HIV, Unsafe Sex, and STIs

Among Women Working in China’s Entertainment Industry


Written by Xiushi Yang, this article explores the prevalence and risk factors of unsafe sex and STIs. 724 female entertainment workers in Shanghai were studied. According to Xiushi (2011), "in 2007, an estimated 50,000 persons in China were newly infected with HIV, and by the year’s end, China was home to 700,000 persons living with HIV/AIDS" (p. 75).


  • 2 Administrative Districts in Shanghai were studied; 1 was the control site and 1 was the intervention site.
  • 24 establishments agreed to the study (Included 13 karaoke bars, 10 massage parlors, and 1 beauty salon)
  • Took place from March to June 2008
  • 724 women consented to the study. After 3 months, only 445 women remained to take the survey.
  • Surveys were completed through face-to-face interviews.


  • Outcome Variables - HIV/STI unsafe sex and history of STIs
    As noted by Xiushi (2010), "unsafe sex is measured by a dichotomous variable, which takes the value of 1 if a respondent self-reported unprotected sex with a casual partner the previous month or a condom was not used in all last three intercourses with a casual partner, and 0 otherwise. History of STIs is measured by self-reports of ever being diagnosed with gonorrhea, syphilis, genital warts, Chlamydia, and/or genital herpes" (p. 77).

  • Explanatory Variables - IMB and Social Risk Factors
  • IMB Measures-
    Behavioral skills index: Five-point scale to seven questions about self-perceived ability to use a condom in sex with a casual partner
    HIV related information/knowledge: Number of correct answers to 16 questions about how HIV is obtained and is not obtained.
    HIV prevention motivation: Negative attitude toward condom index is based on answers on a five-point scale to six questions about condom use.

  • Social Risk Factors-
    Perceived peer support for condom-use:
    Five-point scale to four questions about respondents’ perceptions about how their peers would think about condom-related preventive behaviors.
    Lack of relationship power: Five-point scale to seven questions about the extent to which women should obey their partner in decisions related to sexual practice.
    Venue Support: Five- point scale to questions about rules and practices related to HIV prevention in the establishment.


  • Greater than 17% had unprotected sex with a casual or commercial sex partner in the month prior to the interview or that a condom was not used in all last three intercourses with a casual or commercial partner
  • Almost 5% self-reported a history of STIs.
  • Poor education appears to be a particularly significant risk factor for STIs.
  • Positive association between perceived personal risk of HIV and unprotected casual sex.
  • Important risk factors when it comes to being diagnosed with an STI: education, venue supports for HIV prevention, and unprotected casual sex.


  • Selection of entertainment establishments was not strictly random.
  • The measure of unsafe sex was entirely based on self- reports which can be biased.
  • Covariates of the outcome variables, such as access to condoms and health care and substance abuse, were not available or had high rates of non-response in the data-set and consequently cannot be controlled for in the multiple logistic regression analysis.

Article Information

Yang, X. (2010). Prevalence and correlates of HIV unsafe sex and STIs among
women working in China’s entertainment industry. AIDS Care, 23(1). 75-82.
doi: 10.1080/09540121.2010.525620