HIV incidence and associated risk factors among female sex workers in a high HIV-prevalence area of China.
BACKGROUND
Heterosexual sex is replacing injection drug use as the main mode of HIV transmission in China. The objective of this study is to determine HIV incidence and associated risk factors among female sex workers (FSWs) in China.


METHODS
From March 2006 to November 2009, FSWs in Kaiyuan City, Yunnan were recruited into an open cohort study. Participants were interviewed and tested for HIV and sexually transmitted infections every 6 months. A multivariate Cox proportional hazards regression model with time-dependent variables was used to measure associations between independent variables and HIV seroconversion.


RESULTS
During 3.5 years of follow-up, 19 incident cases of HIV infection were diagnosed, yielding an overall incidence of 1.44 per 100 person-years (95% confidence interval [CI]: 0.87-2.24). In the multivariate Cox proportional hazards regression model, noninjection drug use (adjusted hazard ratio [AHR]: 6.7, 95% CI: 2.25-19.93), inconsistent condom use with clients in the previous week (AHR: 2.9, 95% CI: 1.03-8.34), and number of clients in the previous week ≥7 (AHR: 4.9, 95% CI: 1.81-13.13) were all independent risk factors for HIV seroconversion.


CONCLUSIONS
These results underscore the urgency for preventive interventions on sexual and drug use behaviors among FSWs, including condom promotion as well as sexually transmitted infection screening and treatment.
Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.
Haibo
H
Wang
Kathleen H
KH
Reilly
Katherine
K
Brown
Xia
X
Jin
Junjie
J
Xu
Guowei
G
Ding
Chunpeng
C
Zang
Junjie
J
Wang
Ning
N
Wang
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000276:immunology; D015497:HIV-1 / Q000276:immunology; D006293:Health Promotion; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D011477:Sex Work; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult