Epidemiological profile and molecular genetic characterization of HIV-1 among female sex workers and elderly male clients in Guangxi, China.

The HIV/AIDS prevalence in female sex workers (FSWs) and elderly male clients is increasing in Guangxi, China, but the transmission relationship between them remains unclear. This study aims to illuminate the transmission network between FSWs and elderly male clients using molecular epidemiological analyses. Phylogenetic analysis indicated that CRF01_AE was the dominant strain, followed by CRF07_BC and CRF08_BC in both groups. Multivariate logistic regression analysis indicated that viral loads of 50 to 1000 copies/mL, immunological treatment failure and CRF07_BC were risk factors for entering the transmission network. Transmission network analysis showed that CRF07_BC tended to form large clusters, whereas CRF01_AE tended to form multiple but small clusters. Two groups of 11 FSWs and 169 clients were intricately intertwined. Spatial analysis demonstrated the formation of hotspots and clusters of transmission sharing regional differences. In conclusion, our study provides direct genetic evidence of transmission linkages between FSWs and elderly male clients. Although the CRF01_AE subtype was still the predominant subtype in the region, the higher degree and larger clusters found in CRF07_BC illustrate a rapid and intensive uptrend, which is expected to increase its prevalence in the region in the future.

Prevalence of and factors associated with behavioral intention to take up home-based HIV self-testing among male clients of female sex workers in China - an application of the Theory of Planned Behavior.

ABSTRACTHIV self-testing (HIVST) is a useful means to increase coverage of HIV testing but under-utilized by male clients of female sex workers (MCFSW) in China. This study investigated the prevalence of and factors associated with behavioral intention to take up HIVST in the next year among MCFSW in Hong Kong, China. We recruited Chinse-speaking adult men who had patronized at least one female sex worker in the past six months. A total of 303 MCFSW completed a self-administered questionnaire. Univariate and multivariable ordinal logistic regression models were fit. Only 23.8% of participants indicated that they probably/definitely would take up HIVST in the next year. The multivariable ordinal logistic regression model showed that positive attitudes towards HIVST (adjusted odds ratios (aOR): 1.24, 95%CI: 1.13, 1.37), perceived HIVST uptake is completely under one's control (perceived behavioral control) (aOR: 1.44, 95%CI: 1.08, 1.92), and perceived higher risk of HIV infection (aOR: 1.32, 95%CI: 1.01, 1.76) were associated with higher intention to take up HIVST in the next year. The prevalence of behavioral intention to use HIVST was low among MCFSW in Hong Kong. Perceptions based on the Theory of Planned Behavior and perceived risk of HIV infection were associated with behavioral intention to use HIVST.

A Mixed Methods Analysis of the Venue-Related Social and Structural Context of Drug Use During Sex Among Male Clients of Female Sex Workers in Tijuana, Mexico.

Drug use during sex increases risks for HIV acquisition. Male clients of female sex workers (FSW) represent both a key population at risk for HIV as well as a transmission bridge population. In Tijuana, Mexico, drug use is prevalent and there is a need to understand male clients' drug use during sex with FSW. Characteristics of sex work venues may confer higher risks for drug use, risky sex, and HIV/STI. It is essential to understand the venue-related social and structural factors associated with drug use during sex in order to inform HIV prevention interventions with male clients in this region. We used a Mixed-Methods Sequential Explanatory Design to conduct an enriched examination of drug use during sex among male clients of FSW in Tijuana. Findings from logistic regression analysis showed that drug use during sex was significantly correlated with police harassment (AOR = 4.06, p < .001) and methamphetamine use (AOR = 33.77, p < .001). In-depth interview data provided rich meaning behind and context around the quantitative associations. Social and structural interventions to reduce police harassment, methamphetamine use, and promote condom availability are needed to reduce risks for HIV among male clients of FSW in Tijuana.

[HIV prevalence and correlated factors on male clients of female sex workers in Hekou Yao autonomous county of Yunnan province, 2014-2015].

Objective: To assess the prevalence and related factors of HIV infection among male clients of the female sex workers in Hekou Yao autonomous county of Honghe Hani Yi autonomous prefecture (Hekou county) in Yunnan province in China, 2014-2015. Methods: Serial cross-sectional survey was conducted during June 2014 to November 2015. Convenience sampling methods were used to recruit the male clients for this study. Self-reported information on social-demographic characteristics, with sexual and drug behavior patterns, was gathered. Both blood and urine samples were collected for HIV, with for opiate testing. Multivariate logistic regression and Exhaustive CHAID method were used to determine the correlated factors associated with HIV infection. Statistical analysis was used by SPSS 22.0 software and Clementine 12.0 software. Results: The overall HIV prevalence of male clients was 2.06% (16/776). Male clients who keep using condom with female sex worker was estimated as 68.81% (534/776). The last commercial sexual partner of Vietnamese male clients was all Vietnamese female sex workers. Compared with Chinese male clients, Vietnamese male clients have a higher rate of morphine positive. Factors as: age ≥50 years vs. age <30 years (OR=8.11, 95%CI: 1.26-52.16) and testing for morphine positive vs. morphine negative (OR=7.35, 95%CI: 1.42-38.06) were significantly associated with HIV infection through multiple logistic regression analysis. Through Exhaustive CHAID, it confirmed that age was the primary factor that associated with HIV infection of male clients. Conclusions: Relationship between morphine and HIV infection indicated that HIV prevalence of male clients in Hekou county was influenced by the combined effect of both illegal drug use and commercial sexual behavior. Special attention should be paid to male clients over 50 years of age, on HIV intervention.

Low uptake of HIV testing among male clients of female sex workers in China.

Male client of female sex workers (MCFSW) is a sizable population transmitting HIV from high-risk population to female general population in China. This study was to investigate the prevalence of taking up any forms of HIV testing in lifetime and in the past year among MCFSW in Hong Kong. Factors associated with uptake of any forms HIV testing in the past year were also investigated. A cross-sectional survey was conducted. Participants were Hong Kong Chinese males aged ≥18 years, and self-reported had patronized at least one female sex workers (FSW) in the last six months. A total of 303 MCFSW recruited online (n = 160) or from venues (n = 143) completed the self-administered questionnaire. Logistic regression was used for data analysis. The prevalence of taking up any forms of HIV testing in lifetime and last year was 49.2% and 23.8%, respectively. Adjusting for these background variables, scale scores representing perceived severity of HIV infection (AOR: 1.17), perceived benefits of HIV testing (AOR: 1.18) and perceived self-efficacy in taking up HIV testing (AOR: 1.36) were significantly and positively associated with uptake of any forms of HIV testing in the last year, while negative associations were found for the Perceived Psychological Barrier Scale (AOR= 0.88) and the Perceived Logistical Barrier Scale (AOR: 0.78). MCFSW in Hong Kong reported low uptake of HIV testing. Health promotion is urgently needed. Modifying perceptions related to the Health Belief Model are potential useful strategies. The potential of using HIV self-testing to increase HIV testing coverage among MCFSW should also be considered.

HIV prevalence and correlated factors on male clients of female sex workers in Hekou Yao autonomous county of Yunnan province, 2014-2015 / 中华流行病学杂志

Objective@#To assess the prevalence and related factors of HIV infection among male clients of the female sex workers in Hekou Yao autonomous county of Honghe Hani Yi autonomous prefecture (Hekou county) in Yunnan province in China, 2014-2015.@*Methods@#Serial cross-sectional survey was conducted during June 2014 to November 2015. Convenience sampling methods were used to recruit the male clients for this study. Self-reported information on social-demographic characteristics, with sexual and drug behavior patterns, was gathered. Both blood and urine samples were collected for HIV, with for opiate testing. Multivariate logistic regression and Exhaustive CHAID method were used to determine the correlated factors associated with HIV infection. Statistical analysis was used by SPSS 22.0 software and Clementine 12.0 software.@*Results@#The overall HIV prevalence of male clients was 2.06% (16/776). Male clients who keep using condom with female sex worker was estimated as 68.81% (534/776). The last commercial sexual partner of Vietnamese male clients was all Vietnamese female sex workers. Compared with Chinese male clients, Vietnamese male clients have a higher rate of morphine positive. Factors as: age ≥50 years vs. age <30 years (OR=8.11, 95%CI: 1.26-52.16) and testing for morphine positive vs. morphine negative (OR=7.35, 95%CI: 1.42-38.06) were significantly associated with HIV infection through multiple logistic regression analysis. Through Exhaustive CHAID, it confirmed that age was the primary factor that associated with HIV infection of male clients.@*Conclusions@#Relationship between morphine and HIV infection indicated that HIV prevalence of male clients in Hekou county was influenced by the combined effect of both illegal drug use and commercial sexual behavior. Special attention should be paid to male clients over 50 years of age, on HIV intervention.

Barriers to HIV testing among male clients of female sex workers in Indonesia.

BACKGROUND: Frequent engagement of men in sexual encounters with female sex workers (FSWs) without using condoms places them at a high risk for HIV infection. HIV testing has been noted to be among important strategies to prevent HIV transmission and acquisition. However, it is known that not all men willingly undertake an HIV test as a way to prevent HIV transmission and/or acquisition. This study aimed to identify barriers to accessing HIV testing services among men who are clients of FSWs (clients) in Belu and Malaka districts, Indonesia. METHODS: A qualitative inquiry employing face to face open ended interviews was conducted from January to April 2017. The participants (n = 42) were clients of FSWs recruited using purposive and snowball sampling techniques. Data were analysed using a qualitative data analysis framework. RESULTS: Findings indicated three main barriers of accessing HIV testing services by clients. These included: (1) personal barriers (lack of knowledge of HIV/AIDS and HIV testing availability, and unwillingness to undergo HIV testing due to low self-perceived risk of HIV and fear of the test result); (2) health care service provision barriers (lack of trust in health professionals and limited availability of medication including antiretroviral (ARV)); and (3) social barriers (stigma and discrimination, and the lack of social supports). CONCLUSIONS: These findings indicated multilevelled barriers to accessing HIV testing services among participants, who are known to be among key population groups in HIV care. Actions to improve HIV/AIDS-related health services accessibility are required. The dissemination of the knowledge and information on HIV/AIDS and improved available of HIV/AIDS-related services are necessary actions to improve the personal levelled barriers. System wide barriers will need improved practices and health policies to provide patients friendly and accessible services. The societal levelled barriers will need a more broad societal approach including raising awareness in the community and enhanced discussions about HIV/AIDS issues in order to normalise HIV in the society.

Are men's misogynistic attitudes associated with poor mental health and substance use behaviors? An exploratory study of men in Tijuana, Mexico.

Men's misogynistic attitudes (i.e., dislike or contempt for women) have been shown to be associated with men's perpetration of physical/sexual violence against women and poor health outcomes for women. However, these attitudes have rarely been examined for their influence on men's own health. This paper examines the socio-demographic, substance use, and mental health correlates of misogynistic attitudes among a binational sample of men (n=400) in Tijuana, Mexico with high-risk substance use and sexual behaviors. We used a 6-item scale to measure misogynistic attitudes (α = .72), which was developed specifically for this context. We used descriptive statistics to describe our sample population and the extent to which they hold misogynistic attitudes. Then, using misogynistic attitudes as our dependent variable, we conducted bivariate linear regression and multivariable linear regression to examine the relationship between these attitudes and socio-demographic characteristics, substance use behaviors (i.e., use of alcohol, marijuana, heroin, methamphetamines, cocaine), and mental health (i.e., depression, self-esteem). In the multivariable model, we found significant relationships between misogynistic attitudes and education level (t = -4.34, p < 0.01), heroin use in the past 4 months (t = 2.50, p = 0.01), and depressive symptoms (t = 3.37, p < 0.01). These findings suggest that misogynistic attitudes are linked to poor health outcomes for men and future research needs to further explore the temporality of these relationships and identify strategies for reducing men's misogynistic attitudes with the ultimate aim of improving the health and well-being of both women and men.

Perceptions of Determinants of Condom Use Behaviors Among Male Clients of Female Sex Workers in Indonesia: A Qualitative Inquiry.

This study aimed to explore perceived determinants of condom use behaviors among male clients of female commercial sex workers (FCSWs) in Belu and Malaka districts, Indonesia. One-on-one in-depth interviews guided by the Health Belief Model (HBM) were used to collect the data from participants ( n = 42). The Framework analysis for qualitative data was employed to analyze the data. Results demonstrated several factors associated with lack of and inconsistent condom use among the participants. They included self-perceived risk of contracting HIV infection, knowledge of the severity of HIV illness and its impacts, and condom use: its benefits and its influencing factors. Additionally, factors including reduced sexual pleasure and the lack of knowledge of how and where to access condoms were important perceived barriers to condom use among participants. Having seen images of HIV-/AIDS-positive people, knowing friends and relatives suffering from HIV, and knowing FCSWs as a high-risk group for HIV infection were the cues to using condoms among several participants. Likewise, self-efficacy was also associated with condom use behaviors among the participants. The findings indicate the needs for HIV/AIDS interventions that include dissemination of HIV/AIDS knowledge, condom promotion, and improvement in the availability of condoms for both FCSWs and their clients.

HIV prevalence and correlated factors of female sex workers and male clients in a border region of Yunnan Province, China.

Female sex workers (FSWs) and their male clients are vulnerable to HIV infection and serve as a bridge in HIV transmission from the high-risk population to the general, low-risk population. To examine the factors of FSWs and male clients that correlate with the prevalence of HIV infection in the Chinese-Vietnamese border region, a cross-sectional survey was conducted in 2014 in the Hekou county of the Yunnan province of China. We performed a questionnaire survey to collect data on demographics, sexual behavior, and drug use. Blood and urine samples were collected for testing of HIV/sexually transmitted infections and drug use. We found that the prevalence of HIV infection among FSWs was 2.74%, and 15 male clients (2.62%) were HIV-positive. Multivariate logistic regression analysis revealed that herpes simplex virus type 2 infection was a risk factor for HIV infection in FSWs and male clients, suggesting the increased role of sexual transmission in the HIV epidemic in the Chinese-Vietnamese border region. Positive urinalysis result for amphetamine-type stimulants was observed in FSWs with HIV infection. History of drug use was correlated with HIV infection, which increased the HIV infection risk of male clients, confirming that drug use is an important target in future interventions for HIV prevention.

Disparities in HIV and syphilis prevalence and risk factors between older male clients with and without steady sex partners in southwestern rural China.

BACKGROUND: Heterosexual intercourse accounted for 93% of reported HIV cases in Guangxi, and Guangxi had 10% of China's total number of reported HIV cases. Older men are particularly vulnerable to STIs, for example, 46% of Guangxi's HIV cases were men over 50 years of age. As this is an under-studied population in China, effective prevention and control policies have yet to be developed. Thus, the aim of this study was to use a large-scale cross-sectional survey to understand the demographic and behavior factors associated with HIV and syphilis infections among older male clients of female sex workers (FSWs) in a high epidemic area of rural Guangxi, China. METHODS: A large-scale cross-sectional survey was conducted in 2012 among older male clients of FSWs in low-cost commercial sex venues. Questionnaire interviews were administered to collect sociodemographic and sexual behavior information. Blood samples were collected for HIV and syphilis infection tests. RESULTS: Of the 3485 participants, 2509 (72.0%) clients had a steady sex partner and 976 (28.0%) clients had no steady sex partner. The overall prevalence of HIV and syphilis infection were 3.0% and 3.2%, respectively. Compared to those with a steady sex partner, clients with no steady partner had higher odds of HIV infection (AOR: 1.90, 95% CI: 1.27-2.86), syphilis infection (AOR: 1.53, 95% CI: 1.02-2.30), and having factors associated with HIV or syphilis infection, including non-commercial casual sex encounters in last month (AOR: 3.29, 95% CI: 2.42-4.46), >10 years of commercial sex history (AOR: 1.31, 95% CI: 1.12-1.53), >2 incidents of commercial sex in last month (AOR: 1.53, 95% CI: 1.19-1.96), and aphrodisiac use in last month (AOR: 1.40, 95% CI: 1.16-1.70). Clients with no steady partner had lower odds of having heterosexual intercourse (AOR: 0.66, 95% CI: 0.56-0.79), awareness and knowledge of HIV/AIDS (AOR: 0.75, 95% CI: 0.64-0.88), and having had HIV tests (AOR: 0.65, 95% CI: 0.44-0.98). CONCLUSION: Older male clients of low-cost commercial sex venues in rural southwestern China are at high risk for HIV and syphilis infection, especially those with no steady sex partner. Improved interventions are urgently needed for this neglected risk population.

High HIV Prevalence and Risk Among Male Clients of Female Sex Workers in Hanoi and Ho Chi Minh City, Vietnam.

In Vietnam's concentrated HIV epidemic, female sex workers (FSWs) are at increased risk for acquiring and transmitting HIV, largely through their male clients. A high proportion of males in Vietnam report being clients of FSWs. Studying HIV-related risk factors and prevalence among male clients is important, particularly given the potential for male clients to be a 'bridge' of HIV transmission to the more general population or to sex workers. Time-location sampling was used to identify FSW in Hanoi and Ho Chi Minh City, Vietnam's largest cities, in 2013-2014. Recruited FSWs were asked to refer one male client to the study. Demographic and risk behavior data were collected from FSWs and male clients by administered questionnaires. Biologic specimens collected from male clients were tested for HIV and opiates. Sampling weights, calculated based on the FSWs probability of being selected for enrolment, were applied to prevalence estimates for both FSWs and male clients. Logistic regression models were developed to obtain odds ratios for HIV infection among male clients. A total of 804 male clients were enrolled. Overall, HIV prevalence among male clients was 10.2%; HIV prevalence was 20.7% (95% confidence interval (CI) 15.0-27.9%) among those reporting a history of illegal drug use and 32.4% (95% CI 20.2-47.7%) among those with opioids detected in urine. HIV prevalence among male clients did not differ across 'bridging' categories defined by condom use with FSWs and regular partners over the previous 6 months. HIV among male clients was associated with a reported history of illegal drug use (OR 3.76; 95% CI 1.87-7.56), current opioid use (OR 2.55; 95% CI 1.02-6.36), and being referred by an FSW who self-reported as HIV-positive (OR 5.37; 95% CI 1.46-19.75). Self-reported HIV prevalence among enrolled FSWs was 2.8%. Based on HIV test results of male clients and self-reported status from FSWs, an estimated 12.1% of male client-FSW pairs were sero-discordant. These results indicate high HIV prevalence among male clients of FSWs, particularly among those with a history of drug use. Programs to expand HIV testing, drug-use harm reduction, and HIV treatment for HIV-infected male clients of FSWs should be considered as key interventions for controlling the HIV epidemic in Vietnam.

Older Male Clients of Female Sex Workers in the United States.

Recent research has provided increased information about the clients of sex workers; however, little is known about the population of older male customers who contract for heterosexual services online. Clients (N = 208) between 60 and 84 years of age were obtained through sex work review sites and online discussion forums. Participants completed a 129-item questionnaire focusing on physical health, sexual and non-sexual behaviors with sex providers, and the qualities sought in the same. More than half reported having visited sex providers between 13 and 24 times or more during the past 12 months. Participants' advancing age was positively associated with frequency of paid sex. Most frequent sexual activities with providers were fellatio without a condom, followed by penile-vaginal sex with a condom. Analyses also examine the relationship between aging and buying sex. Those with higher incomes and without spouses or partners were more likely to report non-sexual activities with providers, and many participants sought a "GFE" or girlfriend experience, in which paid sexual exchanges are part of a relationship that mirrors conventional non-remunerative relationships.

High prevalence of unhealthy alcohol use and comparison of self-reported alcohol consumption to phosphatidylethanol among women engaged in sex work and their male clients in Cambodia.

BACKGROUND: In Cambodia, most of the female sex workers (FSW) work in venues where unhealthy alcohol use is ubiquitous and potentially contributing to the HIV epidemic. However, no accurate data exists. We compare self-reported unhealthy alcohol consumption to a biomarker of alcohol intake in Cambodian FSW and male clients, and determine factors associated with unhealthy alcohol use. METHODS: A cross-sectional study was conducted among FSW (n=100) and male clients (n=100) in entertainment and sex work venues in Cambodia. Self-reported unhealthy alcohol use (AUDIT-C) was compared to phosphatidylethanol (PEth) positive (≥50ng/ml), a biomarker of alcohol intake. Sociodemographics data was collected. Correlates of self-reported unhealthy alcohol use and PEth positive were determined. RESULTS: The prevalence of PEth positive in FSW was 60.0%. Self-reported unhealthy alcohol consumption was reported by 85.0% of the women. Almost all women (95.0%) testing PEth positive also reported unhealthy alcohol use. Prevalence of unhealthy alcohol consumption (self-report and PEth positive) was higher in FSW working in entertainment establishments compared to other sex work venues (p<0.01). Among male clients, 47.0% reported unhealthy alcohol consumption and 42.0% had a PEth positive. However, only 57.1% of male clients with PEth positive reported unhealthy alcohol use. CONCLUSIONS: Unhealthy alcohol consumption is prevalent in Cambodian sex work settings. Self-reported unhealthy alcohol use is well reported by FSW, but less by male clients. These findings highlight the urgency of using accurate measures of unhealthy alcohol consumption and integrating this health issue into HIV prevention interventions.

Condom Use During Commercial Sex Among Male Clients of Female Sex Workers in Sichuan China: A Social Cognitive Theory Analysis.

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.

Condom Use, Sexual Risk, and Self-Reported STI in a Sample of Older Male Clients of Heterosexual Prostitution in the United States.

While there is evidence of increasing rates of sexually transmitted infections (STIs) among older men in the United States, there has been little research on older male clients of female sex providers. The purpose of the current study was to understand the sexual risk behaviors and psychosocial correlates among older men hiring sex providers through provider review websites and discussion boards. A convenience sample of 208 male clients ages 60 to 84 completed online surveys about their sexual behavior and psychosocial factors. Participants indicated the most common sexual activities with providers in the past 12 months were receiving condomless fellatio (33.7%) and having penile-vaginal intercourse with a condom (31.7%). Although condomless penile-vaginal sex with a provider in the past 12 months was only reported by 2.9%, about half (51%) of the respondents indicated that they had experienced this at least once during their lifetime. This was associated with a preference for providers who do not require condoms, having been previously diagnosed with an STI, and perceiving one's HIV risk to be higher, as well as advancing age and having more emotional relationships with providers. Findings demonstrate the need for general and sexual health care practitioners to openly discuss protective measures and strategies for avoiding STIs among their older-to-elderly male patients.

Romancing the boundary: client masculinities in the Chinese sex industry.

This paper draws on 24 in-depth interviews and 2 focus-group discussions conducted since 2012 with Hong Kong heterosexual men who buy sex in order to examine men's level of physical and emotional engagement with sex workers under two dominant sexual scripts in contemporary Hong Kong. Torn between companionate sexuality, with its companionate model of relationships, and recreational sexuality, with its promiscuous model of sexual pleasure, Hong Kong male clients seek to satisfy their sexual and affective needs through commercial sexual relationships. The term (meaning 'chicken worm', connoting a 'McSex' form of masculinity) refers to those men who seek impersonal sexual release with as many women as they wish, while the term (meaning 'sunken boat' and connoting a 'Titanic' form of masculinity) refers to those men who seek an intense level of emotional intimacy with sex workers. Between these two contrasting types, the majority of respondents fall into a form of 'bounded' masculinity characteristic of men who emphasise control and balance by seeking emotionally responsive women in a time-bound romance. By comparing clients' variations in the level of physical and emotional engagement with sex workers, this paper seeks to understand individual differences in client types and offers a new understanding of Chinese male sexuality and relationship formation, and the corresponding health risks (e.g., sexual, emotional) associated with each type.

Associations between drug use and sexual risks among heterosexual men in the Philippines.

The relationship between drug use and sexual risk behaviours among 2272 men in the southern Philippines was assessed. Over 20% of participants used drugs. Logistic regression analyses adjusted for age, marital status, income, occupation and geographic region revealed that compared to non-drug users, men who used drugs had earlier sexual debuts (adjusted odds ratio = 1.73; 95% confidence interval = 1.38-2.17), were more likely to report two or more recent sexual partners (adjusted odds ratio = 2.22; 95% confidence interval = 1.59-3.11), and were more likely to report ever having sex with a female sex worker (adjusted odds ratio = 2.99; 95% confidence interval = 2.25-4.00). Condom use was noted to be low overall among the men in this study; however, the odds of more frequent condom use with a regular partner were greater for men who used drugs compared to non-drug users (adjusted odds ratio = 1.60; 95% confidence interval = 1.26-2.02). There were no significant differences in condom use during last sex or frequency of condom use with a sex worker. While injection drug use was not common (1%), use of oral or inhaled substances was prevalent, and associated with increased sexual risk for acquisition and transmission of STI/HIV. Efforts to decrease STI/HIV transmission should specifically target non-injection drug use as a risk factor.

Investigation of AIDS related knowledge and behaviors among female sex workers and their male clients in entertainment venues in Shenzhen / 中国艾滋病性病

Objective To understand AIDS related knowledge and behaviors among female sex workers(FSWs) and their male clients from the same community.Methods One hundred and seventy seven FSWs and one hundred and fifty four male clients were recruited from entertainment venues in the same community by random sampling,and anonymous questionnaires were administered separately.Results(1)Over 80% of FSWs and their male clients understood the basic routes of HIV transmission,but many of them were unclear about non-HIV transmission routes.(2)97.7% of FSWs and 84.2% of the male clients used condoms during their commericial sexual intercourse.The frequency of using condoms during sex with casual or regular sex partners was lower than that during the commercial sexual intercourse(P