Effects of Socioeconomic Status on Engagement with Program Interventions and Condom use at Commercial Sex Settings among Female Sex Workers in Yunnan Province in Southwest China

Background: This study examined whether the socioeconomic status (SES) of female sex workers (FSWs) was related to their participation in a community-based peer-led HIV intervention program and HIV-related behavioral and health outcomes, using data from a behavioral survey conducted in Yunnan Province in Southwest China. Methods: A sample of 348 adult women (ages 18-49) who had exchanged sex for cash in the past month were recruited in Mengzi city, using the time location sampling (TLS) method. Face-to-face interviews were conducted using structured questionnaires. F-ratio test, chi-square analysis and multivariate logistic regression were used to analyze the data. Results: The FSWs on average had more than three commercial partners in past week and 88% had used condoms consistently. 57% of FSWs had sex with regular partners in the past month, among whom 70% used condoms consistently. 17% of FSWs had STs in past three months and 55% reported at least one lifetime abortion. Controlling for confounding factors, the odds of CCU with commercial partners in FSWs who received more than 100 RMB from last sex trade were over five times the odds of those who received less payment (OR=5.38, P<0.1). Attending DiC 1-3 times was related to higher odds of CCU with commercial partners, and the association was stronger for better-educated FSWs (OR high education*DiC 1-3 visits = 13.01, P<0.05; OR DiC 1-3 visits =0.14, P<0.05; OR high education = 0.82, P=0.27 not sig), relative to the less-educated ones. Conclusion and discussion: SES had a significant association with the utilization of HIV prevention services and the risk for HIV/STIs in FSWs in Yunnan. Findings highlighted the need to identify more innovative intervention strategies to address the high co-morbidity of sexual and reproductive health problems in FSWs in China, particularly at the lower-end commercial sex settings. 摘要: 本文运用在云南省蒙自市的女性性工作者（FSWs）人群中所收集的行为跟踪调研数据来研究FSWs的社会经济状况对其参与社区艾滋病预防服务，性行为及其性生殖健康结果之间的关系。本研究采用时间-地点抽样方法，采集样本包括348名在过去一个月曾经以金钱交换过性行为的成年女性(年龄：18-40岁)。数据收集采用结构式问卷和一对一面对面访谈方式。数据分析采用了F-分布检验，卡方分析和二元逻辑回归分析法。研究结果揭示在过去一周蒙自的FSWs平均有三个以上商业性伴，与其持续使用安全套的比率为88%。57%的FSWs在过去一个月中有固定性伴侣，与其持续使用安全套比率为70%。17%的FSWs在过去三个月中有过性病史，55%的FSWs曾经流产至少一次。在控制相关的协变因素后，收入高于100人民币的FSWs在过去一个月和商业性伴持续使用安全套的几率五倍于收入更低的FSWs。参与社区艾滋病干预服务对降低无保护商业性行为的影响在接受中学教育程度或以上的FSWs中效果更显著。FSWs的社会经济状况与其参与防艾项目和感染艾滋病及性病的危险有显著联系。未来的艾滋病项目需要去发掘更创新的干预策略来真正有效地降低FSWs的性生殖健康相关问题,特别是针对社会底层提高低端服务的FSWs。