Zeng Huan, Zhao Yong, Meng Siying, Tang Xiaojun, Guo Hang, Wang Yang, Zhang Lei
School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
Department of Foreign Language, Chongqing Medical University, Chongqing 400016, China.
Int J Environ Res Public Health. 2015 Jan 16;12(1):855-70. doi: 10.3390/ijerph120100855.
Commercial sex plays an increasingly important role in China's growing HIV and sexually transmitted infection (STI) epidemics. In China, street-based sex workers (SSWs) are a subgroup of female sex workers with a particularly high risk of HIV/STI infections but are neglected in responses to HIV. This study assesses changes in HIV voluntary counseling and testing (VCT) utilization and high-risk sexual behaviors following a three-month HIV preventive intervention among SSWs in Chongqing, China.
A three-month intervention was conducted by a team of peer educators, outreach workers from community-based organizations and health professionals. It mainly included distribution of free pamphlets and condoms and delivery of onsite and clinic-based VCT. Cross-sectional surveys were conducted prior to (n = 100) and immediately following (n = 112) the intervention to assess its impact. In-depth interviews were conducted among 12 SSWs after the intervention to further explore potential barriers to HIV prevention.
The intervention significantly increased SSWs' participation in VCT (from 2.0%-15.2%, P < 0.001). Despite participants' improved HIV-related knowledge level (from 24.0%-73.2%, P < 0.001), there were minimal changes in the levels of condom use with clients. Qualitative research revealed that fear of police arrest and stigma were the main barriers to VCT utilization. Low condom use was associated with family financial constraints, inadequate power in condom negotiation, low awareness and misconceptions of HIV infection risks.
HIV intervention improved VCT utilization and knowledge but we did not observe an increase in condom use after this short intervention. SSWs faced substantial economic, social and environmental barriers to VCT utilization and condom use.
商业性行为在中国日益严重的艾滋病病毒（HIV）和性传播感染（STI）疫情中发挥着越来越重要的作用。在中国，街头性工作者是女性性工作者中的一个亚群体，感染HIV/STI的风险特别高，但在应对HIV的工作中却被忽视。本研究评估了在中国重庆对街头性工作者进行为期三个月的HIV预防干预后，HIV自愿咨询检测（VCT）利用率和高危性行为的变化。
由一组同伴教育者、社区组织的外展工作者和卫生专业人员进行为期三个月的干预。主要包括免费发放宣传册和避孕套以及提供现场和基于诊所的VCT。在干预前（n = 100）和干预后立即（n = 112）进行横断面调查，以评估其影响。干预后对12名街头性工作者进行了深入访谈，以进一步探讨HIV预防的潜在障碍。
干预显著提高了街头性工作者对VCT的参与度（从2.0%提高到15.2%，P < 0.001）。尽管参与者与HIV相关的知识水平有所提高（从24.0%提高到73.2%，P < 0.001），但与嫖客使用避孕套的水平变化极小。定性研究表明，害怕被警察逮捕和污名化是VCT利用的主要障碍。避孕套使用率低与家庭经济限制、在避孕套谈判中缺乏影响力、对HIV感染风险的认识不足和误解有关。
HIV干预提高了VCT利用率和知识水平，但在这一短期干预后，我们并未观察到避孕套使用的增加。街头性工作者在VCT利用和避孕套使用方面面临重大的经济、社会和环境障碍。
