HIV and Associated Risk Factors Among Male Clients of Female Sex Workers in a Chinese Border Region

Abstract

Background Male clients of female sex workers (FSWs) serve as a potential bridge of HIV to the general population. Little is known about the characteristics and risk factors for HIV infection among male clients patronizing FSWs in Hekou County, Yunnan Province in southern China bordering with Vietnam. Methods Male clients were recruited through outreach of study staff, referrals by Vietnamese FSWs, their bosses, and snowball sampling. Each participant completed a questionnaire survey and donated a blood specimen to test for HIV, herpes simplex virus type 2 (HSV-2), and syphilis. Logistic regression models were fitted to identify factors associated with HIV infection. Results Among 306 participants, 28 (9.2%) were HIV positive, 81 (26.5%) were HSV-2 positive, and none were infected with syphilis. Approximately half (n=149, 49.2%) reported always using condoms with sex workers in the past year; 36 (11.8%) reported a history of injection drug use (IDU). Compared to HIV negative men, HIV positive men were more likely to have a history of IDU (64.3% vs. 6.5%) and be co-infected with HSV-2 (50.0% vs. 24.1%). Conclusions IDU was the most salient risk factor for HIV infection in this study, which suggests that male clients may acquire HIV from routes other than commercial sex, but the significance of HSV-2 infection indicates that sexual transmission is also of concern. HIV prevention intervention programs for this often ignored and hard-to-reach risk group should be two-pronged, addressing both drug use and commercial sex.

Sexually Transmitted Infections among Heterosexual Male Clients of Female Sex Workers in China: A Systematic Review and Meta-Analysis

“…Three studies reported a median annual income between 1300–2000 US$ [42], [45], [46]. In the other three studies, 40% of participants earned less than 1700 US$ per year [47], 65% earned less than 2900 US$ per year [43], and 33% earned less than 800 US$ per year [48].…”

“…Six studies were undertaken in south central China [45], [49]–[53], eleven in the southwest [12], [38], [42], [44], [46]–[48], [53]–[56], eleven in the east [36], [37], [39], [41], [57]–[63], and seven in the north [64]–[70]. Two studies were national [4] or multi-city samples [71].…”

“…Most studies used convenience sampling, but three studies used snowball sampling with female sex worker or client-client referrals [42], [47], [48], and one used stratified probability sampling [4]. Twenty-four studies sampled detainees [12], [36], [37], [39], [41], [49]–[52], [54], [57]–[70], but other studies sampled miners [46], clients at commercial sex venues [38], [41]–[43], [45], [47], [48], [56], [71], STI clinic attendees [38], [41], [47], [53], [55], [71], or the general population [4]. Four studies defined clients as men who reported purchasing sex in the previous year [4], [47], [48], [55].…”

“…Twenty-four studies sampled detainees [12], [36], [37], [39], [41], [49]–[52], [54], [57]–[70], but other studies sampled miners [46], clients at commercial sex venues [38], [41]–[43], [45], [47], [48], [56], [71], STI clinic attendees [38], [41], [47], [53], [55], [71], or the general population [4]. Four studies defined clients as men who reported purchasing sex in the previous year [4], [47], [48], [55]. Other studies defined clients as men who reported purchasing sex in the previous three months [43] or “recently” [71].…”

Behavioral and Psychosocial Correlates of HIV Testing Among Male Clients of Female Sex Workers in Tijuana, Mexico

“…Globally, FSW have a 13.5 times greater odds of living with HIV than non-FSW women 17 . Given that inconsistent condom use is prevalent among male clients in LMIC 10,18–20 , ensuring that male clients who are infected with HIV are tested and connected to care and treatment may be one of the most effective ways to stem HIV transmission among male clients, their non-commercial sexual and drug partners, and FSW.…”