Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
REVIEW

Condom use in China: prevalence, policies, issues and barriers

Huachun Zou A D , Hui Xue B , Xiaofang Wang B and Damien Lu C
+ Author Affiliations
- Author Affiliations

A Sexual Health Unit, School of Population Health, The University of Melbourne, 580 Swanston Street, Carlton, Vic. 3053, Australia.

B National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Street, Changping District, Beijing 102206, China.

C Aibai Cultural and Education Center, 1347 N. Vista Street, #111, Los Angeles, CA 90046, USA.

D Corresponding author. Email: rolfe1234@gmail.com

Sexual Health 9(1) 27-33 https://doi.org/10.1071/SH11021
Submitted: 10 February 2011  Accepted: 15 July 2011   Published: 21 October 2011

Abstract

In this review, we describe condom use and its influencing factors in China, with a particular focus on the five populations that are at high risk for HIV/sexually transmissible infections (STI) infection: female sex workers, men who have sex with men, migrant workers, young people and sero-discordant couples. The risk for HIV/STI infection is high while condom use rates are low among these five populations. The 100% Condom Use Programme was successful in trial regions in increasing condom use and decreasing HIV/STI prevalence; however, long-term and routine condom promotion strategies should be in place to ensure better awareness of condom use, high availability of condoms and high rate of condom use among populations at high risk of HIV/STI infection in China. Realistic and vigorous condom-related policies and action plans should be developed and implemented to address the issues and barriers facing condom promotion in China.

Additional keywords: HIV, high risk behaviour, sexually transmissible infection.


References

[1]  Zhang D, Bi P, Lv F, Zhang J, Hiller JE. Changes in HIV prevalence and sexual behavior among men who have sex with men in a northern Chinese city: 2002–2006. J Infect 2007; 55 456–63.
Changes in HIV prevalence and sexual behavior among men who have sex with men in a northern Chinese city: 2002–2006.Crossref | GoogleScholarGoogle Scholar |

[2]  Pang L, Hao Y, Mi G, Wang C, Luo W, Rou K, et al Effectiveness of first eight methadone maintenance treatment clinics in China. AIDS 2007; 21 S103–7.
Effectiveness of first eight methadone maintenance treatment clinics in China.Crossref | GoogleScholarGoogle Scholar |

[3]  Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. Evolution of China’s response to HIV/AIDS. Lancet 2007; 369 679–90.
Evolution of China’s response to HIV/AIDS.Crossref | GoogleScholarGoogle Scholar |

[4]  CDC. Condoms and STDs: Fact Sheet for Public Health Personnel. 8 February 2010. Atlanta: CDC; 2010. Available online at: http://www.cdc.gov/condomeffectiveness/latex.htm [verified January 2011].

[5]  UNAIDS. Evaluation of the 100% Condom Programme in Thailand 2000. Geneva: UNAIDS in collaboration with AIDS Division, Ministry of Public Health, Thailand; 2000. Available online at: http://data.unaids.org/publications/IRC-pub01/jc275-100pcondom_en.pdf [verified January 2011].

[6]  National Center for AIDS/STD Control and Prevention. Annual Report on HIV/AIDS/STD Epidemiology, Prevention and Treatment in China in 2009. Beijing: China Center for Disease Control: 2010.

[7]  Rou K, Sullivan SG, Liu P, Wu Z. Scaling up prevention programmes to reduce the sexual transmission of HIV in China. Int J Epidemiol 2010; 39 ii38–46.
Scaling up prevention programmes to reduce the sexual transmission of HIV in China.Crossref | GoogleScholarGoogle Scholar |

[8]  Hong H, Qin QR, Li LH, Ji GP, Ye DQ. Condom use among married women at risk for sexually transmitted infections and HIV in rural China. Int J Gynaecol Obstet 2009; 106 262–5.
Condom use among married women at risk for sexually transmitted infections and HIV in rural China.Crossref | GoogleScholarGoogle Scholar |

[9]  Hong Y, Li X. Behavioral studies of female sex workers in China: a literature review and recommendation for future research. AIDS Behav 2008; 12 623–36.
Behavioral studies of female sex workers in China: a literature review and recommendation for future research.Crossref | GoogleScholarGoogle Scholar |

[10]  Parish WL, Laumann EO, Cohen MS, Pan S, Zheng H, Hoffman I, et al Population-based study of chlamydial infection in China: a hidden epidemic. JAMA 2003; 289 1265–73.
Population-based study of chlamydial infection in China: a hidden epidemic.Crossref | GoogleScholarGoogle Scholar |

[11]  Rou K, Wu Z, Sullivan SG, Li F, Guan J, Xu C, et al A five-city trial of a behavioural intervention to reduce sexually transmitted disease/HIV risk among sex workers in China. AIDS 2007; 21 S95–101.
A five-city trial of a behavioural intervention to reduce sexually transmitted disease/HIV risk among sex workers in China.Crossref | GoogleScholarGoogle Scholar |

[12]  Wang H, Wang N, Chen RY, Sharp GB, Ma Y, Wang G, et al Prevalence and predictors of herpes simplex virus type 2 infection among female sex workers in Yunnan Province, China. Int J STD AIDS 2008; 19 635–9.
Prevalence and predictors of herpes simplex virus type 2 infection among female sex workers in Yunnan Province, China.Crossref | GoogleScholarGoogle Scholar |

[13]  Hong Y, Fang X, Zhou Y, Zhao R, Li X. Factors associated with sexually transmitted infection underreporting among female sex workers in China. J Womens Health (Larchmt) 2011; 1 129–36.

[14]  Lu F, Jia Y, Sun X, Wang L, Liu W, Xiao Y, et al Prevalence of HIV infection and predictors for syphilis infection among female sex workers in southern China. Southeast Asian J Trop Med Public Health 2009; 40 263–72.

[15]  Yang H, Li X, Stanton B, Fang X, Zhao R, Dong B, et al Condom use among female sex workers in China: role of gatekeepers. Sex Transm Dis 2005; 32 572–80.
Condom use among female sex workers in China: role of gatekeepers.Crossref | GoogleScholarGoogle Scholar |

[16]  Country Progress Report China UNGASS. Beijing: Ministry of Health of the People’s Republic of China; 2010. Available online at: http://data.unaids.org/pub/Report/2010/china_2010_country_progress_report_en.pdf [verified January 2011].

[17]  Yang C, Latkin C, Luan R, Nelson K. Condom use with female sex workers among male clients in Sichuan Province, China: the role of interpersonal and venue-level factors. J Urban Health 2010; 87 292–303.
Condom use with female sex workers among male clients in Sichuan Province, China: the role of interpersonal and venue-level factors.Crossref | GoogleScholarGoogle Scholar |

[18]  Li Q, Li X, Stanton B, Fang X, Zhao R. A multilevel analysis of gatekeeper characteristics and consistent condom use among establishment-based female sex workers in Guangxi, China. Sex Transm Dis 2010; 37 700–5.
A multilevel analysis of gatekeeper characteristics and consistent condom use among establishment-based female sex workers in Guangxi, China.Crossref | GoogleScholarGoogle Scholar |

[19]  Lau JT, Zhang J, Zhang L, Wang N, Cheng F, Zhang Y, et al Comparing prevalence of condom use among 15,379 female sex workers injecting or not injecting drugs in China. Sex Transm Dis 2007; 34 908–16.
Comparing prevalence of condom use among 15,379 female sex workers injecting or not injecting drugs in China.Crossref | GoogleScholarGoogle Scholar |

[20]  Choi SY, Chen KL, Jiang ZQ. Client-perpetuated violence and condom failure among female sex workers in southwestern China. Sex Transm Dis 2008; 35 141–6.
Client-perpetuated violence and condom failure among female sex workers in southwestern China.Crossref | GoogleScholarGoogle Scholar |

[21]  Yi H, Mantell JE, Wu R, Lu Z, Zeng J, Wan Y. A profile of HIV risk factors in the context of sex work environments among migrant female sex workers in Beijing, China. Psychol Health Med 2010; 15 172–87.
A profile of HIV risk factors in the context of sex work environments among migrant female sex workers in Beijing, China.Crossref | GoogleScholarGoogle Scholar |

[22]  Hong Y, Li X, Fang X, Zhao R. Depressive symptoms and condom use with clients among female sex workers in China. Sex Health 2007; 4 99–104.
Depressive symptoms and condom use with clients among female sex workers in China.Crossref | GoogleScholarGoogle Scholar |

[23]  Daily C. Chinese gay population announced for the first time. China Daily, 5 April 2006.

[24]  Lau JT, Wang M, Wong HN, Tsui HY, Jia M, Cheng F, et al Prevalence of bisexual behaviors among men who have sex with men (MSM) in China and associations between condom use in MSM and heterosexual behaviors. Sex Transm Dis 2008; 35 406–13.
Prevalence of bisexual behaviors among men who have sex with men (MSM) in China and associations between condom use in MSM and heterosexual behaviors.Crossref | GoogleScholarGoogle Scholar |

[25]  Zou H, Wu Z, Yu J, Li M, Ablimit M, Li F, et al Sexual risk behaviors and HIV infection among men who have sex with men who use the internet in Beijing and Urumqi, China. J Acquir Immune Defic Syndr 2010; 53 S81–7.
Sexual risk behaviors and HIV infection among men who have sex with men who use the internet in Beijing and Urumqi, China.Crossref | GoogleScholarGoogle Scholar |

[26]  State Council AIDS Working Committee Office. UN Theme Group on HIV/AIDS in China. A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007). Beijing: China Ministry of Health; 2007.

[27]  Xu J, Liu E, Mi G, Rou K, Dou Z, Wu Z, et al. HIV, syphilis, HCV and HSV-2 prevalence among men who have sex with men in urban China. XVIII International AIDS Conference, Vienna, 18–23 July 2010.

[28]  Li H, Lau JT, Holroyd E, Yi H. Sociocultural facilitators and barriers to condom use during anal sex among men who have sex with men in Guangzhou, China: an ethnographic study. AIDS Care 2010; 22 1481–6.
Sociocultural facilitators and barriers to condom use during anal sex among men who have sex with men in Guangzhou, China: an ethnographic study.Crossref | GoogleScholarGoogle Scholar |

[29]  National Bureau of Statistics. Report on surveillance of migrant workers 2009. Beijing: National Bureau of Statistics; 2010. Available online at: http://www.stats.gov.cn/tjfx/fxbg/t20100319_402628281.htm [verified January 2011].

[30]  Anderson AF, Qingsi Z, Hua X, Jianfeng B. China’s floating population and the potential for HIV transmission: a social-behavioural perspective. AIDS Care 2003; 15 177–85.
China’s floating population and the potential for HIV transmission: a social-behavioural perspective.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3szislansA%3D%3D&md5=c5f87ce8f166c826ec78f7363a8c6b23CAS |

[31]  He N, Wong FY, Huang ZJ, Ding Y, Fu C, Smith BD, et al HIV risks among two types of male migrants in Shanghai, China: money boys vs. general male migrants. AIDS 2007; 21 S73–9.
HIV risks among two types of male migrants in Shanghai, China: money boys vs. general male migrants.Crossref | GoogleScholarGoogle Scholar |

[32]  Hesketh T, Li L, Ye X, Wang H, Jiang M, Tomkins A. HIV and syphilis in migrant workers in eastern China. Sex Transm Infect 2006; 82 11–4.
HIV and syphilis in migrant workers in eastern China.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28%2Fnslaktw%3D%3D&md5=a47f04e61bae616a14d9815673ce4772CAS |

[33]  Li L, Morrow M, Kermode M. Vulnerable but feeling safe: HIV risk among male rural-to-urban migrant workers in Chengdu, China. AIDS Care 2007; 19 1288–95.
Vulnerable but feeling safe: HIV risk among male rural-to-urban migrant workers in Chengdu, China.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2sjjsV2nuw%3D%3D&md5=317f07a912c25c2ecfaff6696ab335deCAS |

[34]  Wang B, Li X, Stanton B, Fang X, Lin D, Mao R. HIV-related risk behaviors and history of sexually transmitted diseases among male migrants who patronize commercial sex in China. Sex Transm Dis 2007; 34 1–8.
HIV-related risk behaviors and history of sexually transmitted diseases among male migrants who patronize commercial sex in China.Crossref | GoogleScholarGoogle Scholar |

[35]  Liu H, Li X, Stanton B, Liang G, Chen X, Yang H, et al Risk factors for sexually transmitted disease among rural-to-urban migrants in China: implications for HIV/sexually transmitted disease prevention. AIDS Patient Care STDS 2005; 19 49–57.
Risk factors for sexually transmitted disease among rural-to-urban migrants in China: implications for HIV/sexually transmitted disease prevention.Crossref | GoogleScholarGoogle Scholar |

[36]  Ma Q, Ono-Kihara M, Cong L, Pan X, Xu G, Zamani S, et al Behavioral and psychosocial predictors of condom use among university students in Eastern China. AIDS Care 2009; 21 249–59.
Behavioral and psychosocial predictors of condom use among university students in Eastern China.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXhs1SjtrzL&md5=0139ceb5d8f8ea116dffba613747e19aCAS |

[37]  State Council of P.R. China. Regulations on AIDS Prevention and Treatment. Beijing: State Council Office; 2006.

[38]  Ji G, Detels R, Wu Z, Yin Y. Correlates of HIV infection among former blood/plasma donors in rural China. AIDS 2006; 20 585–91.
Correlates of HIV infection among former blood/plasma donors in rural China.Crossref | GoogleScholarGoogle Scholar |

[39]  Ge Z, Luo J, Shan D, Gao X, Ding G, He W, et al. Risk factors for HIV transmission among serodiscordant couples in Henan Province, China. Poster presented at the Fogarty International Clinical Research Scholars and Fellows Support Center @ Vanderbilt University Global Health Clinical Research Alumni Symposium. Nashville, TN: Fogarty International Clinical Research Scholars and Fellows Support Center @ Vanderbilt University 2010. Available online at http://www.fogartyscholars.org/events/2010-alumni-symposium/virtual/posters/day-2/room-3/PDF-73.jpeg/image_view_fullscreen [verified January 2011].

[40]  World Health Organization. Experiences of 100% Condom Use Programme in selected countries of Asia. Geneva: World Health Organization; 2004. Available online at: http://www.wpro.who.int/NR/rdonlyres/CDB9792C-3815-44CD-A285-6D28BA88298E/0/100_condom_program_experience.pdf [verified January 2011].

[41]  Yang HT, Du YP, Ding JP, Qian WJ, Li L, Zhou ZL, et al [Evaluation of the “Jiangsu/WHO 100% condom use programme in China”]. Zhonghua Liu Xing Bing Xue Za Zhi 2005; 26 317–20.
| 1:CAS:528:DC%2BD2MXhtVGnt7nF&md5=e83159f13fff25740033d56f146bd92cCAS |

[42]  Quanlin D. Evaluation on the efficacy of community-based 100% condom use program intervention among female sex workers in low-grade leisure facilities. Masters thesis. Huazhong University of Technology, 2008.

[43]  Zhongdan C, Schilling RF, Shanbo W, Caiyan C, Wang Z, Jianguo S. The 100% Condom Use Program: a demonstration in Wuhan, China. Eval Program Plann 2008; 31 10–21.
The 100% Condom Use Program: a demonstration in Wuhan, China.Crossref | GoogleScholarGoogle Scholar |

[44]  Tang G, Lan S, Wu Z. Evaluation of effect of 100% condom usage promotional project in prevention of STD in Hecheng District, Huaihua City, Hunan, China. Pract Prev Med 2007; 14 920–1.

[45]  World Health Organization. STI/HIV Training Course for 100% Condom Use Programme. Geneva: World Health Organization; 2002. Available online at: http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=52&codcch=1016. [verified January 2011].

[46]  Jiang H, Lu D, Wei W, Zhang J, Gu Y, Dickson S, et al Challenges on China’s HIV/AIDS intervention for men who have sex with men: an appraisal based evidence from community, behaviour and sociological research. J Prevent Med Inform 2009; 25 499–503.

[47]  Deng B, Jiang H, Wang W, Lu D, Dickson S, Lai W, et al A cross-sectional survey of the HIV/AIDS related high-risk behaviour in Chengdu’s men who have sex with men in college campuses. Mod Prev Med 2010; 37 1543–6.

[48]  National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention. Annual Information Report of the National Comprehensive Control of AIDS/STIs, 2008. Beijing: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention; 2008.

[49]  State Council of P.R. China. Action Plan for Reducing and Preventing the Spread of HIV/AIDS (2006–2010). Beijing: State Council Office; 2006.

[50]  Ministry of Health. Program Management Plan for Control and Prevention of HIV/AIDS 2010. Beijing: Ministry of Health; 2010. Available online at: http://www.chinaaids.cn/n16/n1193/n4073/443552.html [verified 17 January 2011].