Lian Zhujun, Xu Ke, Jin Jie, Zhang Xingliang, Xu Junfang
the Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
Medical office, Lishui People's Hospital, Lishui, China.
BMC Public Health. 2025 Apr 1;25(1):1232. doi: 10.1186/s12889-025-22395-y.
BACKGROUND: Female sex workers (FSWs) are high-incidence population of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). The methods used to find clients for commercial sex have diversified in recent years. As a result, it is crucial to analyze the correlation between methods used to find clients and risky sexual behavior and explore changes in risky sexual behavior among FSWs over time. METHODS: HIV sentinel surveillance data were collected from Zhejiang Province, China, between 2016 and 2021. In total, 4,798 FSWs were included in our analysis. We collected information related to socio-demographic variables, HIV knowledge, methods used to find clients, and condom use. Descriptive statistics were used to analyze the socio-demographic characteristics of FSWs. Univariate and sequential logistic regression models were employed to determine the influence of methods used to find clients on risky sexual behavior after controlling for other factors. RESULTS: The average age of the 4,798 FSWs was 33.0 ± 7.4 years. The majority (70.6%) who find clients online reported always using condoms over the past month. The proportion of FSWs engaging in risky sexual behavior, defined as not using condoms at the last sexual encounter or not using them consistently over the past month, was lowest among those who find clients online, whereas the risk was highest among those who worked at a fixed site (p < 0.001). Sequential logistic regression demonstrated that compared to FSWs who find clients at a fixed site, those finding clients online (OR = 0.6, p < 0.001) were significantly associated with risky sexual behavior. CONCLUSION: FSWs had a high knowledge regarding acquired immunodeficiency syndrome (AIDS), but with greater likelihood of risky sexual behavior, particularly among FSWs who find customers at a fixed site. The risk of engaging in condomless sex among FSWs who find client at fixed sites was higher than those online. Therefore, it is essential to explore health interventions that improve condom use among FSWs.
背景：女性性工作者（FSW）是包括人类免疫缺陷病毒（HIV）在内的性传播感染（STI）的高发人群。近年来，用于寻找商业性交易客户的方式日益多样化。因此，分析寻找客户的方式与危险性行为之间的相关性，并探讨女性性工作者危险性行为随时间的变化至关重要。 方法：收集了2016年至2021年期间中国浙江省的HIV哨点监测数据。我们的分析共纳入了4798名女性性工作者。我们收集了与社会人口统计学变量、HIV知识、寻找客户的方式以及避孕套使用情况相关的信息。描述性统计用于分析女性性工作者的社会人口学特征。在控制其他因素后，采用单因素和序贯逻辑回归模型来确定寻找客户的方式对危险性行为的影响。 结果：4798名女性性工作者的平均年龄为33.0±7.4岁。在过去一个月中，大多数（70.6%）通过网络寻找客户的女性性工作者报告称总是使用避孕套。从事危险性行为（定义为在上一次性交时未使用避孕套或在过去一个月中未持续使用避孕套）的女性性工作者比例在通过网络寻找客户的人群中最低，而在固定场所工作的人群中风险最高（p<0.001）。序贯逻辑回归表明，与在固定场所寻找客户的女性性工作者相比，通过网络寻找客户的女性性工作者（OR=0.6，p<0.001）与危险性行为显著相关。 结论：女性性工作者对获得性免疫缺陷综合征（AIDS）有较高的认识，但危险性行为的可能性更大，尤其是在在固定场所寻找客户的女性性工作者中。在固定场所寻找客户的女性性工作者中进行无保护性行为的风险高于通过网络寻找客户的女性性工作者。因此，探索改善女性性工作者避孕套使用情况的健康干预措施至关重要。
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