. 2015 Feb 14:15:147.

doi: 10.1186/s12889-015-1439-5.

Impact evaluation of a community-based intervention to reduce risky sexual behaviour among female sex workers in Shanghai, China

Juan Liu¹, Liviana Calzavara², Joshua B Mendelsohn³, Ann O'Leary⁴, Laiyi Kang⁵, Qichao Pan⁶, Ted Myers⁷, Jinma Ren^{8

9}, Yanfeng Cha¹⁰, Guozheng Shi¹¹, Xiaofeng Liu¹², Xiuhong Tian¹³, Huili Fan¹⁴, Yinqing Ni¹⁵, Robert S Remis¹⁶

Affiliations

¹ Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. jane.liu@utoronto.ca.
² Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. liviana.calzavara@utoronto.ca.
³ Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. joshua.mendelsohn@utoronto.ca.
⁴ US Centres for Disease Control, Atlanta, GA, USA. aao0@cdc.gov.
⁵ Shanghai Centre for Disease Control and Prevention, Shanghai, China. lykang63@hotmail.com.
⁶ Shanghai Centre for Disease Control and Prevention, Shanghai, China. qcpan@scdc.sh.cn.
⁷ Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. ted.myers@utoronto.ca.
⁸ Shanghai Centre for Disease Control and Prevention, Shanghai, China. jinmaren@uicomp.uic.edu.
⁹ Centre for Outcomes Research, University of Illinois, College of Medicine, Peoria, IL, USA. jinmaren@uicomp.uic.edu.
¹⁰ Songjiang District Centre for Disease Control and Prevention, Shanghai, China. chayanfen@sina.com.
¹¹ Jiading District Centre for Disease Control and Prevention, Shanghai, China. stoneking100@sina.com.
¹² Baoshan District Centre for Disease Control and Prevention, Shanghai, China. 66786429@qq.com.
¹³ Minhang District Centre for Disease Control and Prevention, Shanghai, China. txhchm@163.com.
¹⁴ Luwan District Centre for Disease Control and Prevention, Shanghai, China. lykang63@hotmail.com.
¹⁵ Changning District Centre for Disease Control and Prevention, Shanghai, China. niyingjing@hotmail.com.
¹⁶ Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. rs.remis@utoronto.ca.

PMID: 25880416
PMCID: PMC4377073
DOI: 10.1186/s12889-015-1439-5

Impact evaluation of a community-based intervention to reduce risky sexual behaviour among female sex workers in Shanghai, China

Juan Liu et al. BMC Public Health. 2015.

. 2015 Feb 14:15:147.

doi: 10.1186/s12889-015-1439-5.

Authors

Affiliations

¹ Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. jane.liu@utoronto.ca.
² Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. liviana.calzavara@utoronto.ca.
³ Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. joshua.mendelsohn@utoronto.ca.
⁴ US Centres for Disease Control, Atlanta, GA, USA. aao0@cdc.gov.
⁵ Shanghai Centre for Disease Control and Prevention, Shanghai, China. lykang63@hotmail.com.
⁶ Shanghai Centre for Disease Control and Prevention, Shanghai, China. qcpan@scdc.sh.cn.
⁷ Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. ted.myers@utoronto.ca.
⁸ Shanghai Centre for Disease Control and Prevention, Shanghai, China. jinmaren@uicomp.uic.edu.
⁹ Centre for Outcomes Research, University of Illinois, College of Medicine, Peoria, IL, USA. jinmaren@uicomp.uic.edu.
¹⁰ Songjiang District Centre for Disease Control and Prevention, Shanghai, China. chayanfen@sina.com.
¹¹ Jiading District Centre for Disease Control and Prevention, Shanghai, China. stoneking100@sina.com.
¹² Baoshan District Centre for Disease Control and Prevention, Shanghai, China. 66786429@qq.com.
¹³ Minhang District Centre for Disease Control and Prevention, Shanghai, China. txhchm@163.com.
¹⁴ Luwan District Centre for Disease Control and Prevention, Shanghai, China. lykang63@hotmail.com.
¹⁵ Changning District Centre for Disease Control and Prevention, Shanghai, China. niyingjing@hotmail.com.
¹⁶ Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada. rs.remis@utoronto.ca.

PMID: 25880416
PMCID: PMC4377073
DOI: 10.1186/s12889-015-1439-5

Abstract

Background: Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. We implemented an HIV/STI preventive intervention among FSWs in Shanghai that aimed to increase condom use, improve HIV knowledge, and reduce STI and HIV incidence.

Methods: From six districts in Shanghai, 750 randomly selected venue-based FSWs were allocated to either a behavioural intervention or control group. In the intervention and control groups, 221 and 278 participants, respectively, had at least one follow-up at three or six months. In analysis, we randomly selected 57 lost to follow-up cases in the intervention group and imputed baseline values to equalize the arms at n = 278 (74.1% follow-up rate in each group). The impacts of the intervention on condom use, HIV/STI risk perception and knowledge, and STI incidence were assessed using either a logistic or linear model, adjusting for the baseline measure of the outcome and venue type.

Results: The intervention improved consistent condom use with any partner type in the previous month (AOR = 2.09, 95% CI, 1.43-3.04, p = 0.0001). Consistent condom use with clients in the three most recent sex acts increased in both arms, and with primary partners in the intervention arm, but there was no difference between groups after adjusting for baseline condom use and venue type. There were no differences in cumulative incidence of any STI (i.e., chlamydia, gonorrhoea, syphilis) between groups. HIV transmission knowledge (p = 0.0001), condom use skill (p = 0.0421), and self-efficacy for using condoms (p = 0.0071) were improved by the intervention. HIV-related stigma declined (p = 0.0119) and HIV and STI risk perception were improved (4.6 to 13.9%, and 9.4 to 20.0%, respectively). The intervention was associated with these improvements after adjusting for the baseline measure and venue type.

Conclusion: Following a preventive intervention among Shanghai FSWs, our findings demonstrate that a simple, community-based educational intervention improved overall condom use, HIV and STI knowledge, and attitudes in relation to HIV/AIDS. The intervention should be implemented widely after tailoring educational materials regarding condom negotiation with different partner types (i.e., commercial sex clients and primary partners).

PubMed Disclaimer

Figures

**Figure 1**
**Flow chart of intervention and follow-up among 750 FSWs in Shanghai, 2009-10.**

See this image and copyright information in PMC

Cited by

Meeting the Institute of Medicine's 2030 US Life Expectancy Target.
Kindig D, Nobles J, Zidan M. Kindig D, et al. Am J Public Health. 2018 Jan;108(1):87-92. doi: 10.2105/AJPH.2017.304099. Epub 2017 Nov 21. Am J Public Health. 2018. PMID: 29161064 Free PMC article.
Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs).
Bose DL, Hundal A, Singh S, Singh S, Seth K, Hadi SU, Saran A, Joseph J, Goyal K, Salve S. Bose DL, et al. Campbell Syst Rev. 2023 Jan 10;19(1):e1297. doi: 10.1002/cl2.1297. eCollection 2023 Mar. Campbell Syst Rev. 2023. PMID: 36911864 Free PMC article.
Barriers to HIV pre-exposure prophylaxis among African, Caribbean and Black men in Toronto, Canada.
Zhabokritsky A, Nelson LE, Tharao W, Husbands W, Sa T, Zhang N, Thomas-Pavanel J, Baidoobonso S, Kaul R. Zhabokritsky A, et al. PLoS One. 2019 Mar 29;14(3):e0213740. doi: 10.1371/journal.pone.0213740. eCollection 2019. PLoS One. 2019. PMID: 30925582 Free PMC article.
A community-based comprehensive intervention to reduce syphilis infection among low-fee female sex workers in China: a matched-pair, community-based randomized study.
Dong W, Zhou C, Rou KM, Wu ZY, Chen J, Scott SR, Jia MH, Zhou YJ, Chen X. Dong W, et al. Infect Dis Poverty. 2019 Dec 3;8(1):97. doi: 10.1186/s40249-019-0611-z. Infect Dis Poverty. 2019. PMID: 31791415 Free PMC article.
Incidence of unintended pregnancy among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis.
Ampt FH, Willenberg L, Agius PA, Chersich M, Luchters S, Lim MSC. Ampt FH, et al. BMJ Open. 2018 Sep 17;8(9):e021779. doi: 10.1136/bmjopen-2018-021779. BMJ Open. 2018. PMID: 30224388 Free PMC article.

References

1. China Ministry of Health. China Health Statistics Yearbook 2009 [http://www.moh.gov.cn/zwgkzt/ptjnj/200908/42635.shtml]
1. China Ministry of Health. 2012 China AIDS response progress report. UNAIDS, March 2012 [http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourrespon...]
1. National Center for STD Control (NCSTD), China Center for Disease Control HIV epidemic status and control in China. STD Brief Rep. 2012;4:6.
1. Lu F, Wang N, Wu Z, Sun X, Rehnstrom J, Poundstone K, Yu W, Pisani E. Estimating the number of people at risk for and living with HIV in China in 2005: methods and results. Sex Transm Infect. 2006;82(Suppl 3):iii87–91. - PMC - PubMed
1. Huang Y, Henderson GE, Pan S, Cohen MS. HIV/AIDS risk among brothel-based female sex workers in China: assessing the terms, content, and knowledge of sex work. Sex Transm Dis. 2004;31(11):695–700. doi: 10.1097/01.olq.0000143107.06988.ea. - DOI - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

Canadian Institutes of Health Research/Canada

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Impact evaluation of a community-based intervention to reduce risky sexual behaviour among female sex workers in Shanghai, China

Affiliations

Impact evaluation of a community-based intervention to reduce risky sexual behaviour among female sex workers in Shanghai, China

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical