HIV/STI prevention interventions targeting FSWs in China: a systematic literature review

Abstract

A rapid increase in heterosexual transmission of HIV and a high prevalence of sexually transmitted infections (STIs) in China signals potential outbreaks of generalized epidemics. A large proportion of heterosexual transmission has been through commercial sex; thus, millions of female sex workers (FSWs) and their clients play a critical role in the country's HIV/STI epidemics. A number of prevention interventions targeting FSWs have been implemented in response to changes in policy toward HIV as well as growing epidemics. This study reviews existing HIV/STI prevention interventions studies targeting FSWs in China. A total of 25 studies (28 articles) were identified from English and Chinese journal databases. Most studies recruited FSWs from entertainment establishments and had small sample sizes of less than 400. A majority employed a simple pre-post design with an open cohort, none applied a randomized controlled trial, and only two studies had a quasi-experimental design. Venue-based knowledge education and condom promotion represented the typical intervention approach. Some adapted internationally validated programs such as Voluntary Counseling and Testing and 100% Condom Use Programs (CUP), but no scale-up data were reported. Significant intervention effects were reported in most studies, especially increases in HIV/STI-related knowledge and condom use rates. Of the nine studies reporting STI rates, the results were mixed; some even reported increased STIs despite higher condom use. We call for more HIV/STI interventions targeting FSWs in China, particularly, interventions with rigorous design and externally validated measures, and more diversity in intervention programs including biomedical and structural interventions as well as innovative intervention delivery. We also advocate that effective intervention programs be translated into sustainable policies and programs that could have an impact on China's HIV and STI epidemics.

Differences in risk behaviours and HIV/STI prevalence between low-fee and medium-fee female sex workers in three provinces in China

“…The effect of these interventions needs to be evaluated in the future. Analysing the effects of interventions across varying FSW subgroup strata would offer a greater understanding of successful intervention elements 28. Especially, since knowledge alone may not translate necessarily into safe sex, particularly in the context of low literacy levels,29 strategies to increase HIV/STI risk perception and condom negotiation self-efficacy are urgently needed 30.…”

High prevalence of syphilis among street-based female sex workers in Nanchang, China

“…[141516] Approximately four million sex workers are present in China, which comprise a highly heterogeneous population that includes those from both low-end (ie, streets, beauty salons, roadside motels, and temporary sublets) and high-end venues (ie, karaoke clubs, massage parlors, night clubs, and hotels). [171819] Female sex workers (FSWs) play a critical role in the heterosexual transmission of HIV/sexually transmitted infections (STIs) in China. [19] Studies showed that the prevalence rate of syphilis among FSWs ranges from 9.5% to 15.8% in China.…”

A systematic review and meta-analysis of the prevalence, trends, and geographical distribution of HIV among Chinese female sex workers (2000–2011): implications for preventing sexually transmitted HIV

“…9,10 For FSWs in the community, community-based organizations may provide limited HIV interventions, subject to restraint from interference by the public security authorities. 11,12 FSWs work in various venues and are classified as high-, middle-, and low-tier according to the type of sex venue where they sell sex. 13 The sex work tier is often a key determinant of socio-economic status, work environment, type of client, and risk behavioural patterns of FSWs in China.…”