Review of HIV and other sexually transmitted infections among female sex workers in China.

Female sex workers (FSW) are at greater risk for HIV and STIs. A systematic literature review of HIV and STI prevalence and incidence data for FSW in China was conducted to assess current trends. Studies between 1996 and 2010 detailing seroprevalence or incidence data, other laboratory-based tests, and clinical diagnoses of infections among FSW were reviewed. Select articles from Chinese literature around street-based and drug-abusing FSW were also reviewed. Results revealed high median prevalence for a variety of STIs among FSW: active syphilis range 0.8-12.5% (median = 6.9%), herpes range 29.7-70.8% (median = 56.2%), chlamydia range 3.9-58.6% (median = 25.7%), gonorrhea range 2.0-85.4% (median = 16.4%), and trichomoniasis range 7.1-43.2% (median = 12.5%). HIV prevalence has remained relatively low and stable with a range of 0-10.3% (median = 0.6%), with the exception of higher prevalence in several areas of Yunnan and some areas of Guangxi. The FSW who are injecting drug users may be at even greater risk for HIV infection with 12-49% found to be HIV positive and 7-25% self-reporting positive status. A number of gaps in the literature remain, especially in the number of studies that detail prevalence confirmed by laboratory testing or that collect incidence data. Assessment of incidence and prevalence according to sampling methodology appropriate for the population, behavioral risks such as injecting drug use, and diverse venues especially those at the lower end are needed. Theory-based interventions to reduce the incidence and prevalence of HIV/STIs need to be piloted with successful models scaled-up.