High prevalence of syphilis and other sexually transmitted diseases ...

756AIDS 2001, Vol 15 No 6Twenty-one percent of the women complained ofabdominal pain. Seven per cent of the women had ahistory of injecting drug use since 1990.Sexual behaviourThe median number of clients the women had in atypical working week was seven. In the past 2 months,vaginal sexual contact with their clients was reportedby all women, whereas anal intercourse appeared to berare (0.8%). Oral sex was reported by 8%. Consistentcondom use (100% use) in vaginal sexual contact withclients was reported by 30% of the women.Forty-one per cent of the women reported having asteady partner in the past 12 months, with whomcondoms were always used by 8% and never by 53%.The women were asked to state the main two methodsthey had used in the previous 2 months to preventSTD. Seventy-two percent of the women mentionedthe use of condoms, 43% vaginal douching and 20%antibiotics. As current contraception, 47% used condoms,25% intrauterine devices, and 11% oral contraceptives.Seven percent reported having been sterilized.Prevalence of HIV and sexually transmitteddiseasesThirteen women (1.4%) had antibodies to HIV infection.Eight of the 13 women infected with HIV had ahistory of injecting drug use. None of them hadpreviously been tested for the presence of antibodies toHIV.The most predominant STD, diagnosed at study entry,was a genital infection with C. trachomatis (32%).Gonorrhoea was diagnosed in 8% and trichomoniasis in12.5% of the women. Evidence of a syphilis infectionby means of a positive TPHA test was found in 134out of 966 women (14%). A RPR titre of 1:8 or morewas found in 52 of the 134 TPHA-positive women(39%). Genital ulcers were rare.Knowledge on (prevention of) sexuallytransmitted diseases/HIV and self-ef®cacy forcondom useThe women were asked whether they agreed ordisagreed with a number of statements regarding knowledgeabout AIDS and the use of condoms and on selfef®cacyfor condom use. Out of the nine statementsregarding knowledge about AIDS, the median score ofcorrect answers was four. The median score of correctanswers on the ®ve questions related to condom usewas one. The self-ef®cacy of the women with regardto condom use appeared to be very low: the medianscore of the answers on the capability to use condomswas zero.Risk factors for sexually transmitted diseasesIn univariate analyses, a number of general, sexual,knowledge and condom use-related characteristics wereassociated with the various STD. All factors withP , 0.10 were included in the multivariate modelusing a stepwise backward procedure. The resultingmodels are presented in Table 2.A history of injecting drugs was independently relatedto HIV infection: eight out of the 13 HIV-infectedwomen reported to have been injecting drugs. Arelatively large proportion of the HIV-infected womenoriginated from Guangzhou (six out of 13) and werediagnosed with trichomoniasis (seven out of 13). HIVinfectedwomen reported having fewer clients thanHIV-uninfected women. In contrast, independent riskfactors for gonorrhoea, trichomoniasis, chlamydial infectionand syphilis included a number of markers for(unprotected) sexual activity. The presence of eithergonorrhoea, chlamydial infection, or trichomoniasispredicted the presence of the other two remainingSTD. Furthermore, it appeared that younger womenhad a higher risk of chlamydial infection comparedwith older women.Trichomoniasis was related to all other evaluated STD(including HIV) with the exception of syphilis. Womenwith a good knowledge about the transmission ofAIDS/HIV and of the preventative impact of condomuse appeared to have a smaller risk of infection withsyphilis, trichomoniasis or chlamydial infection.DiscussionAlthough prostitution is illegal in China, and arrestedsex workers may be put in re-education centres, thisproject proved that it is also feasible to start such anSTD treatment and prevention centre in the Chinesecontext, and to gain the trust of the women for thisproject. Word of mouth advertisement alone about theexistence of the project was not suf®cient to recruitwomen, as in the ®rst 6 months a mean number ofonly 20 women per month were recruited. Additionalmethods, such as lecturing on reproductive health tothe staff of bars and beauty parlours, were then undertakenand appeared to be much more successful (amean number of 69 women per month in the next 6months recruitment period). During these lectureswomen often raised questions about the increased riskof infertility as a result of their profession as sexworkers, particularly as most of them planned to dothis kind of work for a short period and then to returnto their family home, get married and start a family.Indeed, most women had only recently come toGuangzhou and started sex work.