Predictors of Consistent Condom Use Among Female Commercial Sex Workers in Shanghai, China

Background and Objectives: There are an estimated 3.7 million commercial sex workers (CSW) in China. Few studies have evaluated mental health as a determinant of condom use among CSWs. This survey assessed mental health and other determinants of condom use among CSWs in Shanghai.

Methods: 257 female CSWs were enrolled in the study after identification via venue-based sampling. Potential determinants of condom use, including age, education, access to health care, and knowledge about HIV, were collected. The CHQ-12, a depression screen validated in the Chinese population, was applied. Data were evaluated via bivariate analysis and multiple logistic regression.

Results: 90 out of 257 (35%) CSWs claimed condom use during every sexual encounter. After adjusting for all other variables, the only statistically significant predictors of universal condom use during sexual encounters were a negative depression screen (OR 2.17) and possessing a set physician or clinic for health care (OR 2.18). Education, age, alcohol consumption, and knowledge about HIV were not identified as significant predictors of universal condom use in the adjusted model, although low education and frequent alcohol consumption did predict lower rates of condom use in the unadjusted model.

Conclusion: Among Chinese CSWs, after adjusting for education, age, and other variables, a negative depression screen, and access to a set health care provider predicted consistent condom use. Further research should evaluate the specific mental health needs of Chinese CSWs and assess the value of interventions designed to increase their access to medical and mental health care.