Objective Female injection drug users who are also sex workers (FSW-IDUs) occupy a pivotal population in HIV transmission, whereas their mental health problems are largely overlooked. We aimed to investigate prevalence and associated socio-ecological factors of depression, suicidal ideation and suicidal attempts among FSW-IDUs in China. Methods Using snowball sampling methods, 200 FSW-IDUs were recruited from communities in Liuzhou, China. Anonymous face-to-face interviews were administered by trained doctors. Results Thirty-nine percent of participants had severe or extremely severe depression, 44.7% had suicidal ideation in the last six months and 26.8% had suicidal attempts in the last six months. After adjusting for background variables, self-stigma was significantly associated with severe or extremely severe depression (OR=1.18, 95% CI: 1.07–1.31). Self-stigma (OR=1.08, 95% CI: 1.01–1.15), depression (OR=1.11, 95% CI: 1.05–1.18), having completely broken up with family (OR=2.60, 95% CI: 1.35–5.02) and having been abused by clients or gatekeepers (OR=2.15, 95% CI: 1.32–3.50) were associated with suicidal ideation in the last six months, while self-stigma (OR=1.03, 95% CI: 1.10–1.16), depression (OR=1.12, 95% CI: 1.04–1.20) and being abused by clients or gatekeepers (OR=2.15, 95% CI: 1.09–4.24) were associated with suicidal attempt in the last six months. In mediation analyses, the associations between self-stigma and the two suicidal outcomes were fully mediated by depression. Conclusions There are unmet mental health needs of FSW-IDUs. Screening of mental health problems should be integrated into current HIV-related services. Psychological intervention efforts should include components such as self-stigma, family support and abuse.

We conducted qualitative interviews with 48 female sex workers (FSW) recruited from entertainment venues in Liuzhou, China. Analyses found that HIV knowledge and sexual health seeking strategies differed by size of venue: (1) Women in smaller venues said they douched before/after sex and used condoms with all but their regular partners and clients. Most found the brochures distributed by Chinese CDC workers “irrelevant” or “boring” and relied on friends for health advice. (2) FSW in middle and large venues were less concerned about prevention, claiming their clients were “healthy.” They relied more on the Internet for health information and were less concerned about the cost of seeing a doctor. (3) Pregnancies and abortions were frequent, especially among the younger women in large venues. This research documents the need to develop tailored HIV-related messages and prevention strategies with the help of FSW to address differences among FSW working in venues of different sizes.

To evaluate the incidence and risk factors for human immunodeficiency virus (HIV) seroconversion of HIV-negative partners among HIV-discordant couples in Liuzhou, China, 1854 eligible HIV-serodiscordant couples were retrospectively identified through the HIV epidemiology and follow-up database from January 1, 1996 to June 30, 2013. Cox proportional-hazards model was used to examine risk factors related to HIV seroconversion of negative partners. Finally, 125 HIV seroconversion occurred over 4963.5 person-years, resulting in an overall HIV incidence of 2.52/100 person-years. HIV-positive partners with the last CD4 counts of 350 cells/ul or more were significantly protected against HIV seroconversion compared with those CD4 counts of less than 200 cells/ul (aHR = 0.46, 95% CI: 0.27-0.81, P < 0.01). Men with HIV-positive wives (aHR: 1.96, 95% CI: 1.27-3.02, P < 0.01), HIV-positive partners who did not receive ART before their HIV-negative partners' seroconversion (aHR: 2.22, 95% CI, 1.41-3.51, P < 0.01) and patients reported intermittent condom use (aHR: 7.60, 95% CI, 4.37-13.21, P < 0.01) were associated with increased risk of HIV seroconversion. HIV-negative partners remain high risk of HIV infection in Liuzhou city. Comprehensive package of HIV prevention services should contribute to reduction in HIV transmission of discordant couples.

Background Low-fee female sex workers (FSW) lack power to effectively negotiate male condom use with clients. Female condoms (FCs) may provide an alternative strategy. This study was conducted to assess the acceptability of FC use among low-fee FSWs, and to identify appropriate candidates for future FC promotion. Methods A one-month follow-up study was conducted. At entry into the study, eligible participants completed a baseline questionnaire and were given 10 FCs. At the one-month follow up encounter, the number of used FC packages were counted and each participant completed a follow-up questionnaire. Logistic regression was used to identify variables associated with more frequent use of FCs (> 2 times). Results A total of 312 low-fee FSWs were enrolled at baseline and all participants completed the follow-up evaluation. Among them, 123 (39.4%) participants had used more than two FCs. Participants who were illiterate or had completed at most primary school education (OR: 2.4, 95% CI: 1.4–7.2), charged ≤30 RMB per client (≤30 vs. 51–80 RMB, OR: 3.8, 95% CI: 1.9–7.6), or had consistently used condoms with regular clients in the past month (OR: 2.4, 95%CI: 1.4–4.2) were more likely to use FCs. Conclusion Low-fee FSWs charging ≤30 RMB per client, and those who are less educated may be appropriate initial candidates for FC promotion in China. Strategies to consider include teaching FSWs tactics for negotiation of FC use that can initially be applied with regular clients, and providing education to maximize ease-of use, and minimize discomfort with FC usage. Electronic supplementary material The online version of this article (10.1186/s12905-019-0773-7) contains supplementary material, which is available to authorized users.

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