Fear of low-paying female sex workers and its implications in HIV prevention

Background: Commercial sex plays a critical role in rapidly increasing heterosexual transmission of HIV in China. Low-paying FSWs are especially vulnerable to HIV/AIDS. This study aims to describe the fear of low-paying FSWs and explore how different fears may influence their HIV-related behaviors. Methods: A cross-sectional study was conducted among 794 FSWs recruited from low-paying commercial sex venues in Guangxi, China. FSWs completed a self-administered questionnaire on their demographic information, fear of engaging in commercial sex as well as knowledge, attitudes and behaviors related to HIV/AIDS. Results: Most of the FSWs feared being infected by HIV (70%) or other STDs (54%). About 46% of them feared being arrested by the police. The FSWs were also worried that their involvement in commercial sex would become known to their families (49%) or to familiar people (21%). Fear of HIV infection was significantly associated with consistent condom use with clients (aOR=2.12, 95% CI=1.47, 3.06) after controlling demographic characteristics and other covariates. However, fear of being exposed to their families significantly prevented the FSWs from taking HIV testing (aOR=.60, 95% CI=.43, .83). Fear of being arrested by the police was negatively associated with accessing HIV prevention interventions (aOR=.51, 95% CI=.34,.77) . Discussion: Fear of HIV infection and other STDs may promote safer sexual behaviors among low-paying FSWs, while fear of families and police may prevent them from utilizing HIV prevention services. Our findings are consistent with Social Cognitive Theory, indicating the importance of examining emotional context of FSWs' behaviors in HIV prevention interventions.