HIV/STI prevention interventions targeting female sex workers in China

Background: China has experienced a rapid increase of heterosexual transmission of HIV in the past several years, and commercial sex plays a critical role in the escalating HIV/AIDS epidemic. Millions of female sex workers (FSWs) and their clients are considered the core populations that might link the concentrated HIV epidemic into a generalized one. In the past decade, intervention efforts were made to reduce HIV/STI risks in FSWs; to date, no systematic literature review is available on these interventions.

Methods: Comprehensive search was conducted in all major literature databases of health sciences and social sciences. The selection criteria was 1) published in peer-review journals, 2) intervention targeting FSWs or their clients/partners in China, 3) report at least one cognitive, behavioral our clinic outcomes. Nine studies that met the selection criteria were included in this review.

Results: Existing intervention studies targeting FSWs were most often conducted in South or Southwest China. Most of the existing interventions utilized educational or counseling approaches and targeted the FSWs individually. All studies have reported one or multiple positive outcomes. However, only two studies employed quasi-experimental design and the rest used open-cohort design. Most studies had only one follow-up, and there was no report of dissemination or scale-up of effective intervention.

Conclusion: Interventions to reduce HIV/STI risks among FSWs in China are limited. Future studies need to incorporate more rigorous evaluation design and incorporate other intervention approaches or modality. Structural interventions to go beyond individual knowledge improvement and skill training are needed.