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HIV Prevalence and Risk Behaviors Among Male Clients of Female Sex Workers in Yunnan, China

Jin, Xia MD, MSc*; Smith, Kumi MPIA*; Chen, Ray Y MD, MSPH; Ding, Guowei MD*; Yao, Yan PhD; Wang, Haibo MPH*; Qian, Han-Zhu MD, PhD§; Chang, Dongfang MD; Wang, Guixiang MD; Wang, Ning MD, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 2010 - Volume 53 - Issue 1 - p 131-135
doi: 10.1097/QAI.0b013e3181b3552a
Epidemiology and Social Science

Objectives: To assess the prevalence and risk factors of HIV among male clients of female sex workers (FSWs) in China.

Methods: Convenience sampling methods were used to recruit 315 clients using FSW-client and client-client networks. Subjects provided information on sociodemographic characteristics and sexual and drug behavior patterns. Blood samples were collected for HIV testing and urine samples for opiate testing.

Results: Overall HIV prevalence was 6.0%; among drug users, it was 30.8%. 33.7% of respondents reported that they always use condoms in commercial sex and 63.5% that they used a condom in the last commercial sex episode. Drug use (OR: 6.1; 95% CI: 1.7 to 21.4) and lack of a regular sexual partner (OR: 6.3; 95% CI: 1.8 to 21.9) were significantly associated with HIV infection.

Conclusions: Clients of FSWs serve as potential bridges for HIV transmission from the high-risk FSWs to the low-risk general population, making them a key target for intervention. High HIV prevalence rates among clients in Kaiyuan is particularly alarming given their risk behavior patterns including high rates of partner exchange, low condom use rates, and drug-using behaviors. Innovative interventions are needed to reduce the risk of HIV among clients and reduce the bridge of transmission to the general population.

From the *Department of Epidemiology, National Center for AIDS/sexually transmitted diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; †Office of Global Research, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Based at the US Embassy, Beijing, China; ‡Department of Epidemiology and Medical Statistics, Jilin University School of Public Health, Changchun City, Jilin Province, China; §Department of Medicine, Vanderbilt University, Institute for Global Health, Nashville, TN; and ‖Kaiyuan City Center for Disease Control and Prevention, Kaiyuan, Yunnan Province, China.

Received for publication December 22, 2008; accepted June 8, 2009.

The China Integrated Program for Research on AIDS was funded by US National Institutes of Health/National Institute of Allergy and Infectious Diseases (U19 AI51915).

Correspondence to: Ning Wang, MD, PhD, Deputy Director, National Center for AIDS/sexually transmitted diseases Control and Prevention, Chinese Center for Disease Control and Prevention, No 27 Nanwei Road, Xuanwu District, Beijing 100050, China (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.