Sample Characteristics Among the 633 sexually experienced female migrants, 40 (6.3%) reported that they had engaged in commercial sex. The participants’ sociodemographic characteristics are presented overall and by involvement in commercial sex in . The mean age of the entire sample was 25 years. Nearly half of them had never been married (46.2%) and 59.1% had completed no more than elementary school (9.8%) or junior high school (49.3%). Most of them worked in entertainment establishments (i.e., 46.5% nightclub/bar, barbershop/beauty salon, and bathhouse/massage parlor) or service sectors (i.e., 39.5% restaurant, hotel, retail shop, street stall, and domestic service). Approximately half (59%) worked 10 hours or longer per day. Likewise, about half (52.2%) earned less than 800 RMB (around U.S.$97) per month. Nearly all (91.3%) had been staying in the current city for more than one year, but almost half (48.2%) had changed their jobs at least once per year.
Sociodemographic characteristics of female migrants who were sexually experienced overall and by commercial sex experience
Compared with women who had not engaged in commercial sex, women who engaged in commercial sex were younger (23.9 vs. 25.3 years old, p<.05), less educated (71.8% vs. 58.3% had finished no more than 9 yeas of formal education, p = .10), and more likely to be unmarried (76.9% vs. 44.1% never married, p<.001). A higher proportion worked in entertainment establishments and had higher incomes (75% vs. 46% had monthly incomes of 800 RMB or more, p<.001). They also were more mobile and changed their jobs more frequently ().
Differences in HIV-related risk behaviors by involvement in commercial sex (yes/no) are presented in . Compared with women who had never engaged in commercial sex, women engaging in commercial sex were more likely to have engaged in other HIV-related risk behaviors, including both risky sexual behaviors and other risk behaviors. A larger proportion of them reported that their first sexual episode occurred before marriage (87% vs. 57%, p < .05) and when they were younger than 20 years old, the legal marriage age for women in China (74% vs. 36%, p < .001). More of the women (85% vs. 31%, p<.001) reported that either they knew or they were uncertain whether their sexual partners were having sex with others. Women engaging in commercial sex were more likely to report having multiple sexual partners in the last month (43%), compared with 1.7% for their counterparts (p<.001).
Relationship between HIV-related behaviors and involvement in commercial sex
Around 17% of sexually experienced female migrants had always used a condom during the previous three episodes of sexual intercourse and around 55% had discussed condom use with their sexual partners. No significant differences were found between the two groups regarding condom use or communication with their sexual partner regarding condom use.
A higher proportion of women engaging in commercial sex, compared with women who had not engaged in commercial sex, reported having been intoxicated with alcohol at least once during the previous month (65% vs. 22%, p<.001). They also were more likely to have a lifetime history of drug use (20% vs. 2%, p<.001), and were more likely to sell their blood or plasma for money (10.3% vs. 3.2%), potentially placing themselves at risk, although the difference was not statistically significant.
HIV/STD Awareness and Knowledge
Compared with women who had never engaged in commercial sex, a larger proportion of the women who had engaged in commercial sex perceived themselves to be knowledgeable (e.g., knowing a lot) about HIV (12.5% vs. 2.4%, p<.05) and a lower proportion perceived that they knew little/nothing about HIV (40% vs. 53.2%, p<.05). The same tendency was seen for awareness of STD symptoms (data not shown). The mean value of the HIV knowledge score, which ranged from 0 to 11, was significantly higher for women who had engaged in commercial sex (9.14 vs. 7.94, p<.01; see ).
Association of involvement in commercial sex with HIV-related knowledge, perceptions, and depression
More than half of the women in both groups knew ways to prevent HIV transmission through sex and blood. Significantly more women who had engaged in commercial sex believed that using condoms during sex could prevent HIV, but significantly more women who had not engaged in commercial sex believed that avoiding casual sex could help prevent HIV transmission. Misconceptions regarding HIV prevention were common in both groups. Many women perceived that keeping themselves clean (66%) and after-sex vaginal washing with (salt) water (34%) enabled them to prevent the transmission of HIV/STD (data not shown).
Vulnerability to HIV/STD Infection
A large proportion of women engaging in commercial sex perceived themselves to be susceptible to HIV or other STDs (70% and 82.5%, respectively), which is twice as likely as the perception among women who had not engaged in commercial sex (25.9% and 30.8%, respectively; see ).
Attitudes Toward Condom Use
Perceptions of barriers to condom use were more common among women engaging in commercial sex. Most women perceived that men did not like to use condoms (80%) and that using condoms would reduce the sense of pleasure (87.2%). These rates were 66.8% and 60.2%, respectively, among women who had not been involved in commercial sex (p = .11 and p<.01, respectively). Women engaging in commercial sex were more likely than those who were not to perceive that condoms always break (57.5% vs. 40.3%, p<.05; see ).
Most women (71.5%) believed condom use was effective for HIV/STD prevention, although women engaging in commercial sex were more likely than those who were not to subscribe to this perspective (87.5% vs. 70.4%, p<.05; see ).
About 70% of women believed that they could persuade a sexual partner to use a condom when he was reluctant to use it, and around half of them thought they could refuse sex if their sexual partner refused to use a condom. There was no significant difference in these two items between the two groups.
The majority of women engaging in commercial sex believed that they and their clients knew where to obtain condoms (90%), and that they knew how to correctly use condoms (84.6%). These percentages were marginally higher than those who had not engaged in commercial sex (75.6% and 69.4%, respectively; see ).
Perception of Peer Risk Involvement
As shown in , the mean of the peer risk involvement score was significantly higher for women ever engaging in commercial sex (2.51 vs. 1.35, p<.001). Compared with women who had not engaged in commercial sex, a significantly higher percentage of women engaging in commercial sex believed that some/most of their peers had engaged in a number of HIV/STD risk behaviors, such as having multiple sexual partners (71.8% vs. 13.5%, p<.001), purchasing commercial sex (52.8% vs. 5.5%, p<.001), having paid sex (45.9% vs. 5.7%, p<.001), and having a history of STD infection (48.7% vs. 3.3%, p<.001; data not shown).
Among women ever engaging in commercial sex, the CES-D scores ranged from 0 to 49, with a mean score of 16.80. Among women who had never engaged in commercial sex, CES-D scores ranged from 0 to 51, with a mean score of 11.18. One-half (50%) of women engaging in commercial sex scored 16 or higher on the CES-D, a cut-point for high depressive symptoms in the United States (Radloff, 1977
), while the corresponding percentage was 23.4% among women who had never engaged in commercial sex (p
<.01). After adjusting for age, educational level, and marital status, we found that the odds of involvement in commercial sex among depressed individuals was 2.68 times (95% CI: 1.35-5.31) that of among the nondepressed individuals ().