Trajectories of peer victimization among left-behind children in rural China: The role of positive school climate.

Left-behind children are likely to experience peer victimization, which can have detrimental consequences in their developmental outcomes. Yet, limited longitudinal research have examined peer victimization trajectories over time or the factors associated with left-behind children in China. The purpose of the present study was to examine what, if any, distinct trajectories of peer victimization exist among left-behind children and whether these trajectories are related to school climate, left-behind status, and their interactions. Participants were 853 Chinese left-behind children (Mage = 14.25, SD = 2.39; 43.4% girls) who participated in a four-wave longitudinal study conducted in rural China. Participants reported school climate (indexed by safety and order, acceptance and support, equality and fairness, autonomy and cooperation) at T1 and peer victimization across T1 to T4 spanning 2 years. Latent class growth analyses identified four peer victimization trajectories, including a stably low-decreasing group, a moderate-decreasing group, a high-decreasing group, and an increasing group. Multinomial logistic regression analyses revealed that children who perceived more positive school climate were more likely to exhibit a stably low-decreasing trajectory compared to the other three groups. In addition, among left-behind children who perceived more positive school climate, children with single-parent migrating were more likely to be members of the stably low-decreasing group as compared to those with both-parent migrating. Peer victimization among left-behind children is a concern especially for those who were left behind by both parents and perceived less positive school climate. Targeted school-based interventions and services focused on reducing peer victimization and improving school climate are needed for left-behind children, especially those with both-parent migrating.

Perceived discrimination and multiple indicators of positive development among second-generation Chinese-American youth: The moderating role of ethnic identity.

BACKGROUND: The present study examined the associations among ethnic identity, perceived discrimination and multiple indicators of positive youth development (PYD; i.e., intrapersonal-oriented competence, interpersonal-oriented competence, confidence, caring, character, family connection, peer connection, school and community connection, positive attitudes towards diversity and cultural pride) that were specifically identified among second-generation Chinese-American youth. METHODS: Participants were 196 second-generation Chinese-American youth (N girl = 93; M age = 14.56, SD age = 1.75) primarily from the greater Boston area in MA, United States. Multivariate regression models were estimated to examine the associations between ethnic identity, perceived discrimination, and each potential indicator of PYD, as well as the moderating role of ethnic identity, controlling for key demographics. RESULTS: (1) Ethnic identity was positively related to all PYD indicators, ßs = .32 to .72, ps < .01; (2) perceived discrimination was negatively associated with all indicators of PYD (ßs = -.15 to -.32, ps < .05), except for interpersonal-oriented competence and caring; and (3) ethnic identity significantly moderated the relationship between perceived discrimination and family connection (ß = .23, p < .01). CONCLUSIONS: Findings indicate that whereas discrimination has potential negative effects on the positive development of second-generation Chinese-American youth, ethnic identity may be a key strength that should be considered in PYD promotion practices for these youth.

Integrating Youth Readiness Intervention and Entrepreneurship in Sierra Leone: A Hybrid Type II Cluster Randomized Trial.

OBJECTIVE: Conflict-affected youth are at risk for poor psychological and social outcomes, yet few receive mental health services. Strategies to expand access and sustain evidence-based interventions (EBIs) across novel delivery platforms must be tested. The present study was a hybrid type II implementation-effectiveness trial using a cluster randomized design. The primary goal was to evaluate feasibility and impact of using the collaborative team approach to deliver the Youth Readiness Intervention (YRI), an EBI, integrated into a youth entrepreneurship program (ENTR) with quality control in post-conflict Sierra Leone. METHOD: Youth were screened and randomly assigned to control, ENTR, or combined YRI and ENTR (YRI+ENTR). Implementation outcomes were dissemination and implementation indicators, competence, and fidelity. Effectiveness outcomes were emotion regulation, psychological distress, and interpersonal functioning. Secondary outcomes were third-party reporter assessments of youth functioning and behavior. RESULTS: Data were collected and analyzed from 1,151 youth participants and 528 third-party reporters. Scores on implementation constructs, competence, and fidelity demonstrated acceptable intervention response and quality. YRI+ENTR participants showed overall improvements in depression (ß = -.081, 95% CI -0.124 to -0.038, d = -0.154) and anxiety (ß = -.043, 95% CI -0.091 to -0.005, d = 0.082) symptoms compared with control participants. Community leaders indicated that YRI+ENTR participants demonstrated improvements in overall work or training performance compared with control participants (ß = -.114, 95% CI 0.004 to 0.232, d = 0.374). CONCLUSION: Integration of EBIs such as the YRI into youth employment programs has the potential to address limited reach of EBIs in conflict and post-conflict settings. A collaborative team implementation approach can facilitate integration and fidelity. PLAIN LANGUAGE SUMMARY: In a Hybrid Type-II Implementation-Effectiveness trial conducted in Sierra Leone, researchers tested a Collaborative Team Approach (CTA) for delivering an evidence-based mental health intervention, the Youth Readiness Intervention (YRI), within a youth entrepreneurship program. A total of 1,151 youth participated in the study, with outcomes measured on youth mental health indicators of emotional regulation, psychological distress, and interpersonal functioning, as well as implementation indicators, competence, and fidelity. Results demonstrated that the integrated YRI and entrepreneurship program led to significant improvements in depression and anxiety symptoms compared to the control group. Community leaders also noted enhanced overall performance in YRI participants, suggesting that integrating evidence-based interventions into youth employment programs can effectively address mental health challenges in low-resource regions. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper received support from a program designed to increase minority representation in science. CLINICAL TRIAL REGISTRATION INFORMATION: Youth FORWARD Phase 2 YRI and EPP Study; https://clinicaltrials.gov/; NCT03542500. STUDY PREREGISTRATION INFORMATION: Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD): Study Protocol; https://doi.org/10.1176/appi.ps.202000009.

Reciprocal associations between peer victimization and depressive symptoms among Chinese children and adolescents: Between- and within-person effects.

Peer victimization is detrimental to child mental health. Research has indicated a reciprocal relationship between peer victimization and mental health problems. Yet limited evidence was from children and adolescents in China. The present study used the random intercepts cross-lagged panel model (RI-CLPM) to examine both between-person and within-person associations between peer victimization and depressive symptoms among Chinese children and adolescents. Participants were 1205 Chinese students (Mage = 11.27 years; ranged from 9 to 15 years; SD = 1.75; 55% boys) who completed four surveys (Time 1 to Time 4) between 2017 and 2019 on demographics, peer victimization, and depressive symptoms. At the between-person level, peer victimization was positively associated with depressive symptoms. Controlling for between-person effects, RI-CLPM suggested positive within-person effects from peer victimization to depressive symptoms across adjacent waves. The model also suggested a positive within-person effect from Time 2 depressive symptoms to Time 3 peer victimization. The multi-group analysis showed that these effects did not differ by gender, age, or subjective socioeconomic status. Peer victimization and depression appear to be reciprocally related at the transitioning period between late childhood and early adolescence in Chinese students. Mental health interventions should attend to peer victimization for children and adolescents in China.

Measuring Positive Development among College Students in the United States: Investigating Cross-Sectional and Longitudinal Measurement Invariance across Different Racial Groups.

Measures that are applicable to assess the positive youth development (PYD) of racially diverse college students are needed. The present study tested if a revised version of the very short form of the PYD measure (PYD-VSF) was applicable to college students from five racial groups in the U. S. (White, Black, Latinx, Asian, and other) across three measurement occasions. Participants were 5,735 college students who completed the PYD-VSF at least once across the three waves of a longitudinal study. Confirmatory factor analyses (CFA) indicated that a first-order Five Cs structure, a higher-order structure, and a bifactor structure all provided good fit to the data. Multi-group CFA across racial groups found that the first-order structure fit the data better than the higher-order and the bifactor models, and it showed configural-, factor loading-, intercept-, and residual-invariance. Longitudinal CFA models of the first-order structure supported configural-, factor loading-, intercept-, and residual-invariance. The revised PYD-VSF measure has shown the potential to assess PYD among college students of diverse racial-ethnic backgrounds.

Latent profiles and transition of perceived parental control and their relationship with the psychosocial well-being among rural-to-urban migrant adolescents.

The present study examined what, if any, patterns of parental control are associated with multiple indicators of psychosocial well-being and whether changes in these patterns over time predict subsequent psychosocial well-being. Latent profile analyses and latent transition analyses were applied to identify subgroups of parental control and transitions of these patterns over time among rural-to-urban migrant adolescents who participated in two waves of surveys with 6-month interval in 2014 (NT1  = 660, NT2  = 553). Multivariate logistic regression was conducted to explore their relationship with psychosocial well-being. Four latent profiles were identified based on levels of parental control at wave 1 and wave 2, respectively. The high psychological and behavioral control (HPHB) group was associated with worse psychosocial well-being whereas the low psychological control and high behavioral control (LPHB) group exhibited opposite relationships. Six transitioning groups were identified: "stably low-risk" (14.92%), "stably medium-risk" (7.37%), "stably high-risk" (24.49%), "floating LPHB" (26.52%), "high-decreasing" (15.10%), and "low-increasing" (11.60%) groups. The "stably high-risk" and "low-increasing" groups showed a higher risk in psychosocial well-being. Youth exhibiting higher risks of parental control (i.e. individuals in HPHB groups and higher-risk transition patterns over time) should prioritize for interventions and services.

Classifying childhood war trauma exposure: latent profile analyses of Sierra Leone's former child soldiers.

BACKGROUND: Former child soldiers are at elevated risk for mental health problems (e.g., traumatic stress, emotion dysregulation, and internalizing and externalizing problems). To examine which groups of former child soldiers are more likely to have difficulties with emotion regulation, interpersonal relationships, and mental health postconflict, we explored patterns of war trauma exposure and their effects on subsequent mental health problems among former child soldiers in Sierra Leone. METHODS: Participants were 415 (23.86% female) Sierra Leonean former child soldiers participating in a 15-year, four-wave longitudinal study. At T1 (2002), 282 former child soldiers (aged 10-17) were recruited. T2 (2004) included 186 participants from T1 and an additional cohort of self-reintegrated former child soldiers (NT2 = 132). T3 (2008) and T4 (2016/2017) participants were youth enrolled in previous waves (NT3 = 315; NT4 = 364). Latent profile analysis (LPA) was used to classify participants based on the first-time reports of eight forms of war exposure (separation and loss of assets, parental loss, loss of loved ones, witnessing violence, victimization, perpetrating violence, noncombat activities, and deprivation). ANOVA examined whether patterns of war exposure were associated with sociodemographic characteristics and mental health outcomes between T1 and T4. RESULTS: LPA identified two profiles: higher exposure versus lower exposure, using cumulative scores of eight forms of war-related trauma exposure. The 'higher war exposure' group comprised 226 (54.5%) former child soldiers and the 'lower war exposure' group included 189 (45.5%). Significantly higher levels of violence-related and combat experiences characterized the group exposed to more traumatic events. The 'higher war exposure' group reported more PTSD symptoms at T2, more hyperarousal symptoms across all waves, and more difficulties in emotion regulation at T4. CONCLUSIONS: Former child soldiers exposed to higher levels of war-related traumatic events and loss should be prioritized for mental health services immediately postconflict and as they transition into adulthood.

What Really Matters for Loneliness Among Left-Behind Children in Rural China: A Meta-Analytic Review.

In rural China, left-behind children are likely to suffer chronic loneliness. Research has identified a variety of factors that may be associated with loneliness among these children. A meta-analysis is needed to address the empirical inconsistencies and examine the strength of relations between different factors and loneliness. The current meta-analysis included 51 studies on predictors of loneliness published from 2008 to 2017. Results showed that one individual factor (social anxiety) is a key risk factor for loneliness, whereas eight individual (older age, self-esteem, resilience, extroversion) and contextual factors (family functioning, parent-child relationship, peer relationship, social support) serve as protective factors in predicting loneliness. In addition, boys were more likely to feel lonely than girls. Findings and implications of this study were discussed.

Peer motivational climate and character development: Testing a practitioner-developed youth sport model.

Youth sport is a key developmental context for many reasons, including the opportunities it provides for building relationships with peers and its potential to support character development. Peers can influence adolescent sport experiences and shape their motivations, and different peer motivational climates may differentially support athlete character. Established models identify different dimensions of peer motivational climate, yet these models do not describe how aspects of peer climate may align with character. We therefore assess profiles of peer motivational climate in relation to a multi-dimensional practitioner-developed theoretical model for character development through sport. Participants were 655 adolescent athletes from the greater Boston area, in the United States. Athletes perceiving a mastery-involved peer climate, even with high intra-team competition, were most likely to exhibit positive character attributes at the three levels of character assessed: themselves, their teammates, and the game. This study also demonstrates the utility of practitioner-developed models for adolescent research.

Future Orientation, Social Support, and Psychological Adjustment among Left-behind Children in Rural China: A Longitudinal Study.

Existing research has found that parental migration may negatively impact the psychological adjustment of left-behind children. However, limited longitudinal research has examined if and how future orientation (individual protective factor) and social support (contextual protective factor) are associated with the indicators of psychological adjustment (i.e., life satisfaction, school satisfaction, happiness, and loneliness) of left-behind children. In the current longitudinal study, we examined the differences in psychological adjustment between left-behind children and non-left behind children (comparison children) in rural areas, and explored the protective roles of future orientation and social support on the immediate (cross-sectional effects) and subsequent (lagged effects) status of psychological adjustment for both groups of children, respectively. The sample included 897 rural children (Mage = 14.09, SD = 1.40) who participated in two waves of surveys across six months. Among the participants, 227 were left-behind children with two parents migrating, 176 were with one parent migrating, and 485 were comparison children. Results showed that, (1) left-behind children reported lower levels of life satisfaction, school satisfaction, and happiness, as well as a higher level of loneliness in both waves; (2) After controlling for several demographics and characteristics of parental migration among left-behind children, future orientation significantly predicted life satisfaction, school satisfaction, and happiness in both cross-sectional and longitudinal regression models, as well as loneliness in the longitudinal regression analysis. Social support predicted immediate life satisfaction, school satisfaction, and happiness, as well as subsequent school satisfaction. Similar to left-behind children, comparison children who reported higher scores in future orientation, especially future expectation, were likely to have higher scores in most indicators of psychological adjustment measured at the same time and subsequently. However, social support seemed not exhibit as important in the immediate status of psychological adjustment of comparison children as that of left-behind children. Findings, implications, and limitations of the present study were discussed.

Is the Scoutreach Initiative of Boy Scouts of America Linked to Character Development among Socioeconomically, Racially, and Ethnically Diverse Youth?: Initial Explorations.

Youth development programs represent key tools in the work of youth-serving practitioners and researchers who strive to promote character development and other attributes of youth thriving, particularly among youth who may confront structural and social challenges related to their racial, ethnic, and/or economic backgrounds. This article conducts secondary analyses of two previously reported studies of a relatively recent innovation in Boy Scouts of America (BSA) developed for youth from low-income communities, Scoutreach. Our goal is to provide descriptive and admittedly preliminary exploratory information about whether these data sets-one involving a sample of 266 youth of color from socioeconomically impoverished communities in Philadelphia (M age = 10.54 years, SD = 1.58 years) and the other involving a pilot investigation of 32 youth of color from similar socioeconomic backgrounds in Boston (M age = 9.97 years, SD = 2.46 years)-provide evidence for a link between program participation and a key indicator of positive development; that is, character development. Across the two data sets, quantitative and qualitative evidence suggested the presence of character development among Scoutreach participants. Limitations of both studies are discussed and implications for future longitudinal research are presented. We suggest that future longitudinal research should test the hypothesis that emotional engagement is key to creating the conditions wherein Scoutreach participation is linked to character development.

A pedigree-based proxy measure of genetic predisposition of drinking and alcohol use among female sex workers in China: a cross-sectional study.

Scientific evidence has suggested that genetic factors accounted for more than half of the vulnerability of developing alcohol use problems. However, collecting genetic data poses a significant challenge for most population-based behavioral studies. The aim of this study was to assess the utilities of a pedigree-based proxy measure of genetic predisposition of drinking (GPD) and its effect on alcohol use behaviors as well as its interactions with personal and environmental factors. In the current study, cross-sectional data were collected from 700 female sex workers (FSW) in Guangxi, China. Participants provided information on a pedigree-based proxy measure of GPD and their alcohol use behaviors. Chi-square and independent t-test was applied for examining the bivariate associations between GPD and alcohol use behaviors; multivariate and ordinal regression models were used to examine the effect of GPD on alcohol use. This study found that women with a higher composite score of GPD tended to have a higher risk of alcohol use problem compared to their counterparts (p < .05). GPD was a significant predictor of alcohol use problems (p < .05), especially among women who had mental health issues or lack of health cares. The pedigree-based measure provided a useful proxy of GPD among participants. Both FSW's mental health and health care access interact with GPD and affect their drinking patterns. By understanding the genetic basis of alcohol use, we can develop scalable and efficacious interventions that will take into consideration the individual risk profile and environmental influences.

HIV risk among female sex workers with different patterns of drug use behaviors in Southwest China: a cross-sectional study.

Although many researchers found that drug use behaviors significantly increased HIV risk, few of them investigated the association between HIV risk and different drug use behaviors among female sex workers (FSWs) in China. The current study examines demographic and behavioral risk factors as well as the infections of HIV, syphilis, and among a subgroup of FSWs who are injection drug users (IDU) or noninjection drug users (NIDU) in comparison to Hepatitis C Virus (HCV) nondrug users (non-DU). We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSWs recruited from Guangxi, China. The Guangxi 2010 NSS sample included 2.6% NIDU and 0.5% IDU. Compared to non-DU, IDU were more likely to report no condom use in the last sex act (aOR = 3.25, 95%CI = 1.65, 6.40), inconsistent condom use in the past month (aOR = 4.88, 95%CI = 2.66, 8.96), having an HIV testing (aOR = 2.48, 95%CI = 1.34, 4.58), infections of HIV (aOR = 42.60, 95%CI = 9.45, 192.06), syphilis (aOR = 4.13, 95%CI = 1.86, 9.16), and HCV (aOR = 74.54, 95%CI = 30.26, 183.61). NIDU had 2.89 times higher than non-DU to report a history of sexually transmitted disease and 26% less likely to report inconsistent condom use in the past month (p < 0.05). We called for tailored, accessible, and nonjudgmental drug treatments coupled with effective sexual risk reduction interventions to help FSWs with various drug use problems to reduce their vulnerability and susceptibility of HIV risk in China as well as other cultural settings.

Violence against Chinese female sex workers from their stable partners: a hierarchical multiple regression analysis.

Limited data are available regarding risk factors that are related to intimate partner violence (IPV) against female sex workers (FSWs) in the context of stable partnerships. Out of the 1,022 FSWs, 743 reported ever having a stable partnership and 430 (more than half) of those reported experiencing IPV. Hierarchical multivariate regression revealed that some characteristics of stable partners (e.g., low education, alcohol use) and relationship stressors (e.g., frequent friction, concurrent partnerships) were independently predictive of IPV against FSWs. Public health professionals who design future violence prevention interventions targeting FSWs need to consider the influence of their stable partners.

Predictors of consistent condom use among Chinese female sex workers: an application of the protection motivation theory.

We utilized Protection Motivation Theory to assess predictors of intention and behavior of consistent condom use among Chinese female sex workers (FSWs). A self-administered questionnaire was used in a cross-sectional survey among 700 FSWs in Guangxi, China. Multivariate logistic regression analysis indicated that extrinsic and intrinsic rewards, self-efficacy, and response costs predicted consistent condom use intention and behavior among FSWs. Sexually transmitted infection/ HIV prevention programs need to reduce FSWs' perceptions of positive extrinsic rewards and intrinsic rewards for engaging in consistent condom use, reduce FSWs' perception of response costs for using a condom, and increase condom use self-efficacy among FSWs.

Positive youth development in rural China: the role of parental migration.

This study examined how parental rural-to-urban migration may affect left-behind children's development in rural China. We used two-wave data collected on 864 rural youth age 10-17 years in the Guangxi Province, China in 2010. We tested psychometric properties of a positive youth development (PYD) model theorized and corroborated in the US, compared a range of developmental outcomes among rural youth by their parental migration status, and explored the mediating role of family economic and social resources in observed associations between developmental outcomes and parental migration. The results showed the PYD model had some international validity although modifications would be needed to make it more suitable to Chinese settings. Little difference in the PYD outcomes was detected by parental migration status. On other outcomes (i.e., self-rated health, school grades, educational aspirations, problem behavior), positive influences of parental migration were observed. Increased income but not social resources in migrant families helped explain some of these patterns. The take-home message from this study is that parental migration is not necessarily an injurious situation for youth development. To advance our knowledge about the developmental significance of parental migration for rural Chinese youth, we urgently need large-scale representative surveys to collect comprehensive and longitudinal information about rural children's developmental trajectories and their multilevel social contexts to identify key resources of PYD in order to better help migrant and non-migrant families nurture thriving youth in rural China.

Social context factors, refusal self-efficacy, and alcohol use among female sex workers in China.

Excessive alcohol use is considered as a health-risk behavior that may produce negative health outcomes. Examining predictors of alcohol use in social and individual contexts can advance understanding of why people indulge in alcohol use. Our research on female sex workers (FSWs) examined associations among several social context factors (alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence), refusal self-efficacy, and alcohol use. Seven hundred FSWs were recruited from two cities in southern China. Structural equation modeling (SEM) was used to analyze the direct effects of alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence on FSWs' alcohol use. In addition, the mediation effects of refusal self-efficacy were also examined in the SEM model. Results showed that alcohol use by family members and alcohol use by peers significantly predicted FSWs' alcohol use; the prediction effect of alcohol use by peers on FSWs' alcohol use was stronger than that of alcohol use by family members; client-perpetrated pressure or violence directly predicted FSWs' alcohol use and indirectly influenced FSWs' alcohol use through refusal self-efficacy; refusal self-efficacy directly predicted FSWs' alcohol use. Administrators of effective intervention programs focused on alcohol use in China should adopt a multilevel approach to reduce negative social influences, particularly the influence from peer and sex work establishments on FSWs' alcohol use. Meanwhile, training to improve refusal self-efficacy should also be included in the intervention programs to reduce FSWs' alcohol use.

Psychological stressors in the context of commercial sex among female sex workers in China.

Because of the illegality and stigma associated with female sex workers (FSWs) in China, data were limited regarding their psychological stressors examined through the lens of occupational health. Analyzing qualitative data from 16 gatekeepers and 38 FSWs, we explored these stressors in the context of commercial sex in China. We found that FSWs faced a continuum of stressors that resulted from poverty, limited employment, lack of social protection, violence perpetrated by clients, and limited social support from peers and stable partners. We call for empowerment and a structural approach to address the needs of FSWs to improve their psychological well-being.

HIV-related behavioral risk factors among older female sex workers in Guangxi, China.

Previous literature suggests a high rate of HIV infections among older female sex workers (FSWs) in China. However, limited data are available regarding HIV- related behavioral risk factors among this population. In the current study, we aim to examine the demographic and behavioral factors that place older FSWs at a high risk of HIV infection. We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi, China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSWs in Guangxi, China. The Guangxi 2010 NSS sample included 19.4% FSWs aged 35 years or older ("older FSWs"). The overall HIV prevalence was 1.0% for the entire sample with 2.0% among older FSWs and 0.8% among younger ones. Older age was an independent predictor of unprotected sex, injection drug use, and a self-reported history of syphilis infection. Future HIV prevention interventions targeting FSWs should consider older FSWs' vulnerable status. Efforts are needed to address their financial needs and invest in skills for socio-economic empowerment.

Prevalence of HIV, syphilis, and HCV infection and associated risk factors among male clients of low-paying female sex workers in a rural county of Guangxi, China: a cross-sectional study.

BACKGROUND: The purpose of this study was to examine prevalence of HIV, syphilis and hepatitis C virus (HCV) infection as well as related risk factors among a group of male clients of low-paying female sex workers (FSW) (eg, women who usually encounter their clients on the street or small establishments in rural or less developed areas, or who charge low fees for each sexual service) in a rural county of China. METHOD: Cross-sectional study conducted in 2011 in a rural county of Guangxi in China. A total of 102 clients who reported information on demographics and HIV risks (eg, inconsistent condom use) and provided blood sample to test for HIV, HCV and syphilis were included in the data analysis. Both bivariate and multivariate analyses were employed to explore risk factors of HIV, HCV and syphilis infection. RESULTS: Most of participants were of Han ethnicity with a mean age of 61.8 years. The majority of them lived in rural areas and worked as farmers with limited disposable cash incomes. The sample reported a high rate of unprotected sex with FSW in the last sex episode (83.7%) and inconsistent condom use in the last 6 months (95.9%). The overall prevalence of HIV, HCV and syphilis was 1.9%, 1.0% and 18.4%, respectively. CONCLUSIONS: Findings suggest that male clients, especially the elderly ones, are at a high risk of HIV infection given prevalent unprotected sex and high prevalence of syphilis. Culturally-appropriate, age-specific interventions are urgently needed to curb the HIV/sexually transmitted infection epidemic among this at-risk population in China.