HIV risk among female sex workers with different patterns of drug use behaviors in Southwest China: a cross-sectional study

Abstract

Although many researchers found that drug use behaviors significantly increased HIV risk, few of them investigated the association between HIV risk and different drug use behaviors among female sex workers (FSW) in China. The current study examines demographic and behavioral risk factors as well as the infections of HIV, syphilis and HCV among a subgroup of FSW who are injection drug users (IDU) or non-injection drug users (NIDU) in comparison to non-drug users (non-DU). We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSW recruited from Guangxi, China. The Guangxi 2010 NSS sample included 2.6% NIDU and 0.5% IDU. Compared to non-DU, IDU were more likely to report no condom use in the last sex act (aOR=3.25, 95%CI=1.65, 6.40), inconsistent condom use in the past month (aOR=4.88, 95%CI=2.66, 8.96), having an HIV testing (aOR=2.48, 95%CI=1.34, 4.58), infections of HIV (aOR=42.60, 95%CI=9.45, 192.06), syphilis (aOR=4.13, 95%CI=1.86, 9.16), and HCV (aOR=74.54, 95%CI=30.26, 183.61). NIDU had 2.89 times higher than non-drug users to report a history of STD and 26% less likely to report inconsistent condom use in the past month (p<0.05). We called for tailored, accessible and non-judgmental drug treatments coupled with effective sexual risk reduction interventions to help FSW with various drug use problems to reduce their vulnerability and susceptibility of HIV risk in China as well as other cultural settings.

Drug-Using Female Sex Workers and HIV Risk: A Systematic Review of the Global Literature

“…Drug use among both FSWs and their clients exacerbated gender-based violence, as drug use jeopardized the women's negotiating power in selecting clients and implementing safe sex practices (Parry et al, 2009;Strathdee, et al, 2011), placed them at a greater risk of HIV/STIs (Azim et al, 2006), and often made clients more violent due to their frustrations with impotence (Leggett 2001). Furthermore, compared to their peers who did not use drugs, DU-FSWs were more likely to experience psychological distress, which put the women at enhanced risk for HIV infection (Tang et al, 2014;Seth et al, 2009;Ulibarri, Strathdee, Patterson, 2010).…”

“…In Ho Chi Minh City, Vietnam, injection drug use was independently associated with HIV seropositivity (OR=101.30; 95% CI, 33.55-3-5.89) (Nguyen et al, 2004). In Guangxi province, China, the HIV rate among IDU-FSWs was 8.5% whereas that of other FSWs was 1.0% or less in the 2010 National Sentinel Surveillance sample (Tang et al, 2014).…”

“…The rates of HIV infection were highest among IDU-FSWs, the next highest among NIDU-FSWs, and the lowest among non-DU-FSWs (Table 2; HIV rates were calculated to represent the prevalence among DU-FSWs when the study population was larger than DU-FSWs and the relevant data was available). Six studies show that IDU-FSWs had much higher HIV prevalence than NIDU-FSWs (Medhi et al, 2012;Tang et al, 2014;Szwarcwald et al, 1998;Xu et al, 2012;Tran, et al, 2005). More specifically, in Kaiyuan City, China, IDU-FSWs had the highest rate of HIV infection (49.3%), followed by DU-FSWs (19.6%), whereas the HIV prevalence among FSWs overall was 10.3% ).…”

“…Researchers have increasingly paid attention to DU-FSWs because of the potentially enhanced effects of sexual risks and drug use behaviors (Baral et al, 2013;Malta et al, 2008;Tang et al, 2014;Loza et al, 2010;Lau et al, 2007;Strathdee et al, 2001). The overlap between illicit drug use and sex work has been identified as an important factor responsible for HIV prevalence among FSWs (Medhi et al, 2012), which would indicate double risk for DU-FSWs.…”

“…The overlap between illicit drug use and sex work has been identified as an important factor responsible for HIV prevalence among FSWs (Medhi et al, 2012), which would indicate double risk for DU-FSWs. However, most researchers only focused on either sexual risks or drug use behavior among FSWs, and few have examined HIV risk among injection and non-injection drug-using FSWs (Tang et al, 2014).…”