub‐populations from 2020.ResultsSex between FSWs and their paying clients, and between clients with their non‐paying partners contributed 6.9% (95% credibility interval 4.5% to 9.3%) and 41.9% (35.1% to 53.2%) of new HIV infections in SA over 2010 to 2019 respectively. Sex between low‐risk groups contributed 59.7% (47.6% to 68.5%), sex between men contributed 5.3% (2.3% to 14.1%) and sex between MSM and their female partners contributed 3.7% (1.6% to 9.8%). Going forward, the largest population‐level impact on HIV transmission can be achieved from scaling up ART to clients of FSWs (% IA = 18.2% (14.0% to 24.4%) or low‐risk individuals (% IA = 20.6% (14.7 to 27.5) over 2020 to 2030), with ART scale‐up among KPs being most efficient.ConclusionsClients of FSWs play a fundamental role in HIV transmission in SA. Addressing the HIV prevention and treatment needs of KPs in generalized HIV epidemics is central to a comprehensive HIV response.

The Dark Tetrad and Male Clients of Female Sex Work.

Many scholars have investigated the attitudes, beliefs, motives, and behavior of male clients of female sex workers. However, few have examined individual differences in major dimensions of personality expressed by men who purchase prostitution compared to those who do not. Although several evolutionary psychologists have studied prostitution and those involved in sex work, to our knowledge, none have explicitly considered the utility of an evolutionary personality perspective in trying to understand why particular men pay for sex. In the current mini-review, following other researchers, prostitution is described principally as a form of short-term mating sought primarily by men. We argue that the socially aversive traits embodying the Dark Tetrad (narcissism, Machiavellianism, psychopathy, and sadism) may characterize certain male clients of female sex workers, particularly those consumers expressing the motives of desiring exciting and novel sex with women who are treated with contempt, perceiving prostitution in a business-like manner with little emotional involvement, and seeking to dominate and control sex workers who are viewed as vulnerable and subservient. The traits of the tetrad may also be more prevalent among men who purchase sex from female sex workers in outdoor (e.g., street prostitution) in comparison to indoor settings (e.g., escort agencies).

[Correlation between alcohol drinking and high risk sexual behaviors in HIV negative clients of female sex workers].

Objective: To explore the correlation between alcohol drinking and high-risk sexual behaviors in HIV negative clients of female sex workers and provide scientific evidence for prevention of HIV sexual transmission. Methods: A cross-sectional survey was conducted in HIV negative clients in Ji'nan and Haikou from December 2018 to May 2019. The estimated sample size was 337, the information about their demographic characteristics, AIDS knowledge awareness, sexual behaviors and alcohol drinking habit were collected through convenience sampling. The data were analyzed by using SPSS 24.0 software. Results: A total of 381 clients were included in this study. Most of them were less than 40 years old, accounting for 89.2% (340/381); 85.3% of them (325/381) reported an education level of high school and above; the clients who were married, had cohabitation with females or had girl friends accounted for 53.2% (202/380). The overall awareness rate of AIDS knowledge was 83.7% (318/380). Of all participants, 80.8% (308/381) had commercial sex in the past year, 79.8% (304/381) had non-commercial sex partners, 62.7% (239/381) had high-risk sexual behaviors. The results of logistic regression showed that compared with those with alcohol drinking frequency ≤2 times per month in last year, the clients with alcohol drinking frequency more than once a week (aOR=3.22, 95%CI: 1.25-8.27) were more likely to have high risk sexual behaviors after adjustment for age, living area, location type of residence, time of local residence, education level, monthly income level, occupation, marital status, knowledge awareness of AIDS and HIV related services, the number of commercial or non-commercial sexual partners in the past year, cost of commercial sex and HIV test frequency. Conclusions: Alcohol drinking is related to high risk sexual behaviors in HIV negative clients, and will increase the risk of HIV transmission. To control AIDS, the intervention of alcohol drinking should be combined with other preventions to improve the correct use of condoms.

A Systematic Review of Factors Influencing Condom Use among Female Sex Workers

A systematic review of research published in English was conducted across seven electronic databases in public health, social and psychological sciences. The aim was to ascertain the factors that influence condom use among female sex workers in the commercial sex industry globally. The perspectives and experiences of 29,112 female sex workers (FSWs) and 1,792 male clients of FSWs with regards to condom use are represented across the 47 studies included in this review. Key themes comprised of Perceived self-efficacy, Relationship Types, Condom use and Attitudes, Violence and Abuse, Location and Support, Knowledge and Perceived Risk, Perception and Perspectives of Male Clients, Drug and Alcohol use, Criminalisation and Price and Payment. Female sex workers are defined as a high-risk population for HIV/AIDS. Condoms were used less frequently in situations where structural and cultural determinants heavily impacted the experiences and decisions of FSWs. Cultural contextual factors also heavily impacted on the perspectives and perceptions of male clients and their attitudes towards condom use. Criminalization and anti-sex work legislation in many of the countries where these studies were conducted meant that FSWs were a socially marginalised and ostracized population. Recommendations are explored for theory, practice and education and future research.

Sexually transmitted infections in male heterosexual Dutch clients who visited German cross-border female sex workers; a 3\u2009year retrospective study

BackgroundSome male heterosexual clients prefer to visit a cross-border Female Sex Worker (FSW) because of cheaper sex and unsafe sex practices, and may therefore be at risk for sexually transmitted infections (STI). The objective of this study was to assess whether having commercial cross-border sex is an independent risk factor for being diagnosed with a STI.MethodsAn observational retrospective study was performed using data of 8 Dutch STI clinics bordering Germany, between 2011 and 2013. All male heterosexual clients of FSWs were selected and data on country of FSW visit and occurrence of STI were used for multivariable regression analysis.ResultsThe study population consisted of 2664 clients of FSW. Most clients visited the Netherlands (82.4%), followed by visits to another country (beyond cross-border) (9.9%) and cross-border visits (7.8%). Clients of FSW were less likely to be STI positive when they were younger than 25 years(OR = 0.6, 95%CI 0.4 to 0.8 25–44 years and OR = 0.5, 95%CI 0.4 to 0.7 older than 45 years), and more likely when they had 20 or more sex partners in the last 6 months (OR = 2.9, 95%CI 1.9 to 4.4), did not use a condom during last sexual contact (OR = 2.2, 95%CI 1.6 to 2.9) and made cross-border visits (OR = 1.7, 95%CI 1.1 to 2.6).ConclusionsAs cross-border visits appears to be a novel independent risk factor for STI in clients of FSW, this group should therefore be advised on STI prevention.

Prevalence of and factors associated with behavioral intention to take up home-based HIV self-testing among male clients of female sex workers in China – an application of the Theory of Planned Behavior

ABSTRACT HIV self-testing (HIVST) is a useful means to increase coverage of HIV testing but under-utilized by male clients of female sex workers (MCFSW) in China. This study investigated the prevalence of and factors associated with behavioral intention to take up HIVST in the next year among MCFSW in Hong Kong, China. We recruited Chinse-speaking adult men who had patronized at least one female sex worker in the past six months. A total of 303 MCFSW completed a self-administered questionnaire. Univariate and multivariable ordinal logistic regression models were fit. Only 23.8% of participants indicated that they probably/definitely would take up HIVST in the next year. The multivariable ordinal logistic regression model showed that positive attitudes towards HIVST (adjusted odds ratios (aOR): 1.24, 95%CI: 1.13, 1.37), perceived HIVST uptake is completely under one’s control (perceived behavioral control) (aOR: 1.44, 95%CI: 1.08, 1.92), and perceived higher risk of HIV infection (aOR: 1.32, 95%CI: 1.01, 1.76) were associated with higher intention to take up HIVST in the next year. The prevalence of behavioral intention to use HIVST was low among MCFSW in Hong Kong. Perceptions based on the Theory of Planned Behavior and perceived risk of HIV infection were associated with behavioral intention to use HIVST.

HIV Prevalence and Factors Influencing the Uptake of Voluntary HIV Counseling and Testing among Older Clients of Female Sex Workers in Liuzhou and Fuyang Cities, China, 2016-2017: A Cross-Sectional Study.

Objective To compare the prevalence of HIV and associated factors for participating HIV voluntary counseling and testing (VCT) among older clients of female sex workers (CFSWs) in Liuzhou City and Fuyang City in China. Methods A cross-sectional study was conducted and the study employed 978 male CFSWs, aged 50 years and above from October 2016 to December 2017. All participants were required to complete a questionnaire and provide blood samples for HIV testing. Multivariate logistic regression analysis was used to analyze the influential factors of using VCT program and tested for HIV. Results The HIV infection prevalence rate was 1.2% and 0.5%, while 52.3% and 54.6% participants had ever utilized VCT service and tested for HIV in Liuzhou City and Fuyang City, respectively. The older CFSWs who ever heard of VCT program were more likely to uptake VCT program in both cities (ORLiuzhou = 2.224, ORFuyang = 2.421). Participants, whose marital status was married or cohabiting (ORLiuzhou = 0.548, ORFuyang = 0.495), who have stigma against individuals who are living with HIV/AIDS (ORLiuzhou = 0.273, ORFuyang = 0.371), whose monthly income is more than 500 yuan (ORLiuzhou = 0.622, ORFuyang = 0.600), and whose age is more than 60 years old (ORLiuzhou = 0.639, ORFuyang = 0.554), were less likely to visit VCT clinics. Those who are worried about HIV-infected participants were more likely to utilize VCT services in Fuyang City (AOR = 1.838, 95%CI : 1.146‐2.948). Conclusion Combine strategy will be needed to promote the utilization of VCT service, based on the socioeconomic characteristics of older male CFSWs in different cities of China.

Left behind?: male clients of female sex workers in Zambia

ABSTRACT Male clients of female sex workers (CFSWs) are a key-affected group within the HIV epidemic. However, few studies have quantified HIV/STI burdens among CFSWs. This study used nationally representative data from the 2013–14 Zambia Demographic and Health Survey to estimate proxies for HIV and STI prevalence among sexually active men aged 15–59 paying for sex recently (past 12 months) [5%, n = 679] or in their lifetime [15%, n = 1,887]. Chi-square tests were calculated to assess differences in prevalence estimates between CFSWs and non-clients. Multivariable logistic regression models were generated to identify sociodemographic factors associated with prevention characteristics. CFSWs had higher odds of reporting HIV infection (recent: aOR 1.413, p < 0.05; lifetime: aOR 1.604, p < 0.001) and past-year STI symptomology (recent: aOR 3.342, p < 0.001; lifetime: aOR 2.266, p < 0.001) than non-clients, irrespective of transactional sex recency. Compared to non-clients, CFSWs were more likely to be <25yo (42% vs. 29%, p < 0.001), have a cohabitating partner (43% vs. 35%, p < 0.001), use condoms at last sex (31% vs. 27%, p < 0.001), and never test for HIV (36% vs. 29%, p < 0.001). When comparing CFSWs to non-clients, marital status was an effect modifier of HIV testing, medical circumcision, and condom use at last sex. Findings suggest high HIV/STI burdens and highlight the urgent need for differentiated HIV prevention programming for CFSWs in Zambia including the provision of PrEP.

Do you know how to Cheong? Neutralization techniques adopted by new clients of sex workers

Summary Sex work in Malaysia is seen as a deviant activity that is socially frowned upon. Malaysian laws aiming at curbing sex work has not been effective in eliminating sex work in Malaysia, instead it has pushed sex work underground where it thrives. New Internet technologies have been adopted by clients of sex workers to access hidden commercial sex venues that authorities have tried to suppress and keep away from the view of the public. This study examines the discourses of male clients of female sex workers and the application of Sykes and Matza (1957) techniques of neutralization used by male clients to normalize their ‘deviant’ activities. Part of this study examines the discourses of members from two Internet forums, where members assist other members in uncovering the hidden areas of sex work through their discussions and sharing of commercial sex experiences online. This study suggests that these discourses aim at inculcating a sense of normalcy to their ‘deviant’ activity as suggested by Sykes and Matza. This qualitative study of 35 Malaysian men obtained through snowball sampling from 2015 till 2018 explores their usage of online information in assisting with the purchase of female sex workers; examination of these men's offline discourses and behaviours when purchasing sex workers was conducted through face to face intensive interviews and participation observation. Participants use techniques of neutralization to overcome fear and societal distain when participating in commercial sex activities.

HIV prevalence and correlated factors among male clients of female sex workers in a border region of China.

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.

HIV-positive clients of female sex workers in Hunan Province, China: a mixed methods study assessing sexual relationships and risk behavior by type of partner

BackgroundIn China, clients of female sex workers (CFSWs) have a low rate of condom use and a high prevalence of human immunodeficiency virus (HIV). However, little is known about the high-risk sexual behaviors of HIV-positive CFSWs.MethodsIn 2014, 327 CFSWs diagnosed with HIV for 6 months or longer completed a face-to-face questionnaire for a quantitative survey. In addition, 32 HIV-positive CFSWs were recruited to participate in in-depth interviews (18 participated in both, 14 participated in-depth interviews only) to explore reasons for extramarital sexual behaviors and inconsistent condom use. The quantitative data on sexual risk behaviors were analyzed using chi-square tests. Interviews were coded inductively for emerging themes.ResultsAmong the participants of the quantitative survey, 41.6% (136/327) had sex with regular sexual partners only in the past 6 months, of whom 64.0% (87/136) had consistent condom use; 27.5% (90/327) of the participants had sex with irregular sexual partners in the past 6 months, of which, 46.7% (42/90) had consistent condom use. The qualitative study suggested that HIV positive sero-status, willingness to protect their spouses or regular sexual partners, and lacking a sense of responsibility to protect their commercial and casual sexual partners, influence CFSWs’ sexual behaviors.ConclusionsHIV-positive CFSWs continue to practice unsafe sexual behaviors with regular and irregular partners after HIV diagnosis, but were more willing to protect their regular partners. Future interventions targeting HIV-positive CFSWs should not only be confined to sero-discordant couples, but also need to instill a sense of responsibility to protect the commercial and casual partners and reduce the number of concurrent partners.