BASELINE CHARACTERISTICS OF THE SAMPLE
The mean ages of women in the intervention and control groups were 23.7 and 23.9 years, respectively (). The two groups did not differ with respect to ethnicity, marital status, stable sexual partnership, and living arrangements. However, a larger proportion of women in the intervention group were raised in urban areas, as compared with women in the control group (30.7% vs. 15.5%, p < .01). Women in the intervention group had more years of formal schooling, as compared with women in the control group (6.3 vs. 5.4, p < .05). Preliminary data analysis revealed no differences in outcome measures between those intervention women (about 50%) who received periodic visits from local health care workers and the remainder of the women in the intervention group who did not receive such visits.
Individual Characteristics of Female Sex Workers (FSWs), by Intervention Group Assignment (%)
Individual demographic characteristics and baseline behavioral outcome measures (e.g., condom use) were also compared between the 400 women who were enrolled in the intervention trial and the 54 women who were not enrolled in the trial. They differed only in ethnicity, with a greater proportion of women who were in the intervention trial being Han ethnicity (57.1% vs. 35.2%, p < .01). In addition, baseline demographic characteristics and key outcome measures (rates of condom use and STD infection) were compared between the 278 women who completed the postintervention assessment and the 122 women who were lost to follow–up. None of the demographics characteristics (e.g., ethnicity, schooling, living arrangement, hometown type, and marital status) and baseline outcome measures was significantly different between the follow–up sample and those who were lost to follow–up.
EFFECTS OF THE INTERVENTION ON HIV/STD KNOWLEDGE AND PERCEPTIONS
The total knowledge score increased from baseline to postintervention for women in both the intervention group and the control group. The increase among women in the intervention group was significantly larger than among women in the control group (6.5 vs. 1.3, p < .001). The HIV misconception scale significantly decreased for women in the intervention group, while the scores remained similar over time among women in the control group (change scores: 1.5 vs. 0.0, p < .001). Compared with women in the control group, women in the intervention group demonstrated significant increases over time on scores of STD symptoms, (2.6 vs. 1.0, p < .001), HIV transmission modes (1.3 vs. 0.6, p < .05), and condom use (1.0 vs. 0.2, p < .01) (). There was no significant intervention effect on measures of self–efficacy and response efficacy. Women in both the intervention group and the control group reported similar increases on both measures over the 6 months period (see ).
HIV/STD–Related Knowledge and Efficacy Among Female Sex Workers, by Group Assignment and Timing of Survey
As shown in , GLM analysis of HIV/STD related knowledge yielded a significant main effect of intervention (p < .0001) while controlling for age, ethnicity, hometown type, marital status, schooling, and baseline HIV/STD knowledge. In addition to intervention status, years of formal schooling and the baseline knowledge were significantly predictive of HIV/STD knowledge at 6 months postintervention (p < .05 for schooling and p < .01 for baseline knowledge).
General Linear Model Analysis on the Effects of Intervention on HIV/STD–Related Knowledge Among Chinese Female Sex Workers
EFFECTS OF THE INTERVENTION ON CONDOM USE
Among women in the intervention group, one third at baseline and more than half at postintervention, reported consistent condom use during the previous three sexual episodes with clients (p < .0001). By contrast, one sixth of the women in the control group at baseline and one quarter at postintervention, consistently used condoms. As shown in , women in the intervention group demonstrated a greater increase in consistent condom use than women in the control group (18.6% vs. 9.6%, p < .05).
Condom use with Clients and Sexually Transmitted Diseases (%) Among Female Sex Workers, by Group Assignment and Timing of Survey
In multivariate logistic regression controlling for potential confounders and baseline condom use and STD infection rates, intervention was significantly associated with increased rates of consistent condom use at 6 months postintervention. Women in the intervention group were more likely than women in the control group to use condoms consistently during the last three sexual encounters with clients (OR = 2.23, 95% CI = 1.26–3.96). In addition, condom use at baseline was significantly predictive of consistent condom use at postintervention (OR = 1.72, 95% CI = 1.33–2.22), with women who had used condoms at baseline being more likely to use condoms consistently postintervention (, Model 1).
Logistic Regression Analysis Assessing Impact of Intervention on Consistent Condom use With Clients and 6–month STD Infection Rates at Postintervention
EFFECTS OF THE INTERVENTION ON STD INFECTION RATES AT 6–MONTH FOLLOWUP
As shown in , about 41% of the women in both groups had tested positive for at least one of the five STDs at baseline. All women who tested positive for any of theses STDs received free treatment shortly after testing. At 6–month postintervention, 29.1% of the intervention group and 41% of the control group tested positive for at least one STD (p < .05).
About 6% of the intervention group tested positive for syphilis at baseline and the number of syphilis cases remained the same at 6 months postintervention. However, the number of syphilis infections in the control group increased from 8.8% at baseline to 11.1% at follow–up. Gonorrhea infection was higher among women in the control group as compared with women in the intervention group, both at baseline (17.5% vs. 13.7%) and at follow–up (10.4% vs. 8.5%); however, none of these differences reached statistical significance.
Although chlamydia infection was higher among women in the intervention group compared to women in the control group at baseline (21.6% vs. 13.1%), the 6–month infection rate was lower among women in the intervention group (14.2%) as compared with women in the control group (21.5%). A similar trend was observed with trichomonas infection, with women in the the intervention group reporting a higher infection rate than the control group at baseline (7.9% vs. 7.3%). However, the 6–month infection rate was lower among women in the intervention group (5.7%) as compared with women in the control group (10.5%).
Multivariate logistic regression analysis suggest a significant reduction among the women in the intervention group on the 6–month STD infection rate (OR = 0.44, 95% CI = 0.24–0.80). Ethnicity, stable partnership and baseline STD infection rate were also significantly predictive of the 6–month STD infection rate: women who belonged to ethnic minority groups (OR = 2.12, 95% CI = 1.09–4.12), had stable sexual partners (OR = 2.12, 95% CI = 1.09–4.12), and were infected with at least one STD at baseline (OR = 2.37, 95% CI = 1.37~4.09) were more likely to test positive for an STD at the 6–month follow–up (, Model 2).