title: Burden of HIV and Syphilis: A Comparative Evaluation between Male Sex Workers and Non-Sex-Worker Men Who Have Sex with Men in Urban China.
abstract: BACKGROUND
  The increasing burden of sexually transmitted infections (STIs) including HIV and syphilis among male sex workers (MSWs) is a major global concern. The aim of our study was to evaluate the difference between MSWs and non-commercial MSMs in China.
  
  
  METHODS
  During 2008-09, in a cross-sectional study, 2618 adult MSM were recruited through respondent-driven and snowball sampling from seven cities of China. Information regarding socio-demographics, risk behaviors, HIV-related knowledge and STI-related symptoms were collected and participants were tested for HIV and syphilis.
  
  
  RESULTS
  Among 2618 participating MSM, 9.97% sold sex to males. HIV prevalence was 7.45% (6.13% among MSWs and 7.59% among non-MSW MSM) and syphilis prevalence was 14.32% (10.73% for MSWs and 14.72% for non-MSW MSM). Compared to non-MSW MSM, MSWs were more likely to be younger (adjusted odds ratio: aOR = 0.91, 95% confidence interval: 95%CI=0.88-0.93), never married (aOR = 4.38, 95% CI = 2.38-6.80), less educated, heterosexual (aOR = 13.04, 95% CI = 6.08-27.95), less knowledgeable regarding HIV (aOR = 0.70, 95% CI=0.51-0.96), experiencing symptoms of STI (aOR = 2.16, 95% CI = 1.47-3.19), engaging in condomless vaginal intercourse (aOR = 2.16, 95% CI = 1.47-3.19) and less likely to engage in condomless anal intercourse (aOR = 0.62, 95% CI = 0.46-0.85).
  
  
  CONCLUSIONS
  High HIV and syphilis prevalence warranted urgent intervention targeting MSWs as a separate sentinel group for efficient surveillance owing to their different distribution from non-MSW MSM. Although male sex workers and non-commercial homosexuals have similar rates of HIV and syphilis, MSWs have different characteristics which should be considered in designing intervention programs targeting them.
authors.affiliation: Guangdong Provincial Center for Skin Diseases and STIs Control, No. 2 Lujing Road, Guangzhou, 510085, China; University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510085, China.
authors.forename: Weiming
authors.initials: W
authors.lastname: Tang
authors.affiliation: Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Mahapatra
authors.affiliation: Guangdong Provincial Center for Skin Diseases and STIs Control, No. 2 Lujing Road, Guangzhou, 510085, China.
authors.forename: Fengying
authors.initials: F
authors.lastname: Liu
authors.affiliation: Jiangsu Provincial Central for Disease Prevention and Control, Nanjing, Jiangsu, China.
authors.forename: Gengfeng
authors.initials: G
authors.lastname: Fu
authors.affiliation: Guangdong Provincial Center for Skin Diseases and STIs Control, No. 2 Lujing Road, Guangzhou, 510085, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.affiliation: University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510085, China.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.affiliation: Monitoring and Evaluation Unit, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors.forename: Jinkou
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America.
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D060386:Sex Workers / Q000706:statistics & numerical data*; D013587:Syphilis / Q000453:epidemiology*; D055815:Young Adult