title: Differences in risk behaviours and HIV/STI prevalence between low-fee and medium-fee female sex workers in three provinces in China.
abstract: To better understand risk behaviours and factors associated with low-fee female sex workers (FSW) and support HIV/sexually transmitted infections (STI) epidemic control among this key population in China.
  
  
  
  A cross-sectional study using convenience sampling to recruit 1487 eligible low-fee and medium-fee FSW was conducted in 2012 in three provinces. The participants were interviewed using a structured questionnaire and tested for HIV-1, herpes simplex virus (HSV)-2 and syphilis antibody. Log-binomial modelling was used to estimate prevalence ratios (PR) and examine factors associated with low-fee sex work.
  
  
  
  Prevalence of HIV-1, syphilis and HSV-2 antibody positive were 0.5%, 4.8% and 27.8%, respectively. Low-fee FSW were more likely to have HSV-2 infection (adjusted prevalence ratio (APR)=1.3, 95% CI 1.1 to 1.7), but not more likely to have HIV-1 and syphilis infection compared with medium-fee FSW. Compared with medium-fee FSW, low-fee FSW were more likely to be ≥35 years of age (APR=2.1, 95% CI 1.3 to 3.6), engage in sex work ≥6 days/per week (APR=1.7, 95% CI 1.2 to 2.6), have ≥3 clients per day (APR=2.2, 95% CI 1.5 to 3.3), have clients decide condom use (APR=1.6, 95% CI 1.1 to 2.3), fail to persuade clients to use condoms (APR=1.6, 95% CI 1.1 to 2.6), express willingness to have unprotected sex in return for receipt of a higher fee (APR=1.8, 95% CI 1.2 to 2.8), have had genital symptoms in the past year (APR=1.4, 95% CI 1.1 to 1.8) and have migrated from another city.
  
  
  
  Low-fee FSW in China have unique risks for acquiring HIV/STI, in part due to greater economic pressures. Tailored interventions targeting low-fee FSW and incorporating their prevailing perception of HIV/STI risks and condom use negotiation challenges that they face are urgently needed.
authors.affiliation: US Centers for Disease Control and Prevention (CDC) Global AIDS Programme (GAP), Beijing, China.
authors.forename: Lifeng
authors.initials: L
authors.lastname: Han
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Chu
authors.initials: C
authors.lastname: Zhou
authors.affiliation: US Centers for Disease Control and Prevention (CDC) Global AIDS Programme (GAP), Beijing, China.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Li
authors.affiliation: US Centers for Disease Control and Prevention (CDC) Global AIDS Programme (GAP), Beijing, China.
authors.forename: Adrienne N
authors.initials: AN
authors.lastname: Poon
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Keming
authors.initials: K
authors.lastname: Rou
authors.affiliation: US Centers for Disease Control and Prevention (CDC) Global AIDS Programme (GAP), Beijing, China.
authors.forename: Serena
authors.initials: S
authors.lastname: Fuller
authors.affiliation: Department of HIV/AIDS, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of HIV/AIDS/STD, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China.
authors.forename: Limei
authors.initials: L
authors.lastname: Shen
authors.affiliation: Shandong Provincial Center for Disease Control and Prevention, Jinan, China.
authors.forename: Dianmin
authors.initials: D
authors.lastname: Kang
authors.affiliation: Department of HIV/AIDS/STD, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Huang
authors.affiliation: Shandong Provincial Center for Disease Control and Prevention, Jinan, China.
authors.forename: Meizhen
authors.initials: M
authors.lastname: Liao
authors.affiliation: Department of HIV/AIDS, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Fu
authors.affiliation: US Centers for Disease Control and Prevention (CDC) Global AIDS Programme (GAP), Beijing, China.
authors.forename: Colin
authors.initials: C
authors.lastname: Shepard
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
authors.affiliation: US Centers for Disease Control and Prevention (CDC) Global AIDS Programme (GAP), Beijing, China Division of Global HIV/AIDS, Center for Global Health, CDC, Atlanta, Georgia, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002681:China / Q000453:epidemiology; D060085:Coinfection; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: CHINA; COMMERCIAL SEX; CONDOMS; HIV; SEXUAL BEHAVIOUR