Bridging the epidemic: a comprehensive analysis of prevalence and correlates of HIV, hepatitis C, and syphilis, and infection among female sex workers in Guangxi Province, China.
BACKGROUND
Female sex workers (FSWs) are at highest risk for contracting HIV and facilitating the current heterosexual HIV epidemic in Guangxi, China, yet little is known of the impact of recent harm reduction campaigns in the province. We analyzed sentinel surveillance data collected between 2010 and 2012 in Guangxi to explore correlations between the prevalence of HIV, hepatitis C (HCV), and syphilis and risk behaviors of different categories of FSWs in Guangxi.


METHODS
The sentinel surveillance data for 5,1790 FSWs in all 14 prefectures and 64 city/county regions of Guangxi, China from 2010 to 2012 were collected. Differences between three categories of FSWs (grouped by venue) and disease trends (HIV, HCV, and syphilis) by year were analyzed using bivariate and multivariate logistic regression analyses as to evaluate risk factors correlated with HIV, HCV, or syphilis infection.


RESULTS
HIV and HCV prevalence remained constant across the three FSW categories; however, syphilis prevalence showed a significant increase from 5.7% to 7.3% for low-tier FSWs. Most cases with HIV, HCV, syphilis and intravenous drug use were seen in low-tier FSWs. Testing positive for HIV and syphilis were most correlated with being HCV positive (AOR 4.12 and AOR 4.36), only completing elementary school (AOR 3.71 and AOR 2.35), low tier venues (AOR 2.02 and AOR 2.00), and prior STI (AOR 1.40 and AOR 3.56), respectively. HCV infection was correlated with ever injecting drugs (AOR 60.65) and testing positive for syphilis (AOR 4.16) or HIV (AOR 3.74).


CONCLUSIONS
This study highlights that low tier FSWs with lower formal education levels are the most vulnerable population at risk for acquiring and transmitting HIV, HCV, and syphilis in Guangxi, China. Condom distribution with evolution to safer sex practices are the reasons to explain the non-increasing prevalence of HIV, HCV in Guangxi for 2010-2012.
Guangxi Centers for Disease Control and Prevention, Nanning, China.
Yi
Y
Chen
Guangxi Centers for Disease Control and Prevention, Nanning, China.
Zhiyong
Z
Shen
University of South Florida, Morsani College of Medicine, Division of Infectious Disease and International Medicine, and College of Public Health, Tampa, Florida, United States of America.
Jamie P
JP
Morano
Yale University School of Public Health, New Haven, Connecticut, United States of America.
Kaveh
K
Khoshnood
National Center for AIDS/STD Control and Prevention, China Centers for Disease Control and Prevention, Beijing, China.
Zunyou
Z
Wu
Guangxi Centers for Disease Control and Prevention, Nanning, China.
Guanghua
G
Lan
Guangxi Centers for Disease Control and Prevention, Nanning, China.
Qiuying
Q
Zhu
Guangxi Centers for Disease Control and Prevention, Nanning, China.
Yuejiao
Y
Zhou
Guangxi Centers for Disease Control and Prevention, Nanning, China.
Shuai
S
Tang
Guangxi Centers for Disease Control and Prevention, Nanning, China.
Wei
W
Liu
Health and Family Planning Commission of Guangxi, Zhuang Autonomous Region, Nanning, China.
Jie
J
Chen
Guangxi Centers for Disease Control and Prevention, Nanning, China.
Zhenzhu
Z
Tang
D000328:Adult; D002681:China / Q000453:epidemiology; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D060386:Sex Workers; D012725:Sexual Behavior; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult