Evaluation of an HIV-related behavior change project for female sex workers in Central China

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As female sex workers (FSWs) were becoming the driving force behind the HIV epidemic in Central China, a project to promote condom use by FSWs was implemented from 2004 to 2009. In this study, we discussed the evaluation of the project, the factors associated with condom use among FSWs within the Chinese context, and proposed suggestions for future interventions for FSWs in China.


Two surveys using structured questionnaires were conducted in 2004 and 2009. Data collected from the surveys were analyzed and guided by a behavior change framework. We reviewed relevant articles to supplement the information that was not able to be obtained from the surveys.


In general, the HIV prevalence among FSWs remained low (less than 1%) in the 5 years. With a high coverage of interventions for all FSWs in Central China, the project yielded better outcomes than the national average over the same time period. The awareness about HIV and condom use grew dramatically during the project period. The four factors/ determinants that influence the behavior of FSWs using condoms are population characteristics, opportunity, ability, and motivation. Statistical model shows that the significant variables for using a condom are age, availability of services, HIV-related knowledge, and intention.


With a high coverage of interventions for FSWs, the project achieved its goals. The differences among workplaces of FSWs may serve as a symbol of their socioeconomic status, patterns of condom use, and therefore risks of acquiring HIV.

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