title: HPV and cervical cancer related knowledge, awareness and testing behaviors in a community sample of female sex workers in China.
abstract: BACKGROUND
  Limited data suggested that the prevalence of Human Papillomavirus (HPV) among female sex workers (FSW) is much higher than in the general female population. The current study aimed to examine the HPV and cervical cancer related awareness, knowledge, and behaviors among FSW in China.
  
  
  METHODS
  A total of 360 FSW recruited from entertainment establishments in Beijing completed a self-administered survey including demographics, HPV related knowledge, and health-seeking and cervical cancer preventive behaviors.
  
  
  RESULTS
  Approximately 70.8% of the participants ever heard of cervical cancer, and as few as 22.1% and 13.3% ever heard of HPV and HPV vaccine, respectively. The mean score on a 7-item knowledge scale was 2.2 (SD = 2.4). Less than 10% of FSW perceived any risk of cervical cancer, and only 15.3% ever had a Pap smear. About 40.8% of FSW would accept HPV vaccine if it is free, and 21.8% would accept it even with a charge. Multivariate regression suggested that women with better knowledge of cervical cancer were more likely to have a Pap smear (aOR = 1.35); women who had tested for HIV were 11 times more likely to have a Pap smear, and women who had worked longer in commercial sex (aOR = 1.01) and had regular health check-ups (aOR = 1.95) were more likely to accept HPV vaccine.
  
  
  CONCLUSIONS
  Our study underscores the needs for effective cervical cancer prevention programs for FSW in China and other resource-limited countries. We specifically call for cervical cancer and HPV knowledge and awareness programs and regular screening as well as HPV risk-reduction programs for these vulnerable women.
authors.affiliation: Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Hong
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Li
authors.forename: Danhua
authors.initials: D
authors.lastname: Lin
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D001364:Awareness; D002681:China; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology / Q000821:virology; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
references.citation: J Natl Cancer Inst. 2005 Apr 20;97(8):577-86
references.pmid: 15840880
references.citation: Int J Cancer. 2010 Sep 1;127(6):1404-11
references.pmid: 20049838
references.citation: Am J Epidemiol. 2001 Apr 15;153(8):740-8
references.pmid: 11296145
references.citation: Sex Health. 2006 Mar;3(1):11-4
references.pmid: 16607969
references.citation: Eur J Obstet Gynecol Reprod Biol. 2013 Feb;166(2):196-203
references.pmid: 23141797
references.citation: Sex Transm Infect. 2013 Jun;89(4):311-9
references.pmid: 23112339
references.citation: AIDS Behav. 2008 Jul;12(4):623-36
references.pmid: 17694431
references.citation: Lancet. 2009 Aug 1;374(9687):358
references.pmid: 19647592
references.citation: Sex Transm Infect. 2004 Apr;80(2):118-20
references.pmid: 15054172
references.citation: Int J Gynaecol Obstet. 2009 Dec;107(3):216-9
references.pmid: 19716556
references.citation: Lancet. 2007 Feb 24;369(9562):679-90
references.pmid: 17321313
references.citation: Int J Cancer. 2009 Sep 1;125(5):1161-7
references.pmid: 19415744
references.citation: Int J Cancer. 1992 Nov 11;52(5):743-9
references.pmid: 1330933
references.citation: Int J Cancer. 1999 Sep 24;83(1):59-65
references.pmid: 10449609
references.citation: Lancet Oncol. 2010 Dec;11(12):1112-3
references.pmid: 21075053
references.citation: J Clin Pathol. 2002 Apr;55(4):244-65
references.pmid: 11919208
references.citation: Vaccine. 2009 Feb 18;27(8):1210-5
references.pmid: 19135493
references.citation: Aust N Z J Obstet Gynaecol. 2006 Aug;46(4):311-5
references.pmid: 16866792
references.citation: Cancer Epidemiol Biomarkers Prev. 2005 Jan;14(1):243-50
references.pmid: 15668501
references.citation: J Natl Cancer Inst Monogr. 2003;(31):20-8
references.pmid: 12807941
references.citation: Sex Transm Dis. 2001 Mar;28(3):125-30
references.pmid: 11289192
references.citation: Lancet Infect Dis. 2012 Jul;12(7):538-49
references.pmid: 22424777
references.citation: Vaccine. 2010 Nov 16;28(49):7743-7
references.pmid: 20932498
references.citation: Sex Transm Dis. 2012 Nov;39(11):848-56
references.pmid: 23064533
references.citation: Br J Gen Pract. 1998 Aug;48(433):1509-14
references.pmid: 10024713
references.citation: Int J Cancer. 2009 Jan 1;124(1):188-93
references.pmid: 18785204
references.citation: J Med Virol. 2012 May;84(5):798-803
references.pmid: 22431029
references.citation: Gynecol Oncol. 2005 Dec;99(3 Suppl 1):S236-44
references.pmid: 16150483
references.citation: J Natl Cancer Inst. 1996 Aug 7;88(15):1068-75
references.pmid: 8683638
references.citation: West Indian Med J. 2012 Jan;61(1):58-63
references.pmid: 22808567
references.citation: Chin J Cancer Res. 2011 Mar;23(1):10-4
references.pmid: 23467450
references.citation: Asian Pac J Cancer Prev. 2011;12(5):1149-53
references.pmid: 21875257
references.citation: J Pathol. 1999 Sep;189(1):12-9
references.pmid: 10451482
references.citation: AIDS Behav. 2012 Jan;16(1):44-52
references.pmid: 21538081
references.citation: Int J Gynecol Cancer. 2010 Dec;20(9):1593-6
references.pmid: 21370602
references.citation: Lancet Oncol. 2005 Mar;6(3):139-41
references.pmid: 15737830
references.citation: Sex Transm Infect. 2011 Feb;87(1):81-2
references.pmid: 20813720