title: Condom Use During Commercial Sex Among Male Clients of Female Sex Workers in Sichuan China: A Social Cognitive Theory Analysis.
abstract: There has been little theory-based research focusing on condom use among male clients of female sex workers (CFSW) in China. The current study applied social cognitive theory to condom use behaviors of CFSW in China. Face-to-face structured interviews were conducted among 584 CFSW recruited through snowball sampling. Bivariate and multivariate logistic regression models were applied to examine factors associated with consistent condom use. A minority (30.65 %) of respondents reported using condoms consistently with FSW, and 7 of 12 social cognitive dimensions/subdimensions were found to be significantly influential. The most significant factors were self-efficacy [adjusted prevalence ratio (APR) = 2.11, 95 %, CI = 1.74-2.43] and personal pleasure reduction (APR = 0.3, 95 % CI = 0.15-0.6). HIV-related knowledge, perceived HIV susceptibility, condom cost, condom efficacy, and embarrassment of carrying condoms were not associated with consistent condom uses with FSW. Findings from the current study suggest future prevention programs should target sex venues, and condom access should ensure both quantity and quality. Peer education should focus on knowledge education and peer norms, and knowledge education should include information on HIV infection severity and how to increase pleasure with condom use.
authors.affiliation: Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China.|Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA.
authors.forename: Cui
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Health, Behavior and Society, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA. carl.latkin@jhu.edu.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Latkin
authors.affiliation: Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, 610041, Sichuan, China.
authors.forename: Rongsheng
authors.initials: R
authors.lastname: Luan
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E7638, Baltimore, MD, 21205, USA.
authors.forename: Kenrad E
authors.initials: KE
authors.lastname: Nelson
mesh_terms: D000328:Adult; D002681:China; D003071:Cognition; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D010379:Peer Group; D015995:Prevalence; D021841:Safe Sex / Q000706:statistics & numerical data; D020377:Self Efficacy; D011477:Sex Work; D060386:Sex Workers; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: China; Commercial sex; Condom use; HIV; Male clients; Social cognitive theory