1. www.aids2014.org Sexual and Reproductive Health in Adolescent Female Sex Workers: Kunming, China Xu-Dong Zhang M.Sc International Centre for Reproductive Health, Ghent University July 21 st 2014, 20 th International AIDS Conference, Melbourne

2. www.aids2014.org Background – Adolescents pregnancy is associated with adverse maternal and perinatal outcomes – Adolescents represented almost 14% of the Chinese population with the lowest level of SRH knowledge – limited access to comprehensive sex education and governmental subsidized FP services – Adolescents FSWs are among the most vulnerable for HIV and unplanned pregnancy  There is limited understanding of the unique SRH challenges that young FSW face in China

3. www.aids2014.org Aim and objective The aim of this study among adolescent female sex workers in Kunming, China was to: –describe use of contraception and SRH services, –assess family planning and reproductive health knowledge, and –determine factors associated with unmet need for modern contraception.

4. www.aids2014.org Methods – design, population & setting Study design: A cross-sectional design by using a two- stage cluster sampling method (42 random clusters out of 101 identified locations) Study population: Girls less than 20 years of age, and self-reported to sell or exchange sex for money or goods in past 6 months.

5. www.aids2014.org Results (1) July-September 2012: 310 adolescent FSW Sexual and reproductive health vulnerabilities (HIV) Mean age: 18.7 years (sd=1.2 yrs) 83% rural-urban migrants 82% withdrew from school 96% is living apart from their family 93% solely relied on income from sex work

6. www.aids2014.org Results (2) Prevalence of unintended pregnancy /multiple pregnancies/abortion –46% of women had at least one unintended pregnancy (30% had multiple) –93% of these resulted in abortion But also in the past 12 months, –51% self-reported symptoms of STI –38% experienced physical and/or sexual violence

7. www.aids2014.org Results (3) 98% of adolescent FSWs in this study currently wanting to avoid pregnancy Low rates on: consistent condom use (43%) with all partners Only 7% (23/310) reported dual protective methods Long-acting reversible contraceptives: 2%  35% (110/310) had unmet need for modern contraception

8. www.aids2014.org Results (4) Unmet need for modern contraception was associated with: –Having current non-paying partner (AOR=3.4; 1.8-6.2) –Frequent alcohol use (AOR=3.2; 1.4-7.1) –Lower SRH knowledge score (AOR=1.9; 1.1-3.2) Unmet need for modern contraception Having a current boyfriend or husband Low level of sexual and FP knowledge Frequent alcohol- taking

9. www.aids2014.org Conclusion Action — as early as possible Removing police restriction and barriers to ensure adolescent FSWs’ rights to receive comprehensive SRH services Providing sexuality education in school Address the skill and attitudes of public health providers Integrating full-range of FP services into existing HIV/STI prevention platform and community health fertilities Great involvement of NGOs and tailored outreach programme

10. www.aids2014.org Acknowledgements The local FSW organizations District level of Centres for Disease Control in Kunming Burnet Institute International Centre for Reproductive Health, Ghent University Study participants The authors declare that they have no conflicts of interest