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Int. J. Environ. Res. Public Health 2015, 12(1), 855-870; doi:10.3390/ijerph120100855

Exploring HIV Prevention Strategies among Street-Based Female Sex Workers in Chongqing, China

School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
Department of Foreign Language, Chongqing Medical University, Chongqing 400016, China
Institute of Health Policy, College of Human medicine, Michigan State University, Lansing, MI 48910, USA
Research Center for Public Health, School of Medicine, Tsinghua University, Beijing 100084, China
The Kirby Institute, University of New South Wales, Sydney, New South Wales 2052, Australia
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria 3053, Australia
Authors to whom correspondence should be addressed.
Academic Editor: Janet Seeley
Received: 6 November 2014 / Accepted: 5 January 2015 / Published: 16 January 2015
(This article belongs to the Special Issue HIV/AIDS: Social Perspectives)
View Full-Text   |   Download PDF [299 KB, uploaded 16 January 2015]


Background: 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. Methods: 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. Results: 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. Conclusion: 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. View Full-Text
Keywords: street-based sex worker; Human Immunodeficiency Virus; condom use; commercial sex; peer-based intervention street-based sex worker; Human Immunodeficiency Virus; condom use; commercial sex; peer-based intervention
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Zeng, H.; Zhao, Y.; Meng, S.; Tang, X.; Guo, H.; Wang, Y.; Zhang, L. Exploring HIV Prevention Strategies among Street-Based Female Sex Workers in Chongqing, China. Int. J. Environ. Res. Public Health 2015, 12, 855-870.

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