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; Shu Liang; Weixia Lu; Stephen W Pan; Benli Song; Qianping Liu; Yunan Xu; Hui Dong; Hui Xing; Yiming Shao; Yuhua Ruan

doi:10.1371/journal.pone.0084950

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

PLoS One. 2014 Jan 8;9(1):e84950. doi: 10.1371/journal.pone.0084950. eCollection 2014.

Authors

Li Zhang¹, Shu Liang², Weixia Lu³, Stephen W Pan⁴, Benli Song⁵, Qianping Liu⁵, Yunan Xu³, Hui Dong⁶, Hui Xing³, Yiming Shao³, Yuhua Ruan³

Affiliations

¹ Beijing Centers for Disease Control and Prevention, Beijing, China.
² Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China.
³ State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
⁴ The School of Population and Public Health University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Xichang Center for STD and Leprosy Control, Xichang City, Sichuan, China.
⁶ Beijing Youth Politics College, Beijing, China.

Abstract

Objective: To 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.

Design: Before and after harm reduction program study.

Methods: Two 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.

Results: The 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).

Conclusions: Harm 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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
China / epidemiology
Cross-Sectional Studies
Female
Government Programs / education*
HIV Infections / epidemiology
HIV Infections / transmission
Humans
Logistic Models
Odds Ratio
Risk-Taking*
Sex Work / psychology
Sex Workers / education*
Sex Workers / psychology
Sexual Partners
Substance-Related Disorders / epidemiology
Syphilis / epidemiology
Syphilis / transmission
Unsafe Sex / psychology
Unsafe Sex / statistics & numerical data*

Grants and funding

This study was supported by grants from the National Natural Science Foundation of China (81273188), the Ministry of Science and Technology of China (2008ZX10001-015, 2012ZX10001-002) and Chinese State Key Laboratory for Infectious Disease Develop Grant (2012SKLID103). SWP was supported by a Fulbright grant from the US government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.