Background and Objective Alcohol use has been suggested to interfere with

Background and Objective Alcohol use has been suggested to interfere with condom use and to increase sexual risk behaviors. intoxication was not associated with condom use and STIs. These findings indicate event-specific rather than global associations of alcohol use with inconsistent Afatinib dimaleate manufacture condom use and STIs. Conclusion Alcohol use before commercial sex is associated with unprotected sex and increased risk for STIs. Interventions that address both alcohol use and HIV risk behaviors in the context of commercial sex may have a great impact in preventing the spread of HIV in China. Although the actual HIV sero-prevalence in China remains uncertain, the current official estimate of the number of persons infected with HIV is approximately 700,000 (range, 450,000C1,000,000).1 Among reported cases, two-thirds were male, more than half of whom were 16 to 29 FABP5 years of age.2 In the past few years, there has been a shift in the HIV epidemic from intravenous drug injection to heterosexual transmission and from isolation of the epidemic among high-risk groups to involvement of the general population.1,3 Since 2007, sexual transmission has increased and become the main mode for the spread of HIV in China.2 Contributing to China’s HIV epidemic is widespread commercial sex work; there are an estimated 4 to 10 million commercial sex workers in China.4 The rate of HIV infection among commercial sex workers has been consistently increasing over the past few years. High HIV prevalence rates were reported among commercial sex workers at sentinel surveillance sites, with 10.3% in Yunnan Province and 16% in Guangxi Province.5,6 A community-based study of 966 commercial sex workers in Guangdong province found that 14% were infected with syphilis, 32% with Chlamydia, and 8% with gonorrhea.7 Behavioral-risk assessment data reveal that significant proportions of sex workers never use condoms. In 2001, a total of 37% of commercial sex workers in China reported never using condoms with their clients.8 As one of the modifiable factors that may influence sexual risk behavior, drinking alcohol has received increased attention in HIV-prevention studies in recent years. Alcohol use and intoxication has been linked with increased HIV sexual risk behavior (multiple sex partners and unprotected sex) among injection Afatinib dimaleate manufacture drug users.9 Problem drinking was found to be associated with an increased risk of sexually transmitted infections (STIs) across a wide variety of populations.10 However, a recent meta-analysis reviewing 13 studies on alcohol and condom use revealed that drinking is related to nonuse of condoms at first sexual encounters, but it is unrelated to condom use in recent sexual encounters.11 Some studies have reported that drinking is related to unprotected sex for casual sexual partners but not for primary partners.12,13 These data suggest that the relationship between alcohol use and unprotected sex depends on context and sexual experiences of partners. Nevertheless, several individual studies have not detected a significant association between alcohol use and STIs.14,15 Although alcohol use has long been recognized as a component of commercial sex,16 few studies have specially examined alcohol use and its relationship with unprotected sex and STIs Afatinib dimaleate manufacture in the context of commercial sex. In the Netherlands, FSWs in clubs reported heavy drinking, and two-thirds gained earnings from sale of alcoholic beverage.17 A sample of establishment-based FSWs in the Philippines found that 19% of FSWs used alcohol Afatinib dimaleate manufacture before sex and 37% had sex with intoxicated clients; both groups were associated with an increased risk of STIs.18 A community-based study in Mombasa, Kenya, reported that 33% of FSWs were binge drinkers, having more than 5 drinks at at least 1 occasion in the previous month; binge drinking was related to unprotected sex, sexual violence, and STIs.19 Another study among male clients of FSWs in Mumbai, India, found that drinking alcohol when visiting FSWs was associated with unprotected sex, anal sex, and more than 10 lifetime FSW partners.20 In addition, FSWs’ drinking was found to be associated with group sex in India21; anal intercourse, sex during menses, and intravenous.