Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Sichuan University West China School of Public Health, Chengdu, Sichuan Province, China.
J Urban Health. 2010 Mar;87(2):292-303. doi: 10.1007/s11524-009-9431-y.
Commercial sex work has re-emerged as a widespread industry since China started economic reforms in the 1980s. This study examined the role of interpersonal and venue-level factors in commercial sex male clients' (CSMCs) condom use with female sex workers (FSWs) in China. Given the heterogeneity of commercial sex industry in China, this study also aimed to explore how these factors function differently by social ranks of commercial sex work frequented by CSMCs. A cross-sectional survey was conducted with 601 CSMCs in Sichuan province, China. Human immunodeficiency virus (HIV) prevalence in this sample was 1.7%. In addition to the individual characteristics, interpersonal factor was measured by the frequency of FSWs taking the initiative in condom use and providing condoms. Venue-level factor was assessed by the frequency of the managers of commercial sex venues communicating condom use policies and the frequency of condom availability in commercial sex venues. The primary behavioral outcome was consistent condom use with FSWs. Multivariate logistic regression models revealed that consistent condom use with FSWs was significantly associated with interpersonal (adjusted odds ratio (AOR), 1.62; 95% confidence interval (CI), 1.38, 1.90) and venue-level factors (AOR, 1.98; 95% CI, 1.40, 2.80). Moreover, the associations between interpersonal and venue-level factors and consistent condom use were moderated by social ranks of commercial sex work frequented by the male clients. The present study findings underscore the need for comprehensive HIV prevention approaches that integrate individual, interpersonal, and venue-level factors to reduce HIV risk behaviors among CSMCs in China.
自 20 世纪 80 年代中国开始经济改革以来，商业性性工作已经重新成为一个广泛存在的行业。本研究考察了人际和场所因素在中国商业性男性性客户（CSMCs）与性工作者（FSWs）之间使用安全套的作用。鉴于中国商业性性行业的异质性，本研究还旨在探讨这些因素如何通过 CSMCs 光顾的商业性性工作社会阶层的不同而发挥不同的作用。本研究采用横断面调查方法，在中国四川省对 601 名 CSMCs 进行了调查。该样本中人类免疫缺陷病毒（HIV）的流行率为 1.7%。除了个体特征外，人际因素还通过 FSWs 主动使用安全套和提供安全套的频率来衡量。场所因素通过商业性性场所经理沟通安全套使用政策的频率和商业性性场所提供安全套的频率来评估。主要行为结果是与 FSWs 持续使用安全套。多变量逻辑回归模型显示，与 FSWs 持续使用安全套显著相关的因素包括人际因素（调整后的优势比（AOR），1.62；95%置信区间（CI），1.38，1.90）和场所因素（AOR，1.98；95% CI，1.40，2.80）。此外，男性客户光顾的商业性性工作社会阶层也调节了人际和场所因素与持续使用安全套之间的关系。本研究结果强调需要采取综合的艾滋病毒预防措施，将个人、人际和场所因素结合起来，以降低中国 CSMCs 的艾滋病毒风险行为。
