Female sex workers' stable sexual partners in China: A hidden population at high risk of HIV transmission

Background: Heterosexual transmission has become the dominant mode of HIV transmission in China since 2005. Commercial sex plays a critical role in the country's escalating HIV/AIDS epidemic. Most existing studies on female sex workers (FSWs) were focused on sexual behaviors between FSWs and clients; data are limited on the FSWs' stable sex partners.

Methods: A sample of 1,022 FSWs was recruited through community outreach from different types of commercial sex establishments in two cities of Southwest China. The participants completed a self-administered cross-sectional survey on their demographics and HIV/STI-related behaviors and risk factors.

Results: About 70% (N=716) of FSWs had stable partners, 6% of them had multiple stable partners. FSWs' stable partners included boyfriends (65%), husbands (20%), lovers or return clients (18%) Of these stable partners, 19% had or might have other sexual partners. About 40% FSWs had abortions for stable partners; 18 % FSWs never used and only 17% always used condoms with their stable partners. In the last three sexual acts, only 34% always used condoms. Consistent condom use with stable partners was independently and significantly associated with working in higher level of commercial sex venue (p<.005) and having condom use communication with partners (p<.01).

Conclusion: FSWs' stable partners are at high risks of HIV/STI infection and transmission. Many of FSWs' stable partners had other sexual partners and did not use condoms consistently. Culturally appropriate and effective interventions are urgently needed for FSWs with stable partner and the stable partners themselves.