Objective  To explore patterns and influencing factors of attitude and behavior about condom use when having commercial sex with regular customers among elder female sex workers (EFSWs) in Qingdao city and to provide evidences for developing intervention measures by relevant agencies.

  Methods  Using respondent-driven sampling, we recruited 420 EFSWs (aged≥35 years, living in Qingdao city at least 3 months, and having self-reported commercial sex more than once a week during past one month) for a face-to-face questionnaire survey between March and June 2014. We adopted latent class analysis, χ² test and logistic regression to analyze patterns and influencing factors of attitude and behavior about condom use when having commercial sex with regular customs among the participants.

  Results  Two patterns of attitude and behavior about condom use when having commercial sex with regular customers, namely 'negative consensus' and 'positive contradiction', were identified based on latent class analysis and the ratios of the two patterns were 12.62% (53) and 87.38% (367) among all the participants. The results of χ² test revealed that influencing factors for the attitude and behavior pattern included age (χ² = 13.27, P = 0.001), education level (χ² = 12.23, P = 0.002), income of the commercial sex (χ² = 7.89, P = 0.019), knowledge about human immunodeficiency virus (HIV) infection (χ² = 5.63, P = 0.018), and drug abuse (χ² = 4.03, P = 0.045). The results of logistic regression analysis demonstrated that the participants aged 35 – 39 years (odds ratio OR = 3.47, 95% confidence interval 95% CI: 1.55 – 7.76), aged 40 – 49 years (OR = 2.90, 95% CI: 1.36 – 6.17), with junior high school education (OR = 2.10, 95% CI: 1.05 – 4.19), and having HIV infection related knowledge (OR = 1.89, 95% CI: 1.01 – 3.53) were more likely to manifest ‘positive contradiction′ pattern; while those reporting drug abuse (OR = 0.34, 95% CI: 0.17 – 0.71) were more likely to manifest ‘negative consensus′ pattern.

  Conclusion  There are two main patterns of attitude and behavior about condom use when having commercial sex with regular customers and the patterns are mainly influenced by age, education, HIV knowledge, and drug abuse among EFSWs in Qingdao city.