Female injecting drug users who are sex workers (IDUFSWs) are an important bridge population in HIV transmission. Few studies have investigated the associations between mental health, interpersonal problems, and HIV-related risk behaviors among injecting drug users who are sex workers. A total of 234 non-institutionalized injecting drug users who are sex workers were recruited using the snowball method. Multiple logistic regression was used for data analysis. A high prevalence of mental health (depression, hopelessness, pessimism) and interpersonal (lack of social support and submissive gender power) problems was reported. Optimism and social support were negatively associated with inconsistent condom use during sex work in the last six months (adjusted odds ratios [AOR] = 0.62-0.86); positive associations were observed for depression, hopelessness, pessimism, and gender power (AOR = 1.17 to 1.68). Injecting with others' used syringes in the last six months was negatively associated with social support (AOR = 0.75) and positively associated with hopelessness and gender power (AOR = 1.13-1.27). In two summary models using all significant independent variables as candidates, optimism was negatively (OR = 0.62) and submissive gender powers were positively (OR = 1.67) associated with inconsistent condom use during sex work; submissive gender power was positively associated with injecting with others' used syringes (OR = 1.38). HIV interventions targeting mental health and interpersonal problems are needed among injecting drug users who are sex workers.
Perceived stress among people living with HIV/AIDS (PLWH) was associated with severe mental health problems and risk behaviors. Discrimination toward PLWH in China is prevalent. Both perceived discrimination and social supports are determinants of the stress level among PLWH. Psychological support services for PLWH in China are scarce. It is unknown whether social support is a buffer between the perceived discrimination and perceived stress. With written consent, this study surveyed 258 PLWH recruited from multiple sources in two cities in China. Instruments were validated in previous or the present study, including the perceived stress scale for PLWH (PSSHIV), the perceived social support scale (PSSS), and the perceived discrimination scale for PLWH (PDSHIV). Pearson correlations and multiple regression models were fit. PDSHIV was associated with the Overall Scale and all subscales of PSSHIV, whilst lower socioeconomic status in general and lower scores of PSSS were associated with various subscales of PSSHIV. The interaction item (PSSS×PSDHIV) was nonsignificant in modeling PSSHIV, hence no significant moderating effect was detected. Whilst perceived discrimination is a major source of stress and social support can reduce stress among PLWH in China, improved social support cannot buffer the stressful consequences due to perceived discrimination. The results highlight the importance to reduce discrimination toward PLWH and the difficulty to alleviate its negative consequences. It is warranted to improve mental health among PLWH in China and it is still important to foster social support among PLWH as it has direct effects on perceived stress.
Female injecting drug users who are sex workers (IDUFSWs) is a strategic "bridge population" for HIV transmission. Goals of the study were to investigate condom use behaviors during commercial sex among IDUFSWs using the Theory of Planned Behavior (TPB), and to investigate moderating effects that modify the strength of associations between the TPB-related variables and inconsistent condom use during commercial sex. A total of 281 non-institutionalized IDUFSWs were recruited using snowball sampling method. Anonymous face-to-face interviews were administered by trained doctors. The results showed that the prevalence of inconsistent condom use during commercial sex in the last six months was 64%. After adjusting for some significant background variables (e.g. main venue of sex work), all associations between the five TPB-related variables and the studied condom use variable were statistically significant (Odds Ratio (OR) = 0.43-0.68, p<0.001). In the hierarchical nested models, three background variables (age, venue of sex work, and ever used HIV-related interventions) entered in the first step (-2LL = 294.98, p<0.001) and the Social Norm Scale, the Perceived Behavioral Control Scale and the Behavioral Intention Scale were selected by the second step (OR = 0.67 - 0.72, p<0.01; -2LL = 160.99, p<0.001). Significant moderating effects between some TPB-related variables (Positive Condom use Attitude Scale and Behavioral Intention Scale) and duration of sex work and duration of drug use were also reported. The results highlighted the potential of using the TPB to better understand condom use behaviors in IDUFSWs in China. Theory-based research and intervention work should be developed in China in the future.
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