title: Behavioral Interventions Improve Condom Use and HIV Testing Uptake Among Female Sex Workers in China: A Systematic Review and Meta-Analysis.
abstract: Condomless commercial sex work is a common mode of HIV transmission in China. This study systematically reviews the impacts of behavioral interventions on condom use and HIV testing uptake among female sex workers (FSW) in China. Chinese and English language peer-reviewed articles published between January 2000 and December 2013 were searched in five electronic databases. Odds ratios (OR) were calculated by comparing the levels of improvements in condom use and HIV testing uptake by various intervention strategies. Study quality was assessed for included studies. This review followed the PRISMA guidelines and was registered in PROSPERO. One hundred and twenty-eight studies met inclusion criteria. Meta-analyses indicated that FSW in the post-intervention period were 2.3-5.0 times more likely to use condoms with male clients in their last sexual act and 2.3-3.4 times more likely to use condoms consistently in the last month than in the pre-intervention period. In particular, multiple session intervention were more effective in improving condom use among FSW with male clients (OR=5.6, [4.0-7.8]) than a single session intervention (OR=3.3, [2.8-3.8]). Behavioral interventions also improved past-12-month HIV testing uptake 4.6-fold (95% CI, 2.9-7.4). Comprehensive intervention programs were more effective (OR=8.1, [4.0-16.7]) in improving HIV testing uptake compared with health education only programs (OR=2.7, [1.6-4.5]). Longer intervention duration (>12 months) did not increase effectiveness in improving condom use or HIV testing rate among Chinese FSWs. Behavioral interventions are effective in improving condom use and HIV testing uptake among Chinese FSW. This review highlights both the potentials and limitations of condom promotion interventions targeting female sex workers.
authors.affiliation: 1 Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, VIC, Australia .|2 Melbourne Sexual Health Centre , Alfred Health, Melbourne, VIC, Australia .
authors.forename: Eric P F
authors.initials: EP
authors.lastname: Chow
authors.affiliation: 3 The Kirby Institute , UNSW Australia, Sydney, NSW, Australia .
authors.forename: Keith
authors.initials: K
authors.lastname: Tung
authors.affiliation: 4 The University of North Carolina Project-China , Guangzhou, China .|5 London School of Hygiene and Tropical Medicine , London, United Kingdom .
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.affiliation: 4 The University of North Carolina Project-China , Guangzhou, China .|6 Department of Health Behavior, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill , North Carolina.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Muessig
authors.affiliation: 3 The Kirby Institute , UNSW Australia, Sydney, NSW, Australia .
authors.forename: Shu
authors.initials: S
authors.lastname: Su
authors.affiliation: 7 China Food and Drug Administration Institute of Executive Development , Beijing, China .|8 Research Center for Public Health, School of Medicine, Tsinghua University , Beijing, China .
authors.forename: Xiaohu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: 8 Research Center for Public Health, School of Medicine, Tsinghua University , Beijing, China .
authors.forename: Jun
authors.initials: J
authors.lastname: Jing
authors.affiliation: 1 Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne, VIC, Australia .|3 The Kirby Institute , UNSW Australia, Sydney, NSW, Australia .|8 Research Center for Public Health, School of Medicine, Tsinghua University , Beijing, China .
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D002681:China; D017280:Condoms / Q000706:statistics & numerical data*; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D011613:Psychotherapy / Q000379:methods*; D040242:Risk Reduction Behavior; D021841:Safe Sex; D011477:Sex Work; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult