Liao Susu, Weeks Margaret R, Wang Yanhong, Li Fei, Jiang Jingmei, Li Jianghong, Zeng Xiaomei, He Bin, Dunn Jennifer
Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Peking Union Medical College/China Academy of Medical Sciences, Beijing, China.
AIDS Care. 2011 Jun;23 Suppl 1(Suppl 1):66-74. doi: 10.1080/09540121.2011.555742.
Changes in sexual attitudes and behaviors and resurgence of the sex industry in China have increased concerns about HIV/AIDS and sexually transmitted infections (STI) epidemics. Little attention has been paid to the significant and growing sex industry in rural China. Promotion of barrier protection in this context is most effective to prevent STIs and pregnancy. The female condom (FC) is a barrier method that gives women more autonomy in its application, and has other advantages, but has been little promoted and tested in high risk contexts in China. The China/US Women's Health Project was designed to promote FC use in addition to male condoms (MC) through outreach intervention conducted in sex work establishments in rural and small urban towns in southern China, using the original prototype FC1. The study used quantitative and qualitative methods to document the pre-intervention context, intervention delivery process, and post-intervention outcomes of FC use. In this paper we compare post-intervention FC users and non-users in the first study sites, two rural towns in a single county in Hainan Province. Examination of cross-sectional six-month and 12-month surveys indicated that, despite relatively high MC use, about one-third of the women in sex work establishments in these rural towns had adopted FC at each post-intervention survey. Compared with non-users, FC users were more likely to be freelance women in boarding houses, more sexually experienced, married with children, more sexually active in the prior month, and more exposed to the intervention. The rural context hampered intervention implementation, particularly the significant limits in health and human resources available to manage prevention of HIV/STIs among women in the sex industry. These challenges highlight the need to better understand the context of the rural sex industry and capacity of local resources for better prevention efforts and the benefits that new prevention technologies like FC can offer.
中国性观念和性行为的变化以及性产业的再度兴起，增加了人们对艾滋病毒/艾滋病和性传播感染（STI）流行的担忧。中国农村地区规模可观且不断发展的性产业却很少受到关注。在这种背景下推广屏障保护措施对于预防性传播感染和怀孕最为有效。女用避孕套是一种能让女性在使用时有更多自主权的屏障避孕方法，还有其他优点，但在中国的高风险环境中很少得到推广和测试。中美妇女健康项目旨在通过在中国南方农村和小城镇居民妓院开展外展干预，除推广男用避孕套（MC）外，还推广女用避孕套的使用，使用的是最初的FC1原型。该研究采用定量和定性方法记录女用避孕套使用的干预前情况、干预实施过程以及干预后结果。在本文中，我们比较了首个研究地点（海南省一个县的两个农村城镇）干预后的女用避孕套使用者和非使用者。对为期六个月和十二个月的横断面调查进行分析表明，尽管男用避孕套的使用率相对较高，但在每次干预后的调查中，这些农村城镇妓院中的约三分之一女性都采用了女用避孕套。与非使用者相比，女用避孕套使用者更可能是寄宿妓院的自由职业女性，性经验更丰富，已婚并有子女，前一个月的性活动更频繁，且更多地接触到干预措施。农村环境阻碍了干预措施的实施，特别是在管理性产业中女性艾滋病毒/性传播感染预防方面，可用的卫生和人力资源存在严重限制。这些挑战凸显了有必要更好地了解农村性产业的情况以及当地资源的能力，以便做出更好的预防努力，以及新型预防技术如女用避孕套所能带来的益处。
