title: Social, psychological, and environmental-structural factors determine consistent condom use among rural-to-urban migrant female sex workers in Shanghai China.
abstract: BACKGROUND
  To determine potential social, psychological, and environmental-structural factors that may result in motivating female sex workers (FSWs), who are rural-to-urban migrants, and their paying partners in Shanghai, China to promote consistent condom use (CCU).
  
  
  METHODS
  A cross-sectional study was conducted in five districts of Shanghai, including three suburbs and two downtown locales. We adopted a cluster randomized sampling method to obtain 20 geographic sites, which consisted of 1 or more communities/villages proximal to a location where FSWs were accessible. Five hundred four FSWs from 132 Xitou Fang (shampoo wash rooms), massage parlors, and hair salons who explicitly provided sexual services were enrolled in the study. Each participant completed a questionnaire survey and interview aimed to collect information on the perceptions and behaviors of individuals associated with a risk for human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS),self-efficacy at negotiating safe sex,and the physical, social, and policy environment of the establishments where they worked.
  
  
  RESULTS
  The percentage of FSWs who reported consistent condom use with their paying partners was 63.3%. Controlling for socio-demographic characteristics in multivariate analyses, environmental-structural support (OR, 3.96; CI, 2.52-6.22) for condom use was the most significant positive predictor of CCU among FSWs and their regular paying partners. A high perception of susceptibility and risk of HIV/AIDS (OR, 1.96; CI, 1.25-3.01), a high perception of benefits on condom use to protect themselves (OR, 2.06; CI, 1.32-3.22), and high safe sex self-efficacy (OR, 2.52; CI, 1.64-3.85) also play important roles on CCU based on multivariate analyses.
  
  
  CONCLUSIONS
  Environmental-structural factor support for condom use, in addition to social, psychological, and individual cognitive factors are significant predictors of CCU among FSWs, which should be assessed and addressed in research and interventions related to HIV/AIDS prevention among FSWs in China.
authors.affiliation: Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Children’s Environmental Health, Shanghai 200127, PR China.
authors.forename: Xiuxia
authors.initials: X
authors.lastname: Ye
authors.forename: Meili
authors.initials: M
authors.lastname: Shang
authors.forename: Tian
authors.initials: T
authors.lastname: Shen
authors.forename: Bei
authors.initials: B
authors.lastname: Pei
authors.forename: Xueqin
authors.initials: X
authors.lastname: Jiang
authors.forename: Yong
authors.initials: Y
authors.lastname: Cai
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D011584:Psychology; D012424:Rural Population / Q000706:statistics & numerical data; D021841:Safe Sex / Q000523:psychology / Q000706:statistics & numerical data; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012931:Social Environment; D014171:Transients and Migrants / Q000523:psychology* / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult