title: Exploring HIV prevention strategies among street-based female sex workers in Chongqing, China.
abstract: BACKGROUND
  Commercial sex plays an increasingly important role in China's growing HIV and sexually transmitted infection (STI) epidemics. In China, street-based sex workers (SSWs) are a subgroup of female sex workers with a particularly high risk of HIV/STI infections but are neglected in responses to HIV. This study assesses changes in HIV voluntary counseling and testing (VCT) utilization and high-risk sexual behaviors following a three-month HIV preventive intervention among SSWs in Chongqing, China.
  
  
  METHODS
  A three-month intervention was conducted by a team of peer educators, outreach workers from community-based organizations and health professionals. It mainly included distribution of free pamphlets and condoms and delivery of onsite and clinic-based VCT. Cross-sectional surveys were conducted prior to (n = 100) and immediately following (n = 112) the intervention to assess its impact. In-depth interviews were conducted among 12 SSWs after the intervention to further explore potential barriers to HIV prevention.
  
  
  RESULTS
  The intervention significantly increased SSWs' participation in VCT (from 2.0%-15.2%, P < 0.001). Despite participants' improved HIV-related knowledge level (from 24.0%-73.2%, P < 0.001), there were minimal changes in the levels of condom use with clients. Qualitative research revealed that fear of police arrest and stigma were the main barriers to VCT utilization. Low condom use was associated with family financial constraints, inadequate power in condom negotiation, low awareness and misconceptions of HIV infection risks.
  
  
  CONCLUSIONS
  HIV intervention improved VCT utilization and knowledge but we did not observe an increase in condom use after this short intervention. SSWs faced substantial economic, social and environmental barriers to VCT utilization and condom use.
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China. zenghuan586@aliyun.com.
authors.forename: Huan
authors.initials: H
authors.lastname: Zeng
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China. zhaoyongzy3@sina.com.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Foreign Language, Chongqing Medical University, Chongqing 400016, China. mpsonia2003@163.com.
authors.forename: Siying
authors.initials: S
authors.lastname: Meng
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China. tangxiaoj0726@qq.com.
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Tang
authors.affiliation: Institute of Health Policy, College of Human medicine, Michigan State University, Lansing, MI 48910, USA. Guohang@msu.edu.
authors.forename: Hang
authors.initials: H
authors.lastname: Guo
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China. wangyang8289@163.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Research Center for Public Health, School of Medicine, Tsinghua University, Beijing 100084, China. lzhang@kirby.unsw.edu.au.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D017280:Condoms / Q000706:statistics & numerical data; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D021841:Safe Sex; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000523:psychology; D055815:Young Adult