The objective of this study was to address the role of heterosexual transmission of HIV in China. The goal of this study was to explore the prevalence of unsafe sex and the likelihood of HIV spread heterosexually from core populations to others. The authors conducted a review of behavioral studies. Drug users were more likely to be involved in higher-risk sexual behaviors than were those who abstained from using drugs. Most female drug users (52–98%) reported having engaged in commercial sex. Most female sex workers (FSWs) and individuals with sexually transmitted diseases (STDs) had concurrent sexual partners. Many continued to have unprotected sex after noticing STD symptoms in themselves or their sexual partners. From 5% to 26% of rural-to-urban migrants had multiple sexual partners and 10% of males patronized FSWs during migration. Factors such as high rates of FSW patronage low rates of condom use during commercial sex having sex with both commercial and noncommercial sexual partners and high rates of STD infection may promote a heterosexual epidemic in China. (authors)

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Heterosexual transmission of HIV in China: a systematic review of behavioral studies in the past two decades.

Objective: The objective of this study was to assess the potential role of gatekeepers of establishments in promoting condom use among female sex workers (FSWs) in China. Goals: The goals of this study were to explore FSWs’ perceptions of gatekeeper attitudes and support for condom use, and to assess their association with FSWs’ practice, communication, intention, proper use, knowledge of correct use, and perceptions related to condom use. Study: The authors conducted a cross-sectional study among 454 establishment-based FSWs in one Chinese county. Results: Perceived gatekeeper support for condom use was low among FSWs. Perceived support was positively associated with condom use communication with sexual partners, condom use frequency and intention, but not associated with proper condom use among FSWs. Perceived support was significantly associated with most condom use-related perceptions (e.g., self-efficacy of condom use, barriers to condom use, and perceived peer condom use) among FSWs. Conclusions: Healthcare professionals should work with gatekeepers to create a supportive local environment for condom use in sex work establishments. Gatekeepers need to clearly articulate their support for condom use to the FSWs. Training and skill acquisition regarding correct use of condoms among FSWs will be necessary.

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Condom use among female sex workers in China: role of gatekeepers.

The purpose of this study was to explore the factors associated with suicidal ideation and attempt among female sex workers (FSWs) in China. A cross-sectional survey was administered among 454 FSWs in a rural county of Guangxi, China. About 14% of FSWs had thought of suicide and 8% had attempted suicide in the past 6 months. Multiple logistic regression analyses indicated that those FSWs who were dissatisfied with life, abused alcohol, were deceived or forced into commercial sex, and had stable sexual partners were more likely to report suicidal ideation. Female sex workers who had multiple stable partners, experienced sexual coercion, and worried about an inability to make enough money were more likely to report a suicide attempt. These FSWs who entered commercial sex because of financial needs or who were influenced by the peers were less likely to report a suicide attempt. Our data suggested that the rates of suicidal ideation and attempts were high among FSWs in China, and there were multiple factors associated with their suicidality. Future health education and promotion efforts among FSWs need to take into consideration substance abuse, interpartner conflict, and psychological stress.

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Correlates of suicidal ideation and attempt among female sex workers in China.

This study attempted to determine the association of self-efficacy with condom-use practice and to explore reasons of not using condoms among female sex workers (FSWs) with steady partners in China. Data from 309 establishment-based FSWs with steady partners in one Chinese county were collected through a cross-sectional study. Consistent condom use with steady partners was lower than with clients in entertainment establishments. Condom-use self-efficacy was positively associated with condom-use communication and condom-use frequency with clients but not with steady partners. It was positively associated with condom-use intention and skill with clients and steady partners. However, it was not associated with appropriate use of condoms. Significant differences of reasons about not using condom were also observed between the two partner types. The results may represent an important challenge to STD and HIV intervention programs aimed at achieving consistent condom use in FSWs. Health workers should focus on psychosocial factors affecting inconsistent condom use among FSWs with steady partners in China. In addition, intervention programs that can promote FSWs' self-efficacy through condom-use skill training will still be necessary.

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Condom use and self-efficacy among female sex workers with steady partners in China

There is much speculation regarding the contribution of China's changing demography to the spread of HIV/AIDS. We employ a bio-behavioral macrosimulation model of the heterosexual spread of HIV/AIDS to evaluate the roles that China's unique demographic conditions - (1) masculine sex ratios at birth and (2) a population age structure that reflects rapid fertility decline since the 1970's - play in altering the market for sexual partners, thereby potentially fueling an increase in behaviors associated with greater risk of HIV infection. We first simulate the relative contributions of the sex ratio at birth and the population age structure to the oversupply of males in the market for sexual partners and show that the sex ratio at birth only aggravates the severe oversupply of males which is primarily a consequence of the population age structure. We then examine the potential consequences of this demographic distortion for the spread of HIV infection and show that, to the extent that males adapt to the dearth of suitable female partners by seeking unprotected sexual contacts with female sex workers, the impact of the oversupply of males in the sexual partnership market on the spread of HIV will be severe. 1. Introduction At the end of 2007, China's HIV/AIDS epidemic was classified as "low level", with an estimated 700,000 people living with HIV, corresponding to 0.05 percent of the adult population (UNAIDS 2008). While until now HIV in China has been concentrated among relatively well-defined population subgroups, such as users of injected drugs, former plasma and blood donors and female sex workers and their clients (State Council AIDS Working Committee Office 2007; Wu, Rou, and Cui 2004), new evidence suggests that HIV is spreading from these traditional high-risk groups to the general population through heterosexual contact. The proportion of HIV infections resulting from heterosexual transmission is growing, such that these accounted for half of all new cases in 2005 (MOH, UNAIDS and WHO 2006, Kerr 2005). Heterosexual transmission between high-risk groups and the general population is especially evident in the southern regions of the country, where China's HIV epidemic first took root (Gill, Huang, and Lu 2007; MOH, UNAIDS and WHO 2006; Lin et al. 2008). The extent to which HIV will continue to spread to the general population in China depends largely on the levels and distribution of sexual activity. Results of an empirically grounded compartmental model suggested that in China, overall levels of sexual activity (identified by the rate of partner change) and the fraction of the population with multiple partners would have to be significantly higher than those currently observed in order for HIV prevalence to exceed one percent at any time during a 50-year simulation cycle (Merli et al. 2006). These results, however, do not imply that concerns about continued spread of HIV in China's general population are unwarranted. On the contrary, there are good reasons to suspect that sexual activity in China could contribute to a larger, more widespread HIV epidemic in the future. For example, China's increasingly liberal social and economic environment includes increasing prevalence of higher-risk sexual behaviors, such as casual or concurrent partnerships and commercial sexual activity (Farrer 2002; Sigley and Jeffreys 1999, Parish, Mojola, and Laumann 2007). In addition, as will be explored in this paper, it has been suggested that China's unique demographic conditions have the potential to further influence the sexual landscape in such a way as to place an increasing proportion of the population at risk for HIV infection. Two features of China's demographic profile are hypothesized to potentially shift the distribution of the sexually active population towards higher rates of partner change and more widespread adoption of risky behaviors in the future: (1) highly masculine sex ratios at birth; and (2) the population age structure that reflects the rapid, widespread fertility decline which began in the early 1970's. …

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Masculine sex ratios, population age structure and the potential spread of HIV in China

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Not just another pretty face.