Socio-demographic and economic characteristics
Between July 2010 and February 2011, a total of 231 eligible and consenting women were recruited, with 201 (87%) completing their interview and accepting STI and HIV testing. Women had a mean age of 18.2 years (SD=1.0) and were predominantly of Han ethnicity (75.1%; ). Approximately one-third of women were illiterate or only completed primary level schooling. The majority of respondents were single or never married (71.6%) and 10% reported currently living with their parents. Sex work was the main source of income for most women (91%). More than half of women (57%) reported their recent monthly income to be between US$150 and 500. No significant differences in age, education level, marital status, residential status, ethnicity and living arrangements were identified between women who worked in higher-risk or lower-risk workplaces (). Respondents working at higher-risk venues were less likely to be full-time sex workers (83.3% vs 98.1%, p<0.001); they were more likely to have lower monthly income (<US$150; 14.6% vs 3.8%, p=0.018); and earned less from their last clients (median US$48 vs US$128, p<0.001).
Socio-demographic characteristics of adolescent female sex workers aged 15–19 years enrolled in a cross-sectional survey in Yunnan, China (n=201)
In the past 6 months, most women reported using tobacco (67.7%) and/or alcohol (74.1%), and 67.5% reported using substances everyday or almost everyday. Eight percent of respondents reported using illicit drugs. Respondents who were working at higher-risk venues were less likely to use tobacco (56.2% vs 78.1%, p=0.001) or alcohol (59.4% vs 87.6%; p<0.001) than those at lower-risk venues ().
Sexual behaviour, drug use and HIV/STIs among adolescent female sex workers
A total of 75.3% of women reported using a condom with their last male client. Consistent condom use during the last month with clients was reported by 55%, whereas only 22.2% reported practising consistent condom use with their emotional partners. About half (50.3%) of respondents reported having sex while feeling drunk at least once in the past week, of whom 56.4% reported this act was unprotected. Respondents who were working at higher-risk venues were more likely to report having a shorter duration of sex work, for example, less than 6 months (66.7% vs 41%, p=0.003), and having more clients in the past week (p=0.001) compared with women working at lower-risk venues.
HIV and sexually transmitted infections
Nearly three-quarters of young women (74.0%) reported having STI symptoms in the past year, including vaginal itching or irritation, burning urination, lower abdominal pain, unusual leucorrhoea, or rashes, lumps or blisters around the genitals or anus (). One-third (30.4%) of women had one or more STI during study screening based on clinical or laboratory evaluation. STI prevalence was particularly high among women working at higher-risk venues (38.5%) compared with lower-risk venues (22.9%; p=0.016). The prevalence of syphilis, NG, CT, C acuminatum and genital HSV-2 infection detected during laboratory screening was 1.5%, 13.1%, 14.7%, 6.9% and 0.5%, respectively. Participants who were working at higher-risk venues were significantly more likely to have NG (23.1% vs 4.0%, p<0.001), and more likely to have C acuminatum infection (10.1% vs 4.0%, p=0.09; ). Of 201 participants, two women (1%) tested HIV positive and both were working at higher-risk venues.
Health-seeking behaviour and service use
The majority of women reported a need for additional health knowledge (77.1%), free condom distribution (50.8%) and low-cost STI diagnosis and treatment services (53.7%; ). Of women who reported STI symptoms in the past year (n=148), about half reported having taken self-treatment for STI symptoms (52.4%), and only 25.5% reported seeking care at public health facilities, similarly between those working at higher-risk and lower-risk venues. Compared with the lower-risk group, those working at higher-risk workplaces were significantly less likely to have received peer education and outreach services (62.5% vs 87.5%, p<0.001), and free condoms (59.3% vs 93.3%, p<0.001); and were more likely to have received HIV testing (43.8% vs 17.1%, p<0.001). At the same time, they were less likely aware of test results (35.7% vs 72.2%, p=0.009).
Health-seeking behaviour and access to health services among Chinese female sex workers
Factors associated with unprotected sex and STIs
Among adolescent FSWs, the main predictor independently associated with having any STI was access to free condoms in the past year (). Adolescent FSWs who did not receive services of condom provision were 2.5 times more likely to have at least one STI (95% CI 1.1 to 5.7; p=0.028) than those with service exposure. There seemed to be a trend for women working at higher-risk venues to be at increased risk for having any STI (38.5% and 22.9%, respectively), although this was no longer statistically significant after adjustment of other factors.
Predictors of sexual risk behaviour defined as presence of any sexually transmitted infection at screening, inconsistent condom use in the past month and no condom used during last sex act among 201 adolescent female sex workers
Adolescent FSWs who reported illicit drug use (adjusted OR 8.54, 95% CI 1.04 to 70.41; p=0.048) and received primary education or less (adjusted OR 3.07, 95% CI 1.09 to 8.62; p=0.033) were more likely to report unprotected sex in the past month with any partner compared with women with higher education. In addition, shorter duration in sex work was independently associated with unprotected sex, with less risky behaviour over time.
Four factors were significantly associated with no condom used during last paid sex act, including earlier age at sex debut, currently married or cohabiting, living with current partner for less than 6 months, and not having received HIV testing in the last year.