To examine the HIV/sexually transmitted infection (STI)-related risk behaviours among community-based female sex workers (FSWs) and their clients in Yunnan Province, China, we performed a cross-sectional study of 705 FSWs and 100 male clients. We found that HIV seroprevalence among FSWs was 13.0% and the most prevalent STI was herpes simplex virus type 2 (HSV-2) (71.1%), followed by Chlamydia trachomatis (18.1%) and syphilis (8.8%). The 20% of FSWs who reported injection drug use also reported needle-sharing behaviours in the last three months. Drug-using FSWs had substantially higher HIV and HSV-2 prevalence, serviced more clients and had a longer history of sex work than non-using FSWs. In total, 57.0% of male clients did not consistently use condoms with FSWs, 2.0% reported illicit drug use and 17.0% had STI symptoms in the last year. The dual risk behaviours of drug-using FSWs and clients place them at greater risk of HIV infection. Intervention programmes must adopt comprehensive methods.
LuF, WangN, WuZY, Estimating the number of people at risk for and living with HIV in China in 2005: methods and results. Sex Transm Infect2006;82:iii87–91
2.
State Council AIDS Working Committee Office, China Ministry of Health, UN Theme Group on HIV/AIDS in China. A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007). Beijing: State Council AIDS Working Committee Office, 2007. See. http://www.chinaids.org (last checked 1 March 2009)
3.
China Ministry of Health, UNAIDS, WHO. 2005 Update on The HIV/AIDS Epidemic and Response in China. Beijing: China Ministry of Health, UNAIDS, WHO, 2006 See http://www.chinaids.org (last checked 1 March 2009)
4.
LuL, JiaMH, MaYL, An analysis of epidemic of HIV/AIDS in Yunnan Province in 1989–2005. Chin J AIDS STD2006;12:517–9
5.
WangQ, LinG. Sex exchange and HIV-related risk behaviors among female heroin users in China. J Drug Iss2003;1:119–32
6.
RoyceRA, SenyA, CatesW, Sexual transmission of HIV. N Engl J Med1997;336:1072–8
7.
VoetenHA, EgesahOB, OndiegeMY, Clients of female sex workers in Nyanza province, Kenya: a core group in STD/HIV transmission. Sex Transm Dis2002;29:444–52
8.
Gomes do Espirito SantoME, EtheredgeGD. Male clients of brothel prostitutes as a bridge for HIV infection between high risk and low risk groups of women in Senegal. Sex Transm Infect2005;81:342–4
9.
HanenbergR, RojanapithayakornW. Changes in prostitution and the AIDS epidemic in Thailand. AIDS Care1998;10:69–79
10.
WenigerBG, LimpakarnjanaratK, UngchusakK, The epidemiology of HIV infection and AIDS in Thailand. AIDS1991;5(Suppl. 2):S71–85
11.
MorrisM, PodhisitaC, WawerMJ, Bridge populations in the spread of HIV/AIDS in Thailand. AIDS1996;10:1265–71
12.
SaidelTJ, JarlaisDD, PeerapatanapokinW, Potential impact of HIV among IDUs on heterosexual transmission in Asian settings: scenarios from the Asian Epidemic Model. Int J Drug Policy2003;14:63–74
13.
RazakMH, JittiwutikarnJ, SuriyanonV, HIV prevalence and risks among injection and noninjection drug users in northern Thailand: need for comprehensive HIV prevention programs. J Acquir Immune Defic Syndr2003;33:259–66
14.
WangHB, WangN, MaJG, Study on the association between vaginal douching and sexually transmitted disease among female sex workers in a county of Yunnan province. Chin J Epidemiol2007;28:558–61
15.
ChenXS, YinYP, LiangGJ, Sexually transmitted infections among female sex workers in Yunnan, China. AIDS Patient Care STDs2005;19:853–60
16.
WangHB, ChenR, DingGW, Prevalence and predictors of HIV infection among female sex workers in Kaiyuan City, Yunnan Province, China. Int J Infect Dis2008;13:162–9
17.
ParishWL, LaumannEO, CohenMS, Population-based study of chlamydial infection in China: a hidden epidemic. JAMA2003;289:1265–73
18.
DuanQY, WangN, MinXD, Study of STD/HIV risk factors among miners in a city of Yunnan province. Chin J AIDS STD2006;12:327–9
19.
LiX, FangX, LinD, HIV/STD risk behaviors and perceptions among rural-to-urban migrants in China. AIDS Educ Prev2004;16:538–56
20.
LuL, JiaMH, ZhangXB, Analysis for epidemic trend of acquired immunodeficiency syndrome in Yunnan Province of China. Zhonghua yu Fang yi xue za zhi2004;38:309–12
21.
XuJJ, WangN, LuL, HIV and STIs in clients and female sex workers in mining regions of Gejiu city, China. Sex Transm Dis2008;35:558–65
22.
LuL, JiaMH, LuJY, Analysis of HIV/AIDS prevalence in Yunnan province. China J AIDS/STD2005;11:172–4
23.
XuSM, KuangFG, YangMF. HIV infection rate and behavior factors of the drug abusers in Chongqing. Chin J Health Educ2004;20:699–700
24.
State Council AIDS Working Committee Office and UN Theme Group on HIV/AIDS in China. A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2004). Beijing: State Council AIDS Working Committee Office and UN Theme Group on HIV/AIDS in China, 2004. See http://www.chinaids.org (last checked 1 March 2009)
25.
RottingenJA, CameronDW, GarnettGP. A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known?Sex Transm Dis2001;88:579–97
26.
SchillingerJA, XuF, SternbergMR, National seroprevalence and trends in herpes simplex virus type 1 in the United States, 1976–1994. Sex Transm Dis2004;31:753–60
27.
del Mar Pujades RodriguezM, ObasiA, MoshaF, Herpes simplex virus type 2 infection increases HIV incidence: a prospective study in rural Tanzania. AIDS2002;16:451–62
28.
CoreyL, WaldA, CelumCL, The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics. J Acquir Immune Defic Syndr2004;35:435–45
29.
MillerGA, MendozaW, KroneMR, Clients of female sex workers in Lima, Peru: a bridge population for sexually transmitted disease/HIV transmission?Sex Transm Dis2004;31:337–42
30.
VuylstekeBL, GhysPD, TraoreM, HIV prevalence and risk behavior among clients of female sex workers in Abidjan, Côte d'Ivoire. AIDS2003;17:1691–4
31.
State Council of the People's Republic of China. China HIV/AIDS Prevention & Control Action Plan (2006–2011). State Council of the People's Republic of China: PRC, 2006
32.
FlemingDT, WasserheitJN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect1999;75:3–17
33.
GibsonDR, FlynnNM, PeralesD. Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS2001;15:1329–41
34.
MaS, DukersHN, van den HoekA, Decreasing STD incidence and increasing condom use among Chinese sex workers following a short term intervention: a prospective cohort study. Sex Transm Infect2002;78:110–4
35.
GhysPD, DialloMO, Ettiegne-TraoreV, Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, Cote d'lvoire, 1991–1998. AIDS2002;16:251–8
36.
CelentanoDD, NelsonKE, LylesCM, Decreasing incidence of HIV and sexually transmitted diseases in young Thai men: evidence for success of the HIV/AIDS control and prevention program. AIDS1998;12:29–36
