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HIV Incidence and Associated Risk Factors Among Female Sex Workers in a High HIV-Prevalence Area of China

Wang, Haibo PhD*†; Reilly, Kathleen H. PhD, MPH†‡; Brown, Katherine BS; Jin, Xia MS; Xu, Junjie PhD, MS§; Ding, Guowei MS; Zang, Chunpeng PhD; Wang, Junjie PhD, MS; Wang, Ning MD, PhD

doi: 10.1097/OLQ.0b013e318266b241
Original Study

Background Heterosexual sex is replacing injection drug use as the main mode of HIV transmission in China. The objective of this study is to determine HIV incidence and associated risk factors among female sex workers (FSWs) in China.

Methods From March 2006 to November 2009, FSWs in Kaiyuan City, Yunnan were recruited into an open cohort study. Participants were interviewed and tested for HIV and sexually transmitted infections every 6 months. A multivariate Cox proportional hazards regression model with time-dependent variables was used to measure associations between independent variables and HIV seroconversion.

Results During 3.5 years of follow-up, 19 incident cases of HIV infection were diagnosed, yielding an overall incidence of 1.44 per 100 person-years (95% confidence interval [CI]: 0.87–2.24). In the multivariate Cox proportional hazards regression model, noninjection drug use (adjusted hazard ratio [AHR]: 6.7, 95% CI: 2.25–19.93), inconsistent condom use with clients in the previous week (AHR: 2.9, 95% CI: 1.03–8.34), and number of clients in the previous week ≥7 (AHR: 4.9, 95% CI: 1.81–13.13) were all independent risk factors for HIV seroconversion.

Conclusion These results underscore the urgency for preventive interventions on sexual and drug use behaviors among FSWs, including condom promotion as well as sexually transmitted infection screening and treatment.

HIV incidence was 1.44 per 100 person-years among female sex workers in Yunnan, China; non-injection drug use, high number of clients and inconsistent condom use were independently associated with seroconversion.

From the *Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China; †National Center for AIDS/STD Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China; ‡Tulane University Health Sciences Center, School of Public Health and Tropical Medicine, New Orleans, LA; and §Key Laboratory of Immunology of AIDS, Ministry of Health, First Affiliated Hospital, China Medical University, Shenyang, People’s Republic of China

The authors thank the staff members at the National Center for AIDS/STD Control and Prevention (NCAIDS), Westat, Inc. (Rockville, MD) and the staffs of the Kaiyuan and Yunnan CDCs for all of their time and effort spent in helping conduct this study.

Conflict of Interest and Source of Funding: This study received funding from Comprehensive International Program of Research on AIDS (CIPRA), the National Institute of Allergy and Infectious Diseases, US National Institutes of Health (U19 AI51915–05), Science and Technology major projects in China (2008ZX10001–003), the National Institute of Allergy and Infectious Diseases, US National Institutes of Health (R01 DA024864). The authors declare no conflict of interest.

Correspondence: Ning Wang, MD, PhD, National Center for AIDS/STD Prevention and Control, Chinese Center for Disease Control and Prevention, 155 Changbai Rd Room 206, Changping District, Beijing 102206, People’s Republic of China. E-mail: wangnbj@163.com.

Received for publication March 12, 2012, and accepted June 26, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association