Methods used to find clients and risky sexual behavior among female sex workers in China: a cross-sectional study

Abstract

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.