SPH & DCFM newsletter

December 1st is World AIDS Day. To highlight the continuing efforts to prevent this potentially devastating disease, we published results from a study from the Centre for Health Behaviours Research of the School of Public Health and Primary Care, The Chinese University of Hong Kong (CUHK). Sponsored by the Hong Kong AIDS Trust Fund, the Centre conducted a series of behavioural surveillance surveys targeting male clients of female sex workers (MCFSWs) in Hong Kong. The finding indicated that though the proportion of male Hong Kong adults having patronized female sex workers in the last 6 months decreased from 14% in 1998 to 9% in 2010 (see Table 1), there were around 190,000 projected number of male who were currently patronizing female sex workers based on the mid-2010 census data. This finding came from a series of nine territory-wide random telephone surveys, which successfully interviewed 17,328 Hong Kong Chinese male residents of age 18 to 60. The overall response rate was close to 60%.

The study identified a total of 1,856 MCFSWs; about 33% of these men were under the age of 30 (inclusive) and around 31% attained an education level above Secondary 5. The prevalence of using condoms every-time with female sex workers was around 72-77% in seven of the nine surveys and improvements over time were not found (Figure 1). In other words, around one quarter interviewed had unprotected sex with female sex workers in the last 6 months.Professor Joseph Tak-fai Lau, Director of the Centre for Health Behaviours Research said, 'Our results show that the threat of HIV in this population has not decreased much over the last 12 years. It does not seem that preventive work targeting these men in Hong Kong has been very effective in increasing the prevalence of safer sex with female sex workers'. Professor Lau continued to say that the lack of effectiveness is consistent with the extremely low coverage of HIV prevention services – data obtained from 2008 to 2010 surveys show that only 3.5% (ranges from 2.2 to 4.9% across these 3 surveys) of the MCFSWs had received HIV-related prevention services within the last 6 months. Amongst all MCFSWs, only 12.1-16.4% had taken up HIV antibody testing in the last 6 months throughout 1999 to 2010 (ranges from 6-25% among those MCFSWs who had practiced unprotected sex in the last 6 months.

Moreover, around 51% of all MCFSWs interviewed believed that they were free from any risk of contracting HIV (about 49% among those who have practiced unprotected sex in the last 6 months). Around 26% of the MCFSWs did not believe that condoms could effectively prevent HIV transmission (about 33% among those who have practiced unprotected sex in the last 6 months). These misconceptions are hurdles for using HIV preventive measures such as condoms.

Professor Lau summarized, 'HIV prevention work in Hong Kong in the past few years has been focusing on HIV prevention among men who have sex with men because of the high prevalence in that group, and might have paid less attention to prevention targeting MCFSWs. Quick and enhanced efforts are hence required to control HIV. There are currently over 400 new HIV positive cases reported annually in Hong Kong, implying that on average more than one Hong Kong resident would have contracted HIV per day. HIV positive MCFSWs not only contract the disease themselves but are also at high risk of transmitting the infection to a wife or other female sex partners. Therefore, both the quality and quantity of HIV prevention services targeting MCFSWs in Hong Kong needs to be improved'.