Prevalence and associated factors of condom use during commercial sex by female sex workers who were or were not injecting drug users in China
Joseph T. F. Lau A B F , Jing Gu B C , Hi Yi Tsui A , Hongyao Chen D , Eleanor Holroyd E , Renfan Wang D and Xianyou Hu D
+ Author Affiliations
- Author Affiliations
A Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong.
B Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou 510000, China.
C Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510000, China.
D Dazhou Center for Disease Control and Prevention, Dazhou 635000, Sichuan, China.
E Division of Nursing and Midwifery, School of Health Sciences, RMIT University, Melbourne, Vic. 3001, Australia.
F Corresponding author. Email: jlau@cuhk.edu.hk
Sexual Health 9(4) 368-376 https://doi.org/10.1071/SH11108
Submitted: 4 August 2011 Accepted: 30 January 2012 Published: 11 May 2012
Abstract
Objectives: We compared the prevalence of inconsistent condom use during commercial sex between female sex workers (FSWs) who did or did not inject drugs (FSW-IDUs and FSW-NIDUs) and investigated factors associated with this inconsistent use within these two groups. Methods: Some 158 FSW-NIDUs recruited from sex work venues and 218 FSW-IDUs recruited via the snowball sampling method were interviewed anonymously. Results: Only 16.5% of the FSW-IDUs and 51.3% of the FSW-NIDUs had used condoms consistently during commercial sex in the last month (odds ratio (OR) = 0.19). Factors significantly associated with inconsistent condom use in both groups included: behavioural intention for condom use (adjusted odds ratio (AOR) = 0.05 and 0.13), condom unavailability (AOR = 4.77 and 5.33), a perceived need to engage in unprotected sex if the client paid more (AOR = 8.74 and 10.84) or insisted on demanding unprotected sex (AOR = 19.78 and 7.59), and submissive gender power (AOR = 11.65 and 2.58). One factor, perceived susceptibility (AOR = 2.64), was significant only among FSW-NIDUs, whereas perceived efficacy of condom use in preventing HIV transmission (AOR = 0.08), perceptions that peer FSWs would not use condoms with clients (AOR = 2.23), self-hatred (AOR = 2.25) and lack of social support (AOR = 2.93) were significant only among FSW-IDUs. Injecting with used syringes was also associated with inconsistent condom use among FSW-IDUs (AOR = 4.64). Conclusions: FSW-IDUs were more likely than FSW-NIDUs to possess the cognitive and psychosocial conditions associated with unprotected commercial sex. Interventions need to take these differences into account.
Additional keywords: health behavioural theories, HIV, psychological factors, sexually transmissible infections.
References
[1] Logan TK, Cole J, Leukefeld C. Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychol Bull 2002; 128 851–85.| Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38nksFKgsg%3D%3D&md5=34335cbed7dd12bfdf72314d6730f3baCAS | 12405135PubMed |
[2] Dazhou Center for Disease Control and Prevention (DCDC). Dazhou HIV/AIDS surveillance report 2005. Chengdu, China: DCDC; 2005.
[3] Yin L, Qin G, Qian HZ, Zhu Y, Hu W, Zhang L, et al Continued spread of HIV among injecting drug users in southern Sichuan Province, China. Harm Reduct J 2007; 4 6
| Continued spread of HIV among injecting drug users in southern Sichuan Province, China.Crossref | GoogleScholarGoogle Scholar | 17286871PubMed |
[4] Strathdee SA, Philbin MM, Semple SJ, Pu M, Orozovich P, Martinez G, et al Correlates of injection drug use among female sex workers in two Mexico–U.S. border cities. Drug Alcohol Depend 2008; 92 132–40.
| Correlates of injection drug use among female sex workers in two Mexico–U.S. border cities.Crossref | GoogleScholarGoogle Scholar | 17714888PubMed |
[5] Gu J, Chen H, Chen X, Lau JT, Wang R, Liu C, et al Severity of drug dependence, economic pressure and HIV-related risk behaviors among non-institutionalized female injecting drug users who are also sex workers in China. Drug Alcohol Depend 2008; 97 257–67.
| Severity of drug dependence, economic pressure and HIV-related risk behaviors among non-institutionalized female injecting drug users who are also sex workers in China.Crossref | GoogleScholarGoogle Scholar | 18482804PubMed |
[6] Lau JT, Zhang J, Zhang L, Wang N, Cheng F, Zhang Y, et al Comparing prevalence of condom use among 15,379 female sex workers injecting or not injecting drugs in China. Sex Transm Dis 2007; 34 908–16.
| Comparing prevalence of condom use among 15,379 female sex workers injecting or not injecting drugs in China.Crossref | GoogleScholarGoogle Scholar | 18049424PubMed |
[7] Lau JT, Tsui HY, Siah PC, Zhang KL. A study on female sex workers in southern China (Shenzhen): HIV-related knowledge, condom use and STD history. AIDS Care 2002; 14 219–33.
| A study on female sex workers in southern China (Shenzhen): HIV-related knowledge, condom use and STD history.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD383gs1ynsQ%3D%3D&md5=a032f1a3cfdb68aa912aadc52f1f4cacCAS | 11940280PubMed |
[8] Ruan Y, Cao X, Qian HZ, Zhang L, Qin G, Jiang Z, et al Syphilis among female sex workers in southwestern China: potential for HIV transmission. Sex Transm Dis 2006; 33 719–23.
| Syphilis among female sex workers in southwestern China: potential for HIV transmission.Crossref | GoogleScholarGoogle Scholar | 16708055PubMed |
[9] Logan TK, Cole J, Leukefeld C. Gender differences in the context of sex exchange among individuals with a history of crack use. AIDS Educ Prev 2003; 15 448–64.
| Gender differences in the context of sex exchange among individuals with a history of crack use.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3srkslWrtw%3D%3D&md5=8a39a36c97414e4d7680d6205f2eb0c7CAS | 14626466PubMed |
[10] Yang H, Li X, Stanton B, Liu H, Liu H, Wang N, et al Heterosexual transmission of HIV in China: a systematic review of behavioral studies in the past two decades. Sex Transm Dis 2005; 32 270–80.
| Heterosexual transmission of HIV in China: a systematic review of behavioral studies in the past two decades.Crossref | GoogleScholarGoogle Scholar | 15849527PubMed |
[11] Ding Y, Detels R, Zhao Z, Zhu Y, Zhu G, Zhang B, et al HIV infection and sexually transmitted diseases in female commercial sex workers in China. J Acquir Immune Defic Syndr 2005; 38 314–9.
| 15735451PubMed |
[12] van den Hoek A, Yuliang F, Dukers NH, Zhiheng C, Jiangting F, Lina Z, et al High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: potential for fast spread of HIV. AIDS 2001; 15 753–9.
| High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: potential for fast spread of HIV.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3nt1KitA%3D%3D&md5=1ca5c08c8ec87301fbc9357ae9a16294CAS | 11371690PubMed |
[13] Kulsudjarit K. Drug problem in southeast and southwest Asia. Ann N Y Acad Sci 2004; 1025 446–57.
| Drug problem in southeast and southwest Asia.Crossref | GoogleScholarGoogle Scholar | 15542748PubMed |
[14] Huang Y, Henderson GE, Pan S, Cohen MS. HIV/AIDS risk among brothel-based female sex workers in China: assessing the terms, content, and knowledge of sex work. Sex Transm Dis 2004; 31 695–700.
| HIV/AIDS risk among brothel-based female sex workers in China: assessing the terms, content, and knowledge of sex work.Crossref | GoogleScholarGoogle Scholar | 15502679PubMed |
[15] State Council AIDS Working Committee Office & UN Theme Group on AIDS in China (SCAWCO-UTGAC). A joint assessment of HIV/AIDS prevention treatment and care in China 2007. Beijing: SCAWCO-UTGAC; 2007. Available online at: http://www.chain.net.cn/english/document/20080104163926671004.pdf [verified July 2011].
[16] State Council AIDS Working Committee Office & UN Theme Group on HIV/AIDS in China. A Joint Assessment of HIV/AIDS Prevention Treatment and Care in China ; 2004. Retrieved from http://www.chinaaids.cn/worknet/download/2004/report2004en.pdf. [Assessed July 2011]
[17] Gu J, Lau JT, Chen X, Liu C, Liu J, Chen H, et al Using the Theory of Planned Behavior to investigate condom use behaviors among female injecting drug users who are also sex workers in China. AIDS Care 2009; 21 967–75.
| Using the Theory of Planned Behavior to investigate condom use behaviors among female injecting drug users who are also sex workers in China.Crossref | GoogleScholarGoogle Scholar | 20024752PubMed |
[18] Albarracín D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull 2001; 127 142–61.
| Theories of reasoned action and planned behavior as models of condom use: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 11271752PubMed |
[19] Bennett P, Bozionelos G. The theory of planned behaviour as predictor of condom use: a narrative review. Psychol Health Med 2000; 5 307–26.
| The theory of planned behaviour as predictor of condom use: a narrative review.Crossref | GoogleScholarGoogle Scholar |
[20] Volk JE, Koopman C, Volk JE, Koopman C. Factors associated with condom use in Kenya: a test of the health belief model. AIDS Educ Prev 2001; 13 495–508.
| Factors associated with condom use in Kenya: a test of the health belief model.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FmslSrug%3D%3D&md5=ed73da25918ea37ab4f9d666cf2baa29CAS | 11791782PubMed |
[21] Buckingham RW, Moraros J, Bird Y, Meister E, Webb NC. Factors associated with condom use among brothel-based female sex workers in Thailand. AIDS Care 2005; 17 640–7.
| Factors associated with condom use among brothel-based female sex workers in Thailand.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2MznvVagtQ%3D%3D&md5=e3583ab439c074a268f589a5b148fe84CAS | 16036250PubMed |
[22] Jamner MS, Wolitski RJ, Corby NH, Fishbein M. Using the theory of planned behaviour to predict intention to use condoms among female sex workers. Psychol Health 1998; 13 187–205.
| Using the theory of planned behaviour to predict intention to use condoms among female sex workers.Crossref | GoogleScholarGoogle Scholar |
[23] Gu J, Lau JT, Chen H, Chen X, Liu C, Liu J. Mental health and interpersonal factors associated with HIV-related risk behaviors among non-institutionalized female injection drug users who are also sex workers in China. Women Health 2010; 50 20–36.
| Mental health and interpersonal factors associated with HIV-related risk behaviors among non-institutionalized female injection drug users who are also sex workers in China.Crossref | GoogleScholarGoogle Scholar | 20349393PubMed |
[24] Rosenstock IM. Historical origins of the health belief model. Health Educ Monogr 1974; 2 328–35.
[25] Ajzen I, Madden TJ. Prediction of goal-directed behavior: attitudes, intentions, and perceived behavioral control. J Exp Soc Psychol 1986; 22 453–74.
| Prediction of goal-directed behavior: attitudes, intentions, and perceived behavioral control.Crossref | GoogleScholarGoogle Scholar |
[26] Lai JC, Yue X. Measuring optimism in Hong Kong and mainland Chinese with the revised Life Orientation Test. Pers Individ Dif 2000; 28 781–96.
| Measuring optimism in Hong Kong and mainland Chinese with the revised Life Orientation Test.Crossref | GoogleScholarGoogle Scholar |
[27] Lau JT, Cheng F, Tsui HY, Zhang Y, Zhang J, Wang N, et al Clustering of syringe sharing and unprotected sex risk behaviors in male injecting drug users in China. Sex Transm Dis 2007; 34 574–82.
| 17277610PubMed |
[28] Creel AH, Rimal RN. Factors related to HIV-testing behavior and interest in testing in Namibia. AIDS Care 2011; 23 901–7.
| 21390881PubMed |
[29] Li X, Wang B, Fang X, Zhao R, Stanton B, Hong Y, et al Short-term effect of a cultural adaptation of voluntary counseling and testing among female sex workers in China: a quasi-experimental trial. AIDS Educ Prev 2006; 18 406–9.
| Short-term effect of a cultural adaptation of voluntary counseling and testing among female sex workers in China: a quasi-experimental trial.Crossref | GoogleScholarGoogle Scholar | 17067252PubMed |
[30] Liu H, Grusky O, Zhu Y, Li X. Do drug users in China who frequently receive detoxification treatment change their risky drug use practices and sexual behavior? Drug Alcohol Depend 2006; 84 114–21.
| Do drug users in China who frequently receive detoxification treatment change their risky drug use practices and sexual behavior?Crossref | GoogleScholarGoogle Scholar | 16443333PubMed |
[31] Tang YL, Zhao D, Zhao C, Cubells JF. Opiate addiction in China: current situation and treatments. Addiction 2006; 101 657–65.
| Opiate addiction in China: current situation and treatments.Crossref | GoogleScholarGoogle Scholar | 16669899PubMed |
[32] Exner TM, Seal DW, Ehrhardt AA. A review of HIV interventions for at-risk women. AIDS Behav 1997; 1 93–124.
| A review of HIV interventions for at-risk women.Crossref | GoogleScholarGoogle Scholar |
[33] Chan DK, Cheung SF, Gray A, Ip A, Lee B. Identifying the psychosocial correlates of condom use by female sex workers in Hong Kong. AIDS Care 2004; 16 530–9.
| Identifying the psychosocial correlates of condom use by female sex workers in Hong Kong.Crossref | GoogleScholarGoogle Scholar | 15203420PubMed |
[34] Azim T, Chowdhury EI, Reza M, Ahmed M, Uddin MT, Khan R, et al Vulnerability to HIV infection among sex worker and non-sex worker female injecting drug users in Dhaka, Bangladesh: evidence from the baseline survey of a cohort study. Harm Reduct J 2006; 3 33
| Vulnerability to HIV infection among sex worker and non-sex worker female injecting drug users in Dhaka, Bangladesh: evidence from the baseline survey of a cohort study.Crossref | GoogleScholarGoogle Scholar | 17109763PubMed |
[35] Gossop M, Powis B, Griffiths P, Strang J. Female prostitutes in south London: use of heroin, cocaine and alcohol, and their relationship to health risk behaviours. AIDS Care 1995; 7 253–60.
| Female prostitutes in south London: use of heroin, cocaine and alcohol, and their relationship to health risk behaviours.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28%2Fmsl2qtw%3D%3D&md5=3225163c223f9e5b169344b1e54a21c9CAS | 7578303PubMed |
