HIV-positive clients of female sex workers in Hunan Province, China: a mixed methods study assessing sexual relationships and risk behavior by type of partner

Abstract

Background In China, clients of female sex workers (CFSWs) have a low rate of condom use and a high prevalence of human immunodeficiency virus (HIV). However, little is known about the high-risk sexual behaviors of HIV-positive CFSWs. Methods In 2014, 327 CFSWs diagnosed with HIV for 6 months or longer completed a face-to-face questionnaire for a quantitative survey. In addition, 32 HIV-positive CFSWs were recruited to participate in in-depth interviews (18 participated in both, 14 participated in-depth interviews only) to explore reasons for extramarital sexual behaviors and inconsistent condom use. The quantitative data on sexual risk behaviors were analyzed using chi-square tests. Interviews were coded inductively for emerging themes. Results Among the participants of the quantitative survey, 41.6% (136/327) had sex with regular sexual partners only in the past 6 months, of whom 64.0% (87/136) had consistent condom use; 27.5% (90/327) of the participants had sex with irregular sexual partners in the past 6 months, of which, 46.7% (42/90) had consistent condom use. The qualitative study suggested that HIV positive sero-status, willingness to protect their spouses or regular sexual partners, and lacking a sense of responsibility to protect their commercial and casual sexual partners, influence CFSWs’ sexual behaviors. Conclusions HIV-positive CFSWs continue to practice unsafe sexual behaviors with regular and irregular partners after HIV diagnosis, but were more willing to protect their regular partners. Future interventions targeting HIV-positive CFSWs should not only be confined to sero-discordant couples, but also need to instill a sense of responsibility to protect the commercial and casual partners and reduce the number of concurrent partners.

A Study on the Association Between Family Support and High-Risk Sexual Behavior of Elderly Men in Rural China

“…Li et al, 2013; von Soest et al, 2020; L. Wang et al, 2020; Wu et al, 2019), we predicted that family support factors may affect the occurrence of high-risk sexual behavior of the sample through three intermediate paths: loneliness and life satisfaction, disposable economic conditions, and family responsibility and health belief (Figure 2).…”

“…Li et al, 2013;von Soest et al, 2020;L. Wang et al, 2020;Wu et al, 2019), we predicted that family support factors may affect the occurrence of high-risk sexual behavior of the sample through three intermediate paths: loneliness and life satisfaction, disposable economic conditions, and family responsibility and health belief (Figure 2). This study reported that unmarried, divorced/widowed without fixed sexual partners, and married but separated were the risk factors for the increase of commercial sex among rural elderly men.…”

“…Health belief theory believes that the motivation of behavior and cognition of behavior outcome are important factors to form long-term or short-term health behaviors, and family responsibility is undoubtedly a sufficient motivation to drive each family member to form good health behaviors to maintain the health and stability of the family. Studies have identified that people living with HIV (PLHIV) have a strong sense of responsibility and protection for families ( Chakrapani et al, 2010 ; Wu, 2015 ; Wu et al, 2019 ; Zhang et al, 2013 ). They usually do not have sex with their spouses when facing sexual needs, so as to prevent their spouses from being infected, especially for couples with active relationships, they will engage in less risky sex ( Vamos et al, 2013 ), suggesting the influence of family responsibility and health beliefs on people’s attitudes and behaviors.…”

Spatial Analysis of People Living with HIV/AIDS Transmitted Through Commercial Heterosexual Contact or Non-Marital Non-Commercial Heterosexual Contact — China, 2018

“…There was likely some interweaving between these two populations. For example, some men might be engaged in both commercial and non-marital non-commercial heterosexual behaviors, which may transmit HIV from infected female sex workers (FSWs) to uninfected women in the general population, thereby spreading HIV from high-risk groups to the general population through heterosexual transmission ( 8 ).…”

A thematic analysis of experiences of HIV risks among female sex workers in the Yunnan-Vietnam Chinese border region

“…providing clean needles, methadone) to provide advice such as what gauge of needle to use depending on injection site, not to share water, and use a syringe only once. Drug use is associated with low likelihood of condom use and high likelihood of HIV infection among FSWs [ 83 ]. However, as this study has shown, most FSWs reported working when sober or with a maximum of two drinks, which suggests that the participants were engaging in less risky behavior than those in other studies.…”