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Women engaging in compensated dating is one of the at risk group of HIV infection due to multiple sexual partnerships and risky sexual practices. The present study examined the prevalence of HIV testing behavior and intention, and identified factors associated with HIV testing intention among women engaging in compensated dating in Hong Kong. Factors from the Theory of Planned Behaviors and the role of various types of barriers to HIV testing were also explored. An anonymous, cross-sectional survey was conducted online. Target participants were women who have engaged in compensated dating and provided sex services to clients.
Participants were recruited via three sources, including i online outreaching, ii referral made by NGOs, and iii referral made by participants. A total of participants completed the study.
Respectively The present study demonstrates the applicability of extended TPB in HIV testing intention among women engaging in compensated dating. Interventions to promote HIV testing among this group are greatly warranted. Editor: Amir H. This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The public sharing of the data underlying this study has been restricted by the Behavioral Research Ethics Committee of the Chinese University of Hong Kong because the data contain sensitive participant information for which consent to share publicly was not obtained. The data are thus available on request to researchers who meet the criteria for access to confidential information.
Data access queries may be directed to the following authors of this study: Phoenix K. Mo phoenix. Joseph Lau jlau cuhk.
The funder had no role in study de, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Many women usually start compensated dating off in relationships that only involve emotional companionship but eventually provide sexual services without any coercion.
Most of the women engaging in compensated dating are secondary or college students and mainly seek clients online [ 2 ]. In Hong Kong, a steady increase in young women entering this line of work is observed in the recent years. One cross-sectional telephone-based survey with 1, year-old youth in Hong Kong found that the lifetime prevalence of compensated dating was 2. Compensated dating has been considered a new and unique trend of sex work and an important public health concern in Hong Kong [ 6 ]. Women engaging in compensated dating is one of the at risk groups of HIV infection due to their multiple sexual partnerships and risky sexual practices [ 7 ].
One local study found that compensated dating was ificantly associated with various types of sex-related risk behaviors including unsafe sex, infection of sexually transmitted diseases STDsunintended pregnancy, and abortion [ 3 ].
Service provision to this at risk group is difficult as most of them are highly mobile and marginalized with most of their deals being negotiated over the Internet [ 9 ]. Locally, the prevalence of HIV testing was only 9. Currently, there is a lack of data on the HIV testing rate of women engaging in compensated dating in Hong Kong.
As most of the women engaging in compensated dating are generally younger, they may face certain young-age-specific barriers, i. Together with the limited access to HIV-related information and services, women engaging in compensated dating are expected to have lower HIV testing rate compared to other FSW counterparts.
A report from Global Network of Sex Work Projects also concluded that young female sex workers were often excluded from their services that promoted HIV testing [ 16 ]. studies have reported a of factors associated with uptake of HIV testing among FSWs, including sexual risk behaviors [ 17 ] such as decreased condom use [ 18 ] and recent drug use [ 1417 ], high perceived risk of HIV [ 14 ], and having regular health care provider or clinic [ 17 ].
Likewise, the application of behavioral health models in understanding testing behavior is important for researchers to identify possible mechanisms through which HIV testing can be promoted.
The TPB asserts that intention to engage in a behavior is the proximal determinants of behavior. Three major components, namely, attitudes, subjective norm, and perceived behavioral control, are important in explaining behavioral intention and subsequently the behavior. According to the TPB, individuals would have higher intention to engage in a behavior if the overall evaluation of the behavior is positive attitudesif they believe that people they value think they should perform the behavior subjective normand if they feel that they have the necessary control in performing the anticipated behavior perceived behavioral control.
TPB has been widely applied and found to be effective in understanding a variety of health behaviors, including help-seeking behavior [ 2021 ], physical activity [ 22 ], dietary behaviors [ 23 ] and alcohol consumption [ 2024 ].
In the context of HIV testing, some studies found that among the TPB variables, subjective norms and attitudes were ificant in predicting intention to use HIV counselling and testing among health professionals [ 25 ]. Alternatively, other studies showed that attitudes and perceived behavioral control were ificant in predicting HIV testing intention among Tanzanian teachers [ 26 ], and Nigerian university students [ 27 ].
Nevertheless, no studies have used the TPB in explaining HIV testing intention among women engaging in compensated dating. Despite its wide applicability, the TPB has been criticized for being too parsimonious that it should be modified to fit into various populations or situations. Some studies have proposed an extended TPB [ 2930 ] to take into other factors that may also be important in predicting a behavior.
To produce a more thorough explanation on how women engaging in compensated dating may take up HIV testing, the present study proposed to include perceived barriers to form the extended TPB. One study among FSWs in India have documented that fear of positive HIV test and fear of disclosure of sex work were key personal and interpersonal barriers, while experiences of being discriminated by healthcare professionals, perceived discriminatory attitudes of staff, concerns about maintaining confidentiality, poor physical facilities, non-availability of services, and long waiting times were structural barriers to assessing HIV services [ 13 ].
Other studies have also compensated dating in Miami Fl that fear of social stigma after receiving the HIV positiveand judgmental attitudes of health care workers were important barriers to HIV testing among FSWs [ 3132 ]. Utilizing the extended TPB, attitudes toward HIV testing, subjective norm, and perceived behavioral control were chosen as the potential factors.
The role of various types of barriers to HIV testing was also explored. An anonymous, cross-sectional online survey was conducted between April to February The online survey was placed in a self-developed website. Online surveys have been frequently used in HIV-related research [ 3334 ].
It can access the hard-to-reach population effectively. It can also reduce embarrassments and interviewer bias as the study is anonymous. Inclusion criteria were: i female, ii aged between 18 to 24, iii has engaged in commercial sex in the past six months, which was defined as an exchange of money or gift for a sex trade, iv have recruited sex clients through the internet website or online appsv ability to read Chinese. For the online outreaching, women engaging in compensated dating were identified through the most common websites and online apps for seeking these women in Hong Kong.
These websites and apps contain the contact information of those women who seek to recruit clients online. Electronic personal messages were sent to prospective participants to introduce the study and invite them to take part in the study. Those who completed the survey received an incentive of HKD50 upon the provision of a valid mailing address. Such incentive was mailed to them.
The staff approached prospective participants when they attended their HIV preventive services, and invited them to participate in the study after confirming their eligibility. Participants were informed that participation was voluntary and refusal would not affect their right to use any services of the NGO.
Participants accessed the online survey and provided informed consent before they took part in the online survey. An incentive of HKD50 was given by the staff upon completion. For referral made by participants, those who have completed the online survey would receive a participant referral and were asked to further invite a maximum of three peers to take part in the study. The interested peers would be contacted by our research assistants. The aforementioned procedure for establishing eligibility, briefing and consent was used.
Socio-demographic and background characteristics, including age, education level, duration of engaging in compensated dating, STD history, and frequency of unprotected sex in the past 6 month, were collected. HIV testing.
Participants were asked if they have ever taken HIV testing. It measures the following constructs: attitudes towards HIV testing 2 itemssubjective norm towards HIV testing 2 itemsand perceived behavioral control towards HIV testing 1 item. Barriers to HIV testing. Items on barriers to HIV testing were developed based on the literature on the barriers to HIV testing among FSWs [ 133132 ], as well as discussions made between the authors and staff at the collaborating NGOs which provide HIV preventive services to women engaging in compensated dating.
The items measure 4 dimensions of barriers: perceived discrimination from workers 1 itemnegative feelings about HIV testing 4 itemsconcerns about privacy of HIV testing 3 itemsand structural barriers 2 items. Multiple hierarchical linear regression analyses were performed to identify the factors associated with intention to take up HIV testing.
Demographic and background variables were entered into Block 1, followed by variables related to TPB i. A total of participants completed the online survey.
The mean age of participants was Majority of them Nearly half of the participants About one-tenth Less than a quarter Table 3 shows the correlation between the variables under studied. Table 4 shows the of the multiple hierarchical regression models.
Compensated dating has become an important public health concern due to its strong association with a range of negative correlates including unsafe sex, increased STD and HIV risk.
Furthermore, women engaging in compensated dating are one of the few marginalized groups in Hong Kong. To date, there is limited research in this area. A huge knowledge gap exists.