Perceived HIV risks, types of sexually transmitted diseases, and discordant infection status among low-tier female sex workers in China

Background: Discordant infection status for an individual is defined as the discrepancy between biologically confirmed and self-reported sexually transmitted diseases (STD). Female sex workers (FSWs) with unrecognized STD infection may increase risks of STD transmission to other populations. The current study aims to detect factors associated with discordant status among a sample of low-tier FSWs in China. Method: A total of 907 FSWs were recruited from nine types of low-tier commercial sex venues in Guangxi, China. FSWs who provided consented forms completed a self-administered cross-sectional survey on their demographic and behavioral information, as well as STD history. A blood sample for testing HIV, hepatitis C virus (HCV) and syphilis was also collected. Results: In the current study, 16.0% of FSWs had discordant status with 7.8% of unrecognized STD infection and 8.2% of recovered cases. More FSWs infected with gonorrhea (aOR=10.31, 95%CI=3.19, 33.29) and Chlamydia (aOR=21.41, 95%CI=3.74, 122.59) were likely to have discordant status compared to women with other types of STD (e.g., syphilis, genital herpes). FSWs with higher perceived HIV risks were less likely to have discordant infection status (aOR=0.50, 95%CI=0.27, 0.94). Discussion: The pervasive discordant status among the current sample underscored urgent needs to implement programs including HIV/STD screening, and treatment services, as well as health education focused on increasing risk perceptions among this at-risk population, in order to effectively curb the spread of STD/HIV to other populations due to discordance infection status.