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
ABSTRACT: 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.
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