Individual and social influence correlates of unprotected sex among female entertainment workers in China: a repeated measures analysis

Xiushi Yang, Old Dominion University
Guomei Xia, Shanghai Academy of Social Sciences

Female entertainment workers (FEW) in China are at increased risk of sexually acquiring or transmitting HIV, but causes of their unprotected sex remain poorly understood. Using data from a behavioral intervention among a venue-based sample of 724 FEWs in Shanghai, this paper examines the individual-level risk factors and social influences of unprotected sex. Data were collected at the baseline and three follow-up surveys. Multilevel logistic regression analyses were conducted, taking into account of correlations among repeated measures and among respondents from the same establishment. Results indicated that about 60% of study participants reported unprotected sex with a stable partner; 25% of them with a non-stable partner. Three percent of them self-reported a history of any sexually transmitted infections (STIs). Three percent tested positive for syphilis at the baseline, and 2% at the last follow-up survey (12 months since the baseline). At the bivariate level, all individual and social influence measures were significantly associated with the odds of consistent condom use with both a stable and a non-stable partner. Multiple logistic regression results revealed that in sex with a stable partner unprotected sex was significantly correlated with being married, prevention motivation, and self-efficacy in condom use; none of the five measures of social influences showed statistical significance. In sex with a non-stable partner, unprotected sex was significantly correlated with prevention motivation and self-efficacy in condom use; it is also highly significantly correlated with peer support for condom use. Female entertainment workers in China are at high risk of HIV. Both individual cognitive factors and social influences are important correlates of unprotected sex, particularly with unstable partner(s). Risk reduction interventions need to pay more attention to behavioral skills training and social influences of behavior.