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Microbicide and Female Condom Acceptability for HIV/STD Prevention Among Female Sex Workers in Southern China
Research Method: Basic Research
Principal Investigators: Margaret R. Weeks, Ph.D., PI (ICR), Susu Liao, Ph.D., Co-PI (Peking Union Medical College)
Grant: Fogarty International Research Collaboration Award for HIV-AIDS
Partners: Department of Epidemiology, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS)
Dates of Study: 2003-2006

Abstract
HIV/AIDS and STDs have become important issues in China in the past two decades, with the rising rate of HIV/STD infection, particularly among women. Though HIV/AIDS campaigns have been launched for years by the Chinese government, the population's knowledge of HIV/AIDS is superficial and perception of risk is extremely low. Additionally, social stigma associated with an HIV-positive diagnosis generates a reluctance to access testing, treatment, or information on prevention. The lack of knowledge and prevention models is combined with a shift in social and economic structures, and gender norms, leading to increased drug use and female prostitution in both rural and urban areas, and increased risk for HIV/STD infection. Innovative and multiple HIV/STD prevention approaches, including women-controlled methods, are desperately needed. This three-year study aims to generate knowledge regarding the acceptability of vaginal microbicides and female condoms for high-risk women in China, and these women's ability and willingness to use them for HIV/STD prevention. The study extends the work of ICR's "Microbicide Acceptability to Prevent HIV in High-Risk Women" project by replicating some of the project's design in the Chinese context. This study intends to establish a foundation for a future, larger study of microbicide and female condom acceptability in China.

Project Goals and Objectives


	Examine in three southern Chinese rural and semi-rural towns the readiness for and acceptability of vaginal microbicide prevention methods and the female condom among Chinese female sex workers who are at high risk of contracting or transmitting HIV through unprotected sex.
	Identify the contextual factors in the Chinese setting that affect acceptability of microbicide products and the female condom, including ethnic/cultural beliefs, peer norms, personal risk context (prostitution, migration, abusive partners), economic conditions, social settings, partners and partner relationships, and concern for reproduction.
	Assess the conditions under which Chinese female sex workers will be willing and/or able to use a vaginal microbicide for HIV prevention during their regular sexual activity with their primary, casual, or paying partners.
	Assess the conditions under which Chinese female sex workers will be willing and/or able to use a female condom for HIV prevention during their regular sexual activity with their primary, casual or paying partners.
	Establish the international research partnership, infrastructure and foundation for conducting a larger study of microbicide and female condom acceptability and adoption for HIV/STD prevention with female sex workers in these three or other rural and semi-urban towns in southern China.

Staff Contact:
Margaret R. Weeks, Ph.D.,
Principal Investigator
Associate Director, ICR

Project Staff:
ICR
Margaret R. Weeks, Ph.D., Principal Investigator
Associate Director, ICR

Maryann Abbott, M.A., Ethnographic Trainer

PUMC
Susu Liao, Ph.D.,
Co-Principal Investigator

Project Details
The project will work in three target communities (Fushan, Yongfa, Pingxiang) in the southern Chinese provinces of Hainan and Guangxi. The three communities all have locations that serve as sex establishments (roadside restaurants, hair, beauty and massage parlors, and hotels), and out of which female sex workers operate. The study uses both quantitative and qualitative methods to identify factors that affect the acceptability and use of microbicides and female condoms among high-risk women from the target areas. These factors include: ethnic background, age, martial status, local variations in sex work, educational attainment, reproductive intentions, current contraceptive/STD-prevention methods, history of STD infection, prior exposure to prevention interventions, sexual assertiveness, relationship power, history of abuse, number of sex partners, and prior experience with a female-controlled HIV/STD prevention method. Staff of local collaborating institutions will identify and recruit woman and proprietors for the different components of the study, which will take place in each town, including: 1) elicitation exercises with 40 sex workers; 2) in-depth interviews of 15 sex workers and 5 proprietors; and 3) a survey of 100 sex workers.

A significant component of the study is the transfer and sharing of technologies of research methodologies among the international team of research collaborators, and from the research institutes in the U.S. and China to the local partner organizations in each of the study sites. Staff of local institutions, primarily health agencies, will receive training in both qualitative and quantitative research methods. Qualitative methods, which receive limited consideration in medical and public health training in China, combined with quantitative research, are important tools for conducting applied public health research. This study will set the foundation (training, local relationships, initial data) for a larger microbicide and female condom acceptability study in these - and other - southern Chinese provinces.

Project Findings
Poster presentation - Ethnographic component (pdf)

Link to Research Methods page

Links to Other Projects
Microbicide Acceptability to Prevent HIV in High-Risk Women
Female Condom Use in High Risk Women as Predictor of Microbicide Readiness

Links to External Sites
John E. Fogarty International Center for Advanced Study in the Health Sciences
Peking Union Medical College
Chinese Academy of Medical Sciences