Gatekeeper support and HIV-testing among female sex workers in China

BACKGROUND: Existing studies have suggested a significant relationship between gatekeeper support and condom use among FSWs. Data is limited regarding the role of gatekeepers in HIV-testing among this vulnerable population. The current study aims to examine the association between gatekeeper support and FSWs' HIV-testing behavior and intention.

METHODS: We conducted a cross-sectional survey among 1,022 FSWs recruited through community outreach from two southwest cities in China. Participants completed a self-administered survey on their demographics, gatekeeper support for physical examination, discussion with gatekeeper about HIV prevention, as well as HIV-testing behavior and intention.

RESULTS: A majority of the FSWs reported that their gatekeepers encouraged them to conduct physical examination (85%) and frequently discussed with them about HIV prevention (60%). Younger FSWs and the ones with higher education level were more likely to perceive gatekeeper support for physical examination. Gatekeeper support for physical examination was significantly associated with having ever taken an HIV testing (OR=2.62, 95%CI=1.75, 3.94) and intending to take one (B=0.19, 95%CI=0.06, 0.33) after adjusting demographic characteristics of FSWs. Gatekeeper discussion about HIV was also significantly related to HIV testing behavior (OR=2.24, 95%CI=1.69, 2.97) and intention (B=0.11, 95%CI=0.01, 0.21).

CONCLUSION: The current study examines how gatekeeper support is related to FSWs' HIV-testing behavior and intention. Future HIV prevention program should consider the influence of gatekeeper in FSWs health seeking behavior and intention. Interventions to improve gatekeeper support for physical examination are needed among older FSWs and the ones with lower education level.