Institute for Community Research
China/U.S. Women’s Health Project

China/U.S. Women’s Health Project

Female condom education in China

High-Risk Establishments and Women’s HIV Prevention in Southern China

This was a 5-year study of HIV risk and social dynamics in sex-work establishments conducted in two rural and two mid-sized urban towns in Hainan and Guanxi Provinces, China. The study also developed and evaluated a multi-level, site-based intervention conducted within those establishments to promote use of the female condom along with male condoms for HIV/STD prevention among women who work there. Researchers at ICR and Peking Union Medical College/China Academy of Medical Sciences worked with provincial Centers for Disease Control and Prevention and local communities to conduct the study. We used intensive ethnography to assess the characteristics and changing interactions among sex workers and the sex-work establishments. We used mixed qualitative and quantitative methods to document the feasibility, process, and outcomes of the intervention conducted in those establishments. This included cross-sectional surveys of sex workers in all four towns at three time points (baseline, 6 and 12 months post-baseline) for comparative analyses to assess town-level, sex-work establishment, and individual-level characteristics associated with HIV risk and prevention and outcomes of the intervention. We analyzed factors that enhanced or impeded women’s use of female condoms and other prevention measures in these establishments. Development and testing of the female condom intervention has significant public health implications because of its potential for reducing sexual transmission of HIV and other endemic sexually transmitted diseases like syphilis in this high-risk population and in the broader population of their sexual networks.


Read the Project Abstract and Justification here.


Please read the project findings here.


Dunn, J., Zhang, Q., Weeks, M.R., Li, J., Liao, S.S., Li, F. (2016). Indigenous HIV Prevention Beliefs and Practices among Low-earning Chinese Sex Workers as Context for Introducing Female Condoms and Other Novel Prevention Options. Qualitative Health Research, 27 (9): 1302-1315. PMID: 27811288. PMC5440208.

Weeks, M.R., Li, J., Liao, S., Zhang, Q., Dunn, J., Wang, Y., Jiang, J. (2013) Multilevel dynamic systems affecting introduction of HIV/STI prevention innovations among Chinese women in sex-work establishments. Health Education & Behavior, 40(1S):111S-122S (special issue: Systems Science Applications in Health Promotion and Public Health). PMID: 24084394; PMCID(in progress)

Wang, Y., Liao, S.S., Jiang, J., Weeks, M.R., Nie, L., Li, J., He, B., Zhou, Y., Li, F., Dunn, J., Zhang, Q. (2013). Who are the preferential targets for intervention programs related to the female condom among sex workers in southern China? AIDS Education and Prevention, 25(4): 349-361. PMID: 23837812; PMCID(in progress)

Nie, L., Liao, S., Weeks, M.R., Wang, Y., Jiang, J., Zhang, Q., Zhou, Y., He, B., Li, J., Dunn, J. (2013) Promoting female condom in sex industry in four towns of southern China: Context matters. Sexually Transmitted Diseases, 40(3):264-270. PMID: 23403607; PMC3572509.

Liao, S.S., Weeks, M.R., Wang, Y., Nie, L., Li, F., Zhou, Y., Zeng, X., Jiang, J., He, B., Li, J., Dunn, J. & Zhang, Q. (2011) Inclusion of the female condom in a male condom-only intervention in the sex industry in China: A cross-sectional analysis of pre- and post-intervention surveys in three study sites. Public Health. 125: 283-292. PMID21513961; PMC3112295.

Liao, S., Weeks, M.R., Wang, Y., Li, F., Jiang, J., Li, J., Zeng, X., He, B., & Dunn, J. (2011) Female Condom Use in the Rural Sex Industry in China: Analysis of Users and Non-users at Post-Intervention Surveys. AIDS Care, 23(S1):66-74. PMID: 21660752. PMC3117276.

Weeks, M.R., Liao, S.S., Li, F., Li, J., Dunn, J., He, B., He, Q., Feng, W., & Wang, Y. (2010) Challenges, strategies and lessons learned from a participatory community intervention study to promote female condoms among rural sex workers in southern China. AIDS Education and Prevention, 22 (3): 253-272. PMID: 20528132. PMC2896264.