Transcript Perceived HIV risks, types of sexually transmitted diseases, and discordant infection status among low-tier female sex workers in China (Roundtable Presentation) Presenters: Shan Qiao, Chen Zhang,

Perceived HIV risks, types of sexually
transmitted diseases, and discordant
infection status among low-tier female
sex workers in China
(Roundtable Presentation)
Presenters: Shan Qiao,
Chen Zhang, Xiaoming Li, Yuejiao Zhou, Wei Liu
Acknowledgement
 Funding Agency
 The study was in part supported by NIH Research Grant
R01AA018090 by the National Institute for Alcohol
Abuse and Alcoholism
Background
 Discordant infection status for an individual is defined
as the discrepancy between biologically confirmed and
self-reported sexually transmitted diseases (STD).
 The awareness of their infection status is a key to
modifying their sexual risk behaviors (Porter, Wall, &
Evans 1993).
 A literature gap exists in the global literature to
examine the discordant infection status among highrisk populations (e.g., FSWs).
Background
 Vulnerability of Low-tier FSWs in China
Personal Attributes
Work-Related Risks
New arrivals from rural areas
Having little control over the
sex practice with their clients
The least knowledgeable on
health risk of unprotected sex
The least protected and often
the main target of
government crackdowns
Most desperate for financial
survivals
Older age, less educated, lower
SES
Higher HIV/STD Prevalence
Facing higher and more
severe risks in their life
context (e.g., violence)
Existing Studies on Low-tier FSW in
China
 The low-tier FSW had highest prevalence of
syphilis infection (9.7%, 95%CI: 8.3-11.1%),
followed by the middle-tier (4.3%, 95%CI:3.65.0%), and higher-tier FSW (2.2%, 95%CI:1.62.9%)
 Tucker et al. (2011)’s study indicated that the
prominent syphilis epidemic among low-tier FSW
with the prevalence estimate as high as 12.5%
(IQR 4.1-20.1)
Research Questions
 The prevalence of discordant infection status
among the current sample
 The current study aims to detect factors
associated with discordant status among a
sample of low-tier FSWs in China
Method
 A total of 907 FSWs were recruited from nine
types of low-tier commercial sex venues in
Guangxi, China.
 FSWs who provided consented forms completed
a self-administered cross-sectional survey on
their demographic and behavioral information,
as well as history of STD infection.
 A blood sample for testing HIV, hepatitis C virus
(HCV) and syphilis was also collected.
Characteristics of low-tier FSW
(N=907)
Low-tier
FSW
 The average age of FSWs in the current
sample was 32.1 (14-68) years old
 Majority of them cohabited with their
partners and 43% of them had less than
middle school education
 Averagely, they have been working as sex
workers for 24 months (SD=23.58)
 The low-tier FSWs met 15 (SD=20.24)
clients in the recent week and charged a
price with 41 yuan (about 6 US dollars)
(SD=21.18yuan) for each service
 About 15% of them had clients more than 50
years old and 61% reported inconsistent
condom use with clients last month.
Results
 In the current study, 16.0% of FSWs had
discordant status with 7.8% of unrecognized STD
infection and 8.2% of recovered cases.
 More FSWs infected with gonorrhea (aOR=10.31,
95%CI=3.19, 33.29) and Chlamydia (aOR=21.41,
95%CI=3.74, 122.59) were likely to have
discordant status compared to women with other
types of STD (e.g., syphilis, genital herpes).
 FSWs with higher perceived HIV risks were less
likely to have discordant infection status
(aOR=0.50, 95%CI=0.27, 0.94).
Discussion
 The pervasive discordant status among the
current sample underscored urgent needs to
address this problem
 Several specific STDs were more likely to be
ignored by infected persons
 Perceived HIV risk was a protective factor for
discordant infection status among FSWs
Limitation
 Socially desirable reporting and volunteer
bias
 Limited ability of generalizing the findings to
other areas of China
 Cross-sectional study design prevents us from
making a causal conclusion between
discordant status and its correlates
Implication
 Our findings reinforce the need for a
multidimensional approach to HIV/STD preventions
among this high-risk population
 Resources and efforts are called for making the HIV
testing and counseling service accessible and
available without barriers
 Effective educational outreach is needed
 Empowerment-based interventions are needed
among women in vulnerability
Questions