Open Access Open Badges Research article

A study of HIV/AIDS related knowledge, attitude and behaviors among female sex workers in Shanghai China

Yong Cai15, Rong Shi1, Tian Shen1, Bei Pei1, Xueqin Jiang1, Xiuxia Ye2, Gang Xu1, Shenghui Li1, Hong Huang3* and Meili Shang4

Author affiliations

1 School of Public Health affiliated with Shanghai Jiaotong University School of Medicine, (No.227, South Chongqing Road), Shanghai, (200025), PR China

2 Shanghai Children's Medical Center, affiliated with Shanghai Jiaotong University School of Medicine, (No.1678, Dongfang Road), Shanghai, (200127), PR China

3 Xinhua Hospital affiliated with Shanghai Jiaotong University School of Medicine, (No.1665, Kongjiang Road), Shanghai, (200092), PR China

4 Community Sanitary Service Center of North Sichuan Road, Hongkou Distinct, (No. 300, Tanggu Road), Shanghai, (200085), PR China

5 School of Public Health affiliated with Shanghai Fudan University, (No.130, Dong'an Road), Shanghai,(200032), PR China

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Citation and License

BMC Public Health 2010, 10:377  doi:10.1186/1471-2458-10-377

Published: 28 June 2010



China is currently facing a rapid and widespread increase in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The activities of female sex workers (FSWs) have contributed to the mounting epidemic of HIV/AIDS and other sexually transmitted diseases (STDs). Therefore, this study aimed to assess the HIV/AIDS-related knowledge, attitude and risk behaviors among FSWs operating in Shanghai China.


A cross-sectional study was conducted in five districts of Shanghai, including three suburbs and two downtown locales. We adopted a cluster randomized sampling method to obtain ten geographic sites which consisted of one or more communities/villages proximal to a location where FSWs were accessible. A total of 324 FSWs from 109 Xitou Fang, massage parlors and hair salons who explicitly provided sexual services were enrolled in the study. Each participant completed a questionnaire survey and interview aimed to collect information on the individual's knowledge, attitude, and behaviors associated with risk for HIV/AIDs.


The overall correct answer rate of HIV/AIDS-related knowledge was 60.8%, and the knowledge of FSWs from downtown areas was significantly higher than those from suburban areas (P < 0.05). The percentage of FSWs who reported having experiences in commercial sexual services without the use of condoms was 33.6%. Condom slippage or breakage was reported as having occurred at least once by 51.2% of the FSWs. FSWs from suburban areas were found to more often engage in high-risk behaviors, including oral and anal sex, than those from downtown areas (P < 0.001). Many of the FSWs (65.7%) reported having non-client sexual partners (most were identified as boyfriends or husbands); however, condom usage with these partners were lower (34.3%).


Based on the findings from our survey, we advise that promotion of HIV/AIDS-related knowledge be targeted towards FSWs in Shanghai, especially those operating in the suburbs. HIV prevention efforts, such as urging constant condom usage with both clients and steady partners, should be sustained and reinforced among the female sex workers population.