Sexual risk behaviours among factory workers in Shenzhen, China: a cross-sectional study
Dan Luo A # , Kechun Zhang B # , Yaqi Chen B # , Dahui Chen C , Heping Zhao A , Ganfeng Luo A , Wujian Ke D , Shaomin Wu E , Linghua Li F , He Cao B , Bolin Cao G , Yong Cai H , Zixin Wang I , Qihui Lin B * , Xiaojun Meng J * and Huachun Zou A K *A School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
B Longhua District Center for Disease Control and Prevention, Shenzhen, China.
C Shenzhen Health Development Research and Data Management Center, Shenzhen, China.
D Dermatology Hospital, Southern Medical University, Guangzhou, China.
E School of Public Health, Sun Yat-sen University, Guangzhou, China.
F Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China.
G School of Media and Communication, Shenzhen University, Shenzhen, China.
H School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China.
I Faculty of Medicine, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China.
J Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China.
K Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Handling Editor: Eric Chow
Sexual Health 20(4) 315-322 https://doi.org/10.1071/SH23033
Submitted: 17 February 2023 Accepted: 28 March 2023 Published: 1 May 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Factory workers are a key population for HIV transmission in China, as they often engage in sexual risk behaviours. This study aims to evaluate sexual risk behaviours and associated factors among factory workers in Shenzhen, China.
Methods: A cross-sectional study was conducted by using multi-stage stratified cluster random sampling. Full-time workers aged ≥18 years were eligible to participate in the study. A self-administered questionnaire was used to collect information. Univariate and multivariable logistic regression were applied to assess factors associated with sexual risk behaviours.
Results: A total of 2029 factory workers were included. Mean age was 37.2 (±4.4) years; 48.5% were men. Two-thirds (64.9%) had had vaginal intercourse. Their sexual risk behaviours included condomless sex with casual partners in the last sex episode (23.6%), multiple sex partners (11.5%) and engaging in commercial sex (8.4%), in the past year. Having HIV/AIDS knowledge (adjusted odds ratio (AOR) 0.41, 95% confidence interval (CI) 0.24–0.70) and using a condom at sexual debut (AOR 0.08, 95% CI 0.05–0.13) were factors associated with condomless sex with casual partners in the last sex episode. Males (AOR 3.03, 95% CI 1.96–4.69 and AOR 2.19, 95% CI 1.33–3.60), local workers (AOR 2.11, 95% CI 1.01–4.42 and AOR 3.42, 95% CI 1.63–7.21), being single (AOR 2.04, 95% CI 1.39–3.01 and AOR 2.49, 95% CI 1.61–3.87), having sexual debut aged <18 years (AOR 5.98, 95% CI 3.28–10.89 and AOR 3.34, 95% CI 1.74–6.39), and substance use (AOR 2.01, 95% CI 1.38–2.93 and AOR 4.43, 95% CI 2.85–6.87) were associated with both having multiple sex partners and engaging in commercial sex in the past year.
Conclusions: Sexual risk behaviours were prevalent despite most participants having basic HIV/AIDS knowledge. Future workplace-based prevention programs should target factory workers and there should be a focus on enhanced sexual education to reduce HIV transmission in China.
Keywords: China, commercial sex, condomless sex, factory workers, HIV, knowledge, multiple sex partners, sexual risk behaviours.
References
[1] UNAIDS. Global HIV & AIDS statistics — Fact Sheet; 2023. Available at https://www.unaids.org/en/resources/fact-sheet[2] National Center for AIDS & STD Control and Prevention, The Chinese Center for Disease Control and Prevention (CDC). Annals of Information on Comprehensive Prevention and Treatment for AIDS, STD and Hepatitis C. National Center for AIDS & STD Control and Prevention, The Chinese Center for Disease Control and Prevention (CDC); 2020.
[3] National Center for AIDS/STD Control and Prevention, China CDC. The Latest Core Information on HIV Prevention in 2020; 2020. Available at https://ncaids.chinacdc.cn/zxzx/zxdteff/202011/t20201130_222996.htm
[4] Ministry of Health of the People’s Republic of China, UNAIDS, World Health Organization. Estimated AIDS Epidemic in China in 2011. Chinese Journal of AIDS & STD 2012; 18 1–5.
| Estimated AIDS Epidemic in China in 2011.Crossref | GoogleScholarGoogle Scholar |
[5] Bureau of Disease Prevention and Control. New Progress in the Prevention and Treatment of AIDS in China in 2019; 2019. Available at http://www.nhc.gov.cn/jkj/s3586/201911/c2388ce70bdd404ea6dfcd886591784d.shtml
[6] Li Q, Li X, Stanton B. Alcohol use and sexual risk behaviors and outcomes in China: a literature review. AIDS Behav 2010; 14 1227–36.
| Alcohol use and sexual risk behaviors and outcomes in China: a literature review.Crossref | GoogleScholarGoogle Scholar |
[7] National Bureau of Statistics. 2020 Migrant Workers Monitoring Survey Report; 2021. Available at http://www.stats.gov.cn/xxgk/sjfb/zxfb2020/202104/t20210430_1816937.html
[8] Irwin K, Bertrand J, Mibandumba N, Mbuyi K, Muremeri C, Mukoka M, et al. Knowledge, attitudes and beliefs about HIV infection and AIDS among healthy factory workers and their wives, Kinshasa, Zaire. Soc Sci Med 1991; 32 917–30.
| Knowledge, attitudes and beliefs about HIV infection and AIDS among healthy factory workers and their wives, Kinshasa, Zaire.Crossref | GoogleScholarGoogle Scholar |
[9] Chamratrithirong A, Ford K, Punpuing S, Prasartkul P. A workplace intervention program and the increase in HIV knowledge, perceived accessibility and use of condoms among young factory workers in Thailand. SAHARA J 2017; 14 132–9.
| A workplace intervention program and the increase in HIV knowledge, perceived accessibility and use of condoms among young factory workers in Thailand.Crossref | GoogleScholarGoogle Scholar |
[10] Tiruneh K, Wasie B, Gonzalez H. Sexual behavior and vulnerability to HIV infection among seasonal migrant laborers in Metema District, Northwest Ethiopia: a cross-sectional study. BMC Public Health 2015; 15 122
| Sexual behavior and vulnerability to HIV infection among seasonal migrant laborers in Metema District, Northwest Ethiopia: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
[11] Weine SM, Kashuba AB. Labor migration and HIV risk: a systematic review of the literature. AIDS Behav 2012; 16 1605–21.
| Labor migration and HIV risk: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |
[12] Shenzhen Bureau of Statistics. Shenzhen Statistical Yearbook 2019; 2020. Available at http://tjj.sz.gov.cn/zwgk/zfxxgkml/tjsj/tjnj/content/post_7971762.html
[13] Zhou R, Jiang B. Current status of HIV infection and AIDS epidemic in Shenzhen. Chronic Disease Prevention and Control in China 2017; 25 340–2.
| Current status of HIV infection and AIDS epidemic in Shenzhen.Crossref | GoogleScholarGoogle Scholar |
[14] Amirkhanian YA, Kelly JA, Takacs J, McAuliffe TL, Kuznetsova AV, Toth TP, et al. Effects of a social network HIV/STD prevention intervention for men who have sex with men in Russia and Hungary: a randomized controlled trial. AIDS 2015; 29 583–93.
| Effects of a social network HIV/STD prevention intervention for men who have sex with men in Russia and Hungary: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |
[15] Tucker JD, Tuminez AS. Reframing the interpretation of sex worker health: a behavioral-structural approach. J Infect Dis 2011; 204 S1206–10.
| Reframing the interpretation of sex worker health: a behavioral-structural approach.Crossref | GoogleScholarGoogle Scholar |
[16] Zhuang X, Wu Z, Poundstone K, Yang C, Zhong Y, Jiang S. HIV-related high-risk behaviors among Chinese migrant construction laborers in Nantong, Jiangsu. PLoS One 2012; 7 e31986
| HIV-related high-risk behaviors among Chinese migrant construction laborers in Nantong, Jiangsu.Crossref | GoogleScholarGoogle Scholar |
[17] Zhao R, Gao H, Shi X, Tucker JD, Yang Z, Min X, et al. Sexually transmitted disease/HIV and heterosexual risk among miners in townships of Yunnan Province, China. AIDS Patient Care STDS 2005; 19 848–52.
| Sexually transmitted disease/HIV and heterosexual risk among miners in townships of Yunnan Province, China.Crossref | GoogleScholarGoogle Scholar |
[18] Chinese Center for Disease Control and Prevention. Notice of the Chinese Center for Disease Control and Prevention on the issuance of the core knowledge of AIDS publicity and education and the questionnaire on the knowledge of AIDS; 2018. Available at http://www.ahcdc.cn/content/detail/5ac426b2e1ff8cdc21007fa8.html
[19] Wang Y, Lu R, Wu G, Lan R, Ou R, Zhang Y, et al. Changing trends of HIV, syphilis, and hepatitis C among male migrant workers in Chongqing, China: nine consecutive cross-sectional surveys, 2010–2018. Int J Environ Res Public Health 2020; 17 875
| Changing trends of HIV, syphilis, and hepatitis C among male migrant workers in Chongqing, China: nine consecutive cross-sectional surveys, 2010–2018.Crossref | GoogleScholarGoogle Scholar |
[20] He N, Zhang J, Yao J, Tian X, Zhao G, Jiang Q, et al. Knowledge, attitudes, and practices of voluntary HIV counseling and testing among rural migrants in Shanghai, China. AIDS Educ Prev 2009; 21 570–81.
| Knowledge, attitudes, and practices of voluntary HIV counseling and testing among rural migrants in Shanghai, China.Crossref | GoogleScholarGoogle Scholar |
[21] Weine S, Bahromov M, Mirzoev A. Unprotected Tajik male migrant workers in Moscow at risk for HIV/AIDS. J Immigr Minor Health 2008; 10 461–8.
| Unprotected Tajik male migrant workers in Moscow at risk for HIV/AIDS.Crossref | GoogleScholarGoogle Scholar |
[22] Yang C, Latkin CA, Liu P, Nelson KE, Wang C, Luan R. A qualitative study on commercial sex behaviors among male clients in Sichuan Province, China. AIDS Care 2010; 22 246–52.
| A qualitative study on commercial sex behaviors among male clients in Sichuan Province, China.Crossref | GoogleScholarGoogle Scholar |
[23] Liu H, Li X, Stanton B, Liu H, Liang G, Chen X, 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 and 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 |
[24] Zhao J, Song F, Ren S, Wang Y, Wang L, Liu W, et al. Predictors of condom use behaviors based on the health belief model (HBM) among female sex workers: a cross-sectional study in Hubei Province, China. PLoS One 2012; 7 e49542
| Predictors of condom use behaviors based on the health belief model (HBM) among female sex workers: a cross-sectional study in Hubei Province, China.Crossref | GoogleScholarGoogle Scholar |
[25] 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.
[26] 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 |
[27] 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 |
[28] Yip PSF, Zhang H, Lam TH, Lam KF, Lee AM, Chan J, et al. Sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong. BMC Public Health 2013; 13 691
| Sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong.Crossref | GoogleScholarGoogle Scholar |
[29] Oliver MB, Hyde JS. Gender differences in sexuality: a meta-analysis. Psychol Bull 1993; 114 29–51.
| Gender differences in sexuality: a meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[30] Lau JTF, Tsui HY, Lam LT. Alcohol consumption, sex, and use of psychotropic substances among male Hong Kong-Mainland China cross-border substance users. Addict Behav 2007; 32 686–99.
| Alcohol consumption, sex, and use of psychotropic substances among male Hong Kong-Mainland China cross-border substance users.Crossref | GoogleScholarGoogle Scholar |
[31] Lin D, Li X, Yang H, Fang X, Stanton B, Chen X, et al. Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China. Drug Alcohol Depend 2005; 79 103–12.
| Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China.Crossref | GoogleScholarGoogle Scholar |
[32] Weine S, Bahromov M, Loue S, Owens L. HIV sexual risk behaviors and multilevel determinants among male labor migrants from Tajikistan. J Immigr Minor Health 2013; 15 700–10.
| HIV sexual risk behaviors and multilevel determinants among male labor migrants from Tajikistan.Crossref | GoogleScholarGoogle Scholar |
[33] Martins-Fonteyn EMV, Sommerland N, Meulemans H, Degomme O, Raimundo I, Wouters E. Targeting vulnerable populations: a synthetic review on alcohol use and risky sexual behaviour among migrant populations. AIDS Res Ther 2016; 13 33
| Targeting vulnerable populations: a synthetic review on alcohol use and risky sexual behaviour among migrant populations.Crossref | GoogleScholarGoogle Scholar |
[34] Amirkhanian YA, Kuznetsova AV, Kelly JA, Difranceisco WJ, Musatov VB, Avsukevich NA, et al. Male labor migrants in Russia: HIV risk behavior levels, contextual factors, and prevention needs. J Immigr Minor Health 2011; 13 919–28.
| Male labor migrants in Russia: HIV risk behavior levels, contextual factors, and prevention needs.Crossref | GoogleScholarGoogle Scholar |
[35] El-Bassel N, Marotta PL. Alcohol and sexual risk behaviors among male Central Asian labor migrants and non-migrants in Kazakhstan: implications for HIV prevention. AIDS Behav 2017; 21 183–92.
| Alcohol and sexual risk behaviors among male Central Asian labor migrants and non-migrants in Kazakhstan: implications for HIV prevention.Crossref | GoogleScholarGoogle Scholar |
[36] Bam K, Thapa R, Newman MS, Bhatt LP, Bhatta SK. Sexual behavior and condom use among seasonal Dalit migrant laborers to India from far West, Nepal: a qualitative study. PLoS One 2013; 8 e74903
| Sexual behavior and condom use among seasonal Dalit migrant laborers to India from far West, Nepal: a qualitative study.Crossref | GoogleScholarGoogle Scholar |