Concurrent sexual relationship among male clients of female sex workers in China

Background: There is growing evidence about the importance of male clients of female sex workers (FSWs) in the trajectory of HIV epidemic in China. Clients who concurrently have sex with noncommercial partners may play as a bridging role to spread HIV and other sexually transmitted diseases (STDs) both to the high-risk population (e.g., FSWs) and to general populations (e.g., spouses). Methods: The data were collected in 2011 from P County, China. One hundred and three male clients with 27-90 years of age were included in a cross-sectional survey with a self-administered questionnaire. Collected information included their demographics, concurrent status, and HIV risk behaviors. Clients provided blood samples to test their HIV, Hepatitis C virus (HCV) and syphilis infection. Results: The prevalence of HIV, HCV and syphilis among the current sample was 1.9%, 1.0% and 19.4%, respectively. Of the total sample, 53.4% concurrently had sex with noncommercial partners. Clients who wanted to “kill boredom” (aOR=6.27, 95%CI=1.07, 36.82) and who thought “seeking FSWs was popular” (aOR=7.22, 95%CI=1.61, 32.30) were significantly associated with the clients having concurrent sexual partners. In addition, HIV knowledge and positive psychological effects on having sex with FSWs were all positively associated with concurrent partners among clients. Discussion: The prevalence of concurrent sexual relationship among clients is alarmingly high in the current sample. Social norms on acceptance of commercial sex and boredom were main motivations for client had concurrent partners. Tailored programs including HIV/STD health education, condom promotion, marriage/partnership counseling and HIV/STD screening services are urgently needed.