The Relationship Between Condom Use, Sexually Transmitted Diseases, and Location of Commercial Sex Transaction Among Male Hong Kong Clients

Cross-border commercial sex is an important element in the spread of HIV, the current study reports. Commercial sex clients sometimes serve as "bridge populations," transmitting the disease from one place to another. Surveys have estimated that approximately 12-14 percent of the adult male population of Hong Kong engaged in commercial sex within the previous six months, and about half of them patronized female sex workers (FSW) in mainland China.

Hong Kong residents visited mainland China 50 million times in 2002, according to the report. More than 10,000 of those travelers, studies estimate, patronized FSW daily. There are an estimated 600,000+ HIV-infected persons in China, and increased rates of STDs have been reported in China and Hong Kong over the past few years.

The authors undertook the current study to examine whether or not consistent condom use by Hong Kong commercial sex clients varies by the geographical location of the commercial sex transaction, and to determine whether the prevalence of self-reported STDs during the previous six months varies geographically, independent of condom use.

Investigators conducted three independent, population-based surveys in 1998, 1999 and 2001. The surveys interviewed 1,020, 2,074 and 2,065 male Hong Kong residents, respectively, in the three years. A total of 618 men were identified as having had sexual intercourse with FSW during the previous six months: 143 (14 percent) in 1998, 252 (12.2 percent) in 1999 and 223 (10.8 percent) in 2001.

The study classified respondents into four groups by the location of commercial sex: Hong Kong only (18 percent), mainland China only (18.2 percent), mainland China and other places (44.9 percent) and other scenarios (combinations not included in the prior categories, 18.9 percent). The authors found that subjects patronizing FSW in mainland China only and mainland China and other places were more likely to be inconsistent condom users (28 and 34 percent, respectively) than those who fit into the Hong Kong only category (9.1 percent). Furthermore, the prevalence of self-reported STDs among FSW patrons in mainland China (10.1 percent) and patrons in mainland China and other places (8.1 percent) were much higher than among FSW patrons in Hong Kong only (1.0 percent). Further analysis showed that patronizing FSW in mainland China was associated with higher self-reported STDs independent of consistent condom use and other factors such as age and education.

"The results of this study indicate that the social and cultural milieu of the geographical location where commercial sex acts take place needs to be carefully considered when promoting safer sex measures among commercial sex clients," the authors wrote. "The data suggest that condom use depends not only on the characteristics of individual commercial sex clients, but is likely to be related to the local socioeconomic, cultural and health environments. This may include factors such as HIV or STD-related knowledge, the attitudes and practices of FSW, as well as their extent of control over condom use."

Lau and co-authors point to the increasing prevalence of HIV in the Pearl Delta Region and suggest that because of observed bridging effects, the low HIV prevalence in Hong Kong might not be maintained. "The results of this study substantiate concerns over the bridging effect on the future trajectory of the HIV epidemic in Hong Kong," they wrote. "To increase the number of consistent condom users in mainland China is, therefore, a high priority of AIDS prevention workers in Hong Kong. A regional approach needs to be taken."

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