Open Access Highly Accessed Research article

An integrated individual, community, and structural intervention to reduce HIV/STI risks among female sex workers in China

Dianmin Kang1*, Xiaorun Tao1, Meizhen Liao1, Jianzhuo Li2, Na Zhang1, Xiaoyan Zhu1, Xiaoguang Sun1, Bin Lin1, Shengli Su1, Lianzheng Hao1 and Yujiang Jia3*

Author Affiliations

1 Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China

2 Institute for AIDS/STD Control and Prevention, Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong Province 250001, P. R. China

3 Department of Preventive Medicine, Vanderbilt University, Nashville, TN 37232, USA

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BMC Public Health 2013, 13:717  doi:10.1186/1471-2458-13-717

Published: 4 August 2013



We assessed the effectiveness of an integrated individual, community, and structural intervention to reduce risks of HIV and sexually transmitted infections (STIs) among female sex workers (FSWs).


The integration individual, community, and structural intervention was implemented from 2004 to 2009 in six counties of Shandong Province. Post-intervention cross-sectional surveys were conducted in six intervention counties and 10 control counties.


Of 3326 female sex workers were recruited and analyzed in the post-intervention survey with 1157 from intervention sites and 2169 from control sites. No HIV positive was found in both intervention and control counties. The rate of syphilis was 0.17% for intervention sites and 1.89% for control sites (OR = 11.1, 95% CI: 2.7, 46.1). After adjusted for age, marital status, education, economic condition, recruitment venues, the rates of condom use in the last sex with clients(AOR = 2.7; 95% CI: 1.9, 3.8), with regular sex partners(AOR = 1.5; 95% CI: 1.1, 1.9) and consistent condom use in the last month with clients (AOR = 3.3; 95% CI: 2.6, 4.1) and regular sex partners (AOR = 1.7; 95% CI: 1.3, 2.3) were significantly higher in intervention sites than that in control sites. The proportion of participants correctly answered at least six out of eight HIV-related questions (83.3%) in intervention sites is significant higher than that (21.9%) in control sites (AOR = 24.7; 95% CI: 2.5, 42.7), the five indicators related to HIV-related intervention services ever received in the last year including HIV testing(AOR = 4.9; 95% CI: 2.8, 6.7), STD examination and/or treatment(AOR = 5.1; 95% CI: 4.2, 6.4), free condom(AOR = 20.3; 95% CI: 14.3, 28.9), peer education(AOR = 4.3; 95% CI: 3.5, 5.4), education materials(AOR = 19.8; 95%CI: 13.1, 29.8) were significantly higher in intervention sites than that in control sites, the participants in the intervention sites are more likely to seek medical treatment when they had any disorders (AOR = 3.2; 95% CI: 2.5, 4.2).


This study found that the integrated individual, community, and structural intervention showed positive impact in reducing HIV and STI risks among FSWs.

Female sex workers; HIV; Condom use; Intervention counties; China