title: 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 human immunodeficiency virus (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 and 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 was 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 with HIV-negative men, HIV-positive men were more likely to have a history of IDU (64.3% vs. 6.5%) and be coinfected 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.
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: Reilly
authors.forename: Junjie
authors.initials: J
authors.lastname: Wang
authors.forename: Zhibin
authors.initials: Z
authors.lastname: Zhu
authors.forename: Shuanghe
authors.initials: S
authors.lastname: Li
authors.forename: Tinghua
authors.initials: T
authors.lastname: Yang
authors.forename: Guowei
authors.initials: G
authors.lastname: Ding
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
authors.forename: Patricia
authors.initials: P
authors.lastname: Kissinger
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D011477:Sex Work; D060386:Sex Workers; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult