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


Autoři: Jing Zhu aff001;  Dan Hu aff002;  Yueqi Yin aff001;  Zhibin Zhu aff003;  Ning Wang aff004;  Bei Wang aff001
Působiště autorů: Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China aff001;  Department of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, P.R. China aff002;  Hekou Center for Disease Control and Prevention, Hekou, Yunnan, P.R. China aff003;  National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P.R. China aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225072

Souhrn

Objectives

To 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.

Methods

A 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.

Results

Of 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.

Conclusion

The 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.

Klíčová slova:

Enzyme-linked immunoassays – HIV epidemiology – HIV infections – HIV prevention – China – Morphine – Vietnam


Zdroje

1. Lu L, Jia M, Ma Y, Yang L, Chen Z, Hu DD, et al. The changing face of HIV in China. Nature2008; 455:609–611. doi: 10.1038/455609a 18833270

2. ZANG Chun-peng, JIA Zhong-wei, Brown Katherine, Reilly KH, Wang JJ, Wang N. Heterosexual risk of HIV infection in China: systematic review and meta-analysis. Chin Med J 2011; 124(12): 1890–1896. 21740849

3. NCAIDS, NCSTD, China CDC. Update on the AIDS/STD epidemic in China and main response in control and prevention in the first quarter of 2016. Chin J AIDS STD 2016; 22: 311 (in Chinese).

4. NCAIDS, NCSTD, China CDC. Update on the AIDS/STD epidemic in China and main response in control and prevention in the second quarter of 2016. Chin J AIDS STD 2016; 22: 585 (in Chinese).

5. Wang HB, Chen RY, Sharp GB, Brown K, Smith K, Ding G, et al. Mobility, risk behavior and HIV/STI rates among female sex workers in Kaiyuan City, Yunnan Province, China. Bmc Infectious Diseases 2010; 10.

6. Wang H, Wang N, Bi A, Wang G, Ding G, Jia M, et al. Application of cumulative odds logistic model on risk factors analysis for sexually transmitted infections among female sex workers in Kaiyuan city, Yunnan province, China. Sexually Transmitted Infections 2009; 85(4): 290–295. doi: 10.1136/sti.2008.033100 19158150

7. Goldenberg S, Gallardo Cruz M, Strathdee S, Nguyen L, Semple S, Patterson T. Correlates of unprotected sex with female sex workers among male clients in Tijuana, Mexico. Sex Transm Dis. 2010; 37(5):319–25. doi: 10.1097/OLQ.0b013e3181c5334f 20081558

8. Pan S, Parish WL, Huang Y. Clients of female sex workers: a population-based survey of China[J]. J Infect Dis (Suppl 5) 2013: S1211–1217.

9. Mc Laughlin MM, Chow EPF, Wang C, Yang LG, Yang B, Huang JZ, et al. (2013) Sexually Transmitted Infections among Heterosexual Male Clients of Female Sex Workers in China: A Systematic Review and Meta-Analysis. PLo S ONE 8(8): e71394.

10. Wang HB, Reilly KH, Brown K, Jin X, Xu J, Ding G, et al. HIV Incidence and Associated Risk Factors Among Female Sex Workers in a High HIV-Prevalence Area of China. Sexually Transmitted Diseases 2012; 39(11): 835–841. doi: 10.1097/OLQ.0b013e318266b241 23064531

11. Xu JJ, Smith MK, Chu J, Ding GW, Chang DF, Sharp GB, et al. Dynamics of the HIV epidemic in southern China: sexual and drug-using behaviours among female sex workers and male clients in Yunnan. International Journal of Std & Aids 2012; 23(9): 670–675.

12. Jia M, Luo H, Ma Y, Wang N, Smith K, Mei J, et al. The HIV epidemic in Yunnan Provinc, China, 1989–2007[J]. J Acquir Immune DeficSyndr, 2010, 53Suppl 1: S34–40.

13. Hekou Bureau of Statistics. Hekou Yao Autonomous County Almanac 2008. (in Chinese)

14. Wang J, Ding G, Zhu Z, Zhou C, Wang N. Analysis of HIV correlated factors in Chinese and Vietnamese female sex workers in Hekou, Yunnan Province, a Chinese border region. PLoS ONE 2015; 10: e0129430. doi: 10.1371/journal.pone.0129430 26053040

15. Zhu J, Yuan R, Hu D, Zhu Z, Wang N, Wang B. HIV prevalence and correlated factors of female sex workers and male clients in a border region of Yunnan Province, China. International Journal of STD & AIDS 2018, Vol. 29(5) 424–434.

16. Jin X, Smith K, Chen RY, Ding G, Yao Y, Wang H, et al. HIV prevalence and risk behaviors among male clients of female sex workers in Yunnan, China. J Acquir Immune DeficSyndr. 2010 January; 53(1): 131–135.

17. Xu JJ, Wang N, Lu L, Pu Y, Zhang GL, Wong M, et al. HIV and STIs in clients and female sex workers in mining regions of Gejiu City, China. Sexually transmitted diseases 2008; 35(6): 558–565. doi: 10.1097/OLQ.0b013e318165926b 18354344

18. Nguyen NT, Nguyen HT, Trinh HQ, Mills SJ, Detels R. Clients of Female Sex Workers as a Bridging Population in Vietnam. AIDS Behav. 2009 October; 13(5): 881–891. doi: 10.1007/s10461-008-9463-4 18830814

19. Reilly KH, Wang J, Zhu Z, Li S, Yang T, Ding G, et al. HIV and Associated Risk Factors Among Male Clients of Female Sex Workers in a Chinese Border Region. Sexually Transmitted Diseases 2012; 39: 750–755. doi: 10.1097/OLQ.0b013e31825f7af7 23007705

20. Yao Y, Yang F, Chu J, Siame G, Lim HJ, Jin X, et al. Associations between drug use and risk behaviours for HIV and sexually transmitted infections among female sex workers in Yunnan, China. International Journal of Std & Aids 2012; 23(10): 698–703.

21. Zhang C, Li XM, Su SB, Zhang L, Zhou Y, Shen Z, et al. Prevalence of HIV, syphilis, and HCV infection and associated risk factors among male clients of low-paying female sex workers in a rural county of Guangxi, China: a cross-sectional study. Sexually Transmitted Infections 2014; 90(3): 230–236. doi: 10.1136/sextrans-2013-051275 24482489

22. Huang Y, Maman S, Pan S. Understanding the diversity of male clients of sex workers in China and the implications for HIV prevention programmes. Global Public Health 2012; 7(5): 509–521. doi: 10.1080/17441692.2012.657663 22313090

23. Yao Y, Wang N, Chu J, Ding G, Jin X, Sun Y, et al. Sexual behavior and risks for HIV infection and transmission among male injecting drug users in Yunnan, China. Int J Infect Dis 2009; 13:154–161. doi: 10.1016/j.ijid.2008.05.1228 18778963

24. Hail-Jares K, Choi S, Duo L, Luo Z, Huang ZJ. Occupational and demographic factors associated with drug use among female sex workers at the China–Myanmar border. Drug and Alcohol Dependence 2016; 161:42–49. doi: 10.1016/j.drugalcdep.2016.01.026 26897586

25. Xu J, Brown K, Ding G, Wang H, Zhang G, Reilly K, et al. Factors associated with HIV testing history and HIV-test result follow-up among female sex workers in two cities in Yunnan, China. Sex Transm Infect 2011;38: 89–95.

26. Han L, Zhou C, Li Z, Poon AN, Rou K, Fuller S, et al. Differences in risk behaviours and HIV/STI prevalence between low-fee and medium-fee female sex workers in three provinces in China. Sex Transm Infect 2016; 92:309–315. doi: 10.1136/sextrans-2015-052173 26474599

27. Chen Y, Bussell SA, Shen Z, Tang Z, Lan G, Zhu Q, et al. Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers Analysis From Sentinel Surveillance Sites (2010–2015), Guangxi, China. Medicine 2016; 95(22).

28. Huang ZJ, Wang W, Martin MC, Nehl EJ, Smith BD, Wong FY. “Bridge populations”: sex workers or their clients of female sex workers in China. AIDS Care 2011; 23 suppl 1:45–53.

29. Beyrer C, Crago AL, Bekker LG, Butler J, shannon K, Kerrigan D, et al. AN ACTION AGENDA FOR HIV AND SEX WORK. Lancet. 2015 January 17; 385(9964): 287–301. doi: 10.1016/S0140-6736(14)60933-8 25059950

30. Xu J, Smith MK, Ding G, Chu J, Wang H, Li Q, et al. Drug Use and Sex Work: Competing Risk Factors for Newly Acquired HIV in Yunnan, China. PLoS ONE 2013, 8(3): e59050. doi: 10.1371/journal.pone.0059050 23555616


Článek vyšel v časopise

PLOS One


2019 Číslo 11