Our data were derived from a large cross-sectional study conducted among low-tier FSWs in 21 counties within Zhejiang province, China. Data were collected from September to November Bivariable and multiple logistic regression analyses were used to identify factors associated with self-reported consistent condom use among FSWs working at hair salons. Of FSWs working at hair salons, Commercial sex is not effectively protected, and behavioural interventions targeting FSWs should take into account the various factors that are correlated to condom use.
Heterosexual commercial sex has played an important role in the transmission of HIV and other sexually transmitted infections STIs. A meta-analysis estimated that, due to biological, behavioural, and structural risk factors, female sex workers FSWs are FSWs work in different venues and can be classified as high-, middle-, and low-tier based on the venues where they operate [ 3 ]. The sex-work tiers usually represent the socioeconomic level, the sex-selling environment, the type of client, and the risky behaviours of FSWs in China [ 4 ].
Low-tier refers to FSWs who generally work on the streets and at small venues, such as hair salons, massage parlours, roadside shops, and so on, and charge much less for each sex act [ 5 ]. These sociodemographic characteristics, which reflect greater vulnerability including poorer attraction to clients, lower socio-economic level, may be associated with higher observed rates of condomless sex [ 6 ] and lower use of HIV prevention services [ 6 , 8 ].
Studies have shown that FSWs working in low-tier venues tend to have more clients but use condoms infrequently because they are offered extra payment for condomless sex [ 9 , 10 , 11 ], they fear losing clients [ 12 ], and they spend very little money on healthcare, which hinders their access to STI diagnosis and treatment [ 13 ]. Men who patronise low-tier FSWs in China tend to be equally uneducated and of low socioeconomic status [ 5 , 14 , 15 ].
They may also be at a higher risk of HIV infection as low-tier FSWs are usually less likely to practice safer sex compared with their counterparts working at high-tier venues [ 14 ]. In contrast, men who visit high-tier FSWs usually have a high socioeconomic status, and they may be more concerned about their health and more likely to practice protected sex [ 14 , 16 ]. The HIV prevalences among FSWs from high-, middle- and low-tier venues nationwide have been found to differ substantially, at 0.
