title: HIV, syphilis, and behavioral risk factors among female sex workers before and after implementation of harm reduction programs in a high drug-using area of China.
abstract: OBJECTIVE
  To evaluate the impact of harm reduction programs on HIV and syphilis infection and related risk behaviors among female sex workers (FSWs) in a drug trafficking city in Southwest China.
  
  
  METHODS
  Before and after harm reduction program study.
  
  
  METHODS
  Two cross-sectional surveys were conducted among FSWs before and after harm reduction programs were launched in Xichang city, Sichuan province. The first and second cross-sectional surveys were conducted in 2004 and 2010, respectively. Temporal changes in odds of HIV, syphilis, and behavioral risk factors were assessed by multivariable logistic regression while controlling for socio-demographics.
  
  
  RESULTS
  The 2004 and 2010 cross-sectional surveys recruited 343 and 404 FSWs, respectively. From 2004 to 2010, the odds of syphilis infection decreased by 35% and was of borderline statistical significance (AOR: 0.65, 95% CI: 0.41-1.03), while odds of HIV infection rose, but not significantly (AOR: 4.12, 95% CI: 0.76-22.45). Although odds of unprotected sex with primary sex partners did not significantly change over time (AOR: 0.96; 95% CI: 0.61-1.50), odds of unprotected sex with clients declined significantly and remarkably (AOR: 0.14, 95% CI: 0.09-0.21). Notably, the odds of reporting ≥10 new sex partners in the previous month increased by 37% (AOR: 1.37; 95% CI: 0.98-1.90).
  
  
  CONCLUSIONS
  Harm reduction strategies may be an effective means of reducing unprotected sex with clients among FSWs. Future research is needed to better target both FSWs and IDUs and interrupt bridging networks for HIV transmission in high drug-using areas of China.
authors.affiliation: Beijing Centers for Disease Control and Prevention, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China.
authors.forename: Shu
authors.initials: S
authors.lastname: Liang
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
authors.forename: Weixia
authors.initials: W
authors.lastname: Lu
authors.affiliation: The School of Population and Public Health University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Pan
authors.affiliation: Xichang Center for STD and Leprosy Control, Xichang City, Sichuan, China.
authors.forename: Benli
authors.initials: B
authors.lastname: Song
authors.affiliation: Xichang Center for STD and Leprosy Control, Xichang City, Sichuan, China.
authors.forename: Qianping
authors.initials: Q
authors.lastname: Liu
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
authors.forename: Yunan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Beijing Youth Politics College, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Dong
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Xing
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006078:Government Programs / Q000193:education*; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D012309:Risk-Taking; D011477:Sex Work / Q000523:psychology; D060386:Sex Workers / Q000193:education* / Q000523:psychology; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000453:epidemiology; D013587:Syphilis / Q000453:epidemiology / Q000635:transmission; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*