China faces a new HIV/STI challenge: HIV/STIs are spreading among the older adult population (e 50 years). The HIV/STI epidemics in older adults are driven by older female sex workers (e35 years), with the majority of HIV infected older adults reporting a history of cheap commercial sex with these women. Therefore, effective interventions must target older female sex workers - the main source of HIV/STI transmission. However, few epidemiologic data from community-based studies are currently available to examine the nature and contexts of sexual risk for HIV/STIs among older female sex workers in China. Our long-term goal is to develop an HIV/STI intervention that is culturally sensitive for older female sex workers. The objective in this particular application is to quantify the collective roles of social network components (relations, structures, and functions) and environmental factors (physical, social and political factors) on HIV/STI risk behavior in older female sex workers. The central hypothesis is that network-based interpersonal factors mediate the effects of environmental factors on HIV/STI risk behavior in female sex workers aged 35 years or older. The formulation of this hypothesis is based on the social ecological model, the feature of Chinese collectivistic culture, and our previous studies of social networks. We will achieve the objective by pursuing the following specific aims: (1) qualitatively describe environmental and social network factors for sexual risk among older Chinese female sex workers;(2) determine the prevalence of HIV and syphilis;and (3) quantitatively examine the collective roles of social network components and environmental factors on sexual risk for HIV/STIs.
Aim 1 will be addressed by conducting in-depth interviews with older female sex workers and focus groups with stakeholders (e.g., pimps and owners of beauty salons and hotels).
Aims 2 and 3 will be accomplished through a community-based survey of older female sex workers recruited from their social network ties in three cities in China (N=1,200;400/site). This study is significant since (1) little is known about the environmental and social network factors for sexual risk among older female sex workers;and (2) findings will be used to develop the first theory-based HIV intervention that is culturally sensitive for older Chinese female sex workers in China. The application is innovative as (1) it is guided by the social ecological model and social network model;(2) it applies a novel network-based sampling method (i.e., respondent-driven sampling) to recruit more representative samples at the community level;and (3) it uses on- site bio-tests for HIV and syphilis and an on-site bio-test for prostate-specific antigen to validate self-reported condom use. The expected findings of the study will have an important positive impact, because, once the collective roles of the multi-faceted factors for sexual risk are known, intervention strategies can be developed to effectively target these factors, resulting in innovative approaches to the prevention of sexual risk for older female sex workers, which will ultimately reduce the sexual transmission of HIV to the older adult population.

Public Health Relevance

This application targets an important and under-investigated area of social epidemiology that has potential applicability to understanding the collective roles of social network components (relations, structures, and functions) and environmental factors (physical, social and political factors) on HIV/STI risk behavior among older female sex workers. Findings will provide much needed empirical data and theoretical guidance for the development of an effective intervention program to reduce sexual risk for HIV/STIs among older female sex workers.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD068305-05
Application #
8692437
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Newcomer, Susan
Project Start
2011-09-19
Project End
2015-06-30
Budget Start
2014-07-01
Budget End
2015-06-30
Support Year
5
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Maryland College Park
Department
Biostatistics & Other Math Sci
Type
Schools of Public Health
DUNS #
City
College Park
State
MD
Country
United States
Zip Code
20742
Guida, Jennifer; Hu, Liangyuan; Liu, Hongjie (2018) Sexual Behavior With Noncommercial Partners: A Concurrent Partnership Study Among Middle-Aged Female Sex Workers in China. J Sex Res :1-11
Guida, Jennifer; Fukunaga, Ami; Liu, Hongjie (2017) Biomarker validation of self-reported sex among middle-aged female sex workers in China. Ann Epidemiol 27:181-186.e1
Liu, Hongjie (2017) Can Burt's Theory of Structural Holes be Applied to Study Social Support Among Mid-Age Female Sex Workers? A Multi-Site Egocentric Network Study in China. AIDS Behav 21:3567-3577
Liu, Hongjie; Dumenci, Levent; Morisky, Donald E et al. (2016) Syphilis among middle-aged female sex workers in China: a three-site cross-sectional study. BMJ Open 6:e010420
Liu, Hongjie; Morisky, Donald E; Lin, Xinqin et al. (2016) Bias in Self-Reported Condom Use: Association Between Over-Reported Condom Use and Syphilis in a Three-Site Study in China. AIDS Behav 20:1343-52
Xu, Y Q; Li, Y F; Jiang, Z X et al. (2016) [Characteristics of social supportive network serving the older female sex workers in Qingdao]. Zhonghua Liu Xing Bing Xue Za Zhi 37:197-201
Guida, Jennifer; Hu, Liangyuan; Liu, Hongjie (2016) The Impact of Occupational Stigma on the Social Networks of Older Female Sex Workers: Results from a Three-Site Egocentric Network Study in China. AIDS Patient Care STDS 30:1-3
Liu, Hongjie (2016) Egocentric Network and Condom Use Among Mid-Age Female Sex Workers in China: A Multilevel Modeling Analysis. AIDS Patient Care STDS 30:155-65
Hao, Chun; Guida, Jennifer; Morisky, Donald E et al. (2015) Family Network, Workplace Network, and Their Influence on Condom Use: A Qualitative Study Among Older Female Sex Workers in China. J Sex Res 52:924-35
Zang, Chunpeng; He, Xin; Liu, Hongjie (2015) Selective disclosure of HIV status in egocentric support networks of people living with HIV/AIDS. AIDS Behav 19:72-80

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