Correlates of alcohol and illicit drug use before commercial sex among transgender women with a history of sex work in China
Qian Wang A , Ruijie Chang A , Ying Wang A , Xueqin Jiang A , Shuxian Zhang A , Qiuming Shen A , Zixin Wang B , Tiecheng Ma C , Joseph T. F. Lau B D and Yong Cai A DA School of Public Health, Shanghai Jiao Tong University School of Medicine, No 227, South Chongqing Road, Shanghai 200025, China.
B Center for Health Behaviours Research, 5/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region.
C Shenyang Consultation Centre of AIDS Aid and Health Service, Shenyang, China.
D Corresponding authors. Email: caiyong202028@hotmail.com; jlau@cuhk.edu.hk
Sexual Health 17(1) 45-52 https://doi.org/10.1071/SH18194
Submitted: 7 October 2018 Accepted: 13 August 2019 Published: 11 December 2019
Abstract
Background: Research on substance use among transgender female sex workers in China is scarce. The aims of this study were to examine: (1) the prevalence of alcohol or illicit drug use before commercial sex among this population; and (2) correlates of alcohol and illicit drug use. Methods: Complete survey data were analysed from 397 transgender female sex workers recruited from three of the largest cities in China: Shenyang, Shanghai and Guangzhou. Information was collected about demographics, alcohol or illicit drug use, alone or in combination, and their psychosocial correlates using structured questionnaires. Multinomial logistic regression models were used to examine the association between substance use and its correlates. Results: Before commercial sex, approximately one-third of the sample reported exclusive alcohol use (28.5%), 9.3% reported exclusive drug use and 7.3% reported combined use of alcohol and drugs. Before commercial sex, participants with low self-esteem had twice the odds of using alcohol exclusively (adjusted odds ratio (aOR) 2.05; 95% confidence interval (CI) 1.01–4.17), those with higher levels of loneliness had almost threefold the odds of exclusive drug use (aOR 2.92; 95% CI 1.21–7.07) and those with depression (aOR 2.97; 95% CI 1.11–7.96) and unknown HIV status (aOR 3.00; 95% CI 1.02–8.87) had threefold the odds of combined use of alcohol and drugs. Conclusion: Programs aimed at reducing alcohol or drug use among transgender female sex workers in China may consider adding components that help support mental health and encouraging HIV screening.
Additional keywords: depression, loneliness, perceived social support, self-esteem, transgender female sex workers.
References
[1] United Nations Development Programme, Asia Pacific Transgender Network. Lost in transition: transgender people, rights and HIV vulnerability in the Asia-Pacific Region. 2012. Available online at: https://www.undp.org/content/dam/undp/library/hivaids/UNDP_HIV_Transgender_report_Lost_in_Transition_May_2012.pdf [verified 10 November 2019].[2] UNAIDS. The gap report. 2014. Available online at: http://files.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2014/UNAIDS_Gap_report_en.pdf [verified 25 September 2018].
[3] China Society. Sex change? Here are the rules. China Daily 17 June 2009. Available online at: http://english.peopledaily.com.cn/90001/90776/90882/6679958.html [verified 24 September 2018].
[4] Chinese Society of Psychiatry. The Chinese Classification and Diagnostic Criteria of Mental Disorders Version 3 (CCDM-3). Jinan: Chinese Society of Psychiatry; 2001. [In Chinese]
[5] Asia Catalyst. ‘My life is too dark to see the light’: a survey of the living conditions of transgender female sex workers in Beijing and Shanghai. 2015. Available online at: http://asiacatalyst.org/wp-content/uploads/2014/09/Asia-Catalyst-TG-SW-Report.pdf [verified 25 July 2018].
[6] Cusick L, Martin A, May T. Vulnerability and involvement in drug use and sex work. Home Office Research Study 268. London: Home Office; 2003.
[7] Deering KN, Kerr T, Tyndall MW, Montaner JSG, Gibson K, Irons L, et al. A peer-led mobile outreach program and increased utilization of detoxification and residential drug treatment among female sex workers who use drugs in a Canadian setting. Drug Alcohol Depend 2011; 113 46–54.
| A peer-led mobile outreach program and increased utilization of detoxification and residential drug treatment among female sex workers who use drugs in a Canadian setting.Crossref | GoogleScholarGoogle Scholar | 20727683PubMed |
[8] Operario D, Nemoto T. Sexual risk behavior and substance use among a sample of Asian Pacific Islander transgendered women. AIDS Educ Prev 2005; 17 430–43.
| Sexual risk behavior and substance use among a sample of Asian Pacific Islander transgendered women.Crossref | GoogleScholarGoogle Scholar | 16255639PubMed |
[9] Nemoto T, Iwamoto M, Perngparn U, Areesantichai C, Kamitani E, Sakata M. HIV-related risk behaviors among Kathoey (male-to-female transgender) sex workers in Bangkok, Thailand. AIDS Care 2012; 24 210–19.
| HIV-related risk behaviors among Kathoey (male-to-female transgender) sex workers in Bangkok, Thailand.Crossref | GoogleScholarGoogle Scholar | 21780964PubMed |
[10] Sevelius JM. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles 2013; 68 675–89.
| Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color.Crossref | GoogleScholarGoogle Scholar | 23729971PubMed |
[11] Nuttbrock L, Bockting W, Rosenblum A, Hwahng S, Mason M, Macri M, et al. Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study. Am J Public Health 2013; 103 300–7.
| Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study.Crossref | GoogleScholarGoogle Scholar | 22698023PubMed |
[12] Yadegarfard M, Meinhold-Bergmann ME, Ho R. Family rejection, social isolation, and loneliness as predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behavior) among Thai male-to-female transgender adolescents. J LGBT Youth 2014; 11 347–63.
| Family rejection, social isolation, and loneliness as predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behavior) among Thai male-to-female transgender adolescents.Crossref | GoogleScholarGoogle Scholar |
[13] Harcourt C, van Beek I, Heslop J, McMahon M, Donovan B. The health and welfare needs of female and transgender street sex workers in New South Wales. Aust N Z J Public Health 2001; 25 84–9.
| The health and welfare needs of female and transgender street sex workers in New South Wales.Crossref | GoogleScholarGoogle Scholar | 11297309PubMed |
[14] Brook DW, Brook JS, Zhang C, Cohen P, Whiteman M. Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Arch Gen Psychiatry 2002; 59 1039–44.
| Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders.Crossref | GoogleScholarGoogle Scholar | 12418937PubMed |
[15] Canham SL, Mauro PM, Kaufmann CN, Sixsmith A. Association of alcohol use and loneliness frequency among middle-aged and older adult drinkers. J Aging Health 2016; 28 267–84.
| Association of alcohol use and loneliness frequency among middle-aged and older adult drinkers.Crossref | GoogleScholarGoogle Scholar | 26082130PubMed |
[16] Mannes ZL, Burrell LE, Bryant VE, Dunne EM, Hearn LE, Whitehead NE. Loneliness and substance use: the influence of gender among HIV+ Black/African American adults 50+. AIDS Care 2016; 28 598–602.
| Loneliness and substance use: the influence of gender among HIV+ Black/African American adults 50+.Crossref | GoogleScholarGoogle Scholar | 26654243PubMed |
[17] Saha TD, Grant BF, Chou SP, Kerridge BT, Pickering RP, Ruan WJ. Concurrent use of alcohol with other drugs and DSM-5 alcohol use disorder comorbid with other drug use disorders: sociodemographic characteristics, severity, and psychopathology. Drug Alcohol Depend 2018; 187 261–9.
| Concurrent use of alcohol with other drugs and DSM-5 alcohol use disorder comorbid with other drug use disorders: sociodemographic characteristics, severity, and psychopathology.Crossref | GoogleScholarGoogle Scholar | 29689486PubMed |
[18] Yurasek AM, Aston ER, Metrik J. Co-use of alcohol and cannabis: a review. Curr Addict Rep 2017; 4 184–93.
| Co-use of alcohol and cannabis: a review.Crossref | GoogleScholarGoogle Scholar |
[19] Cai Y, Wang Z, Lau JT, Li J, Ma T, Liu Y. Prevalence and associated factors of condomless receptive anal intercourse with male clients among transgender women sex workers in Shenyang, China. J Int AIDS Soc 2016; 19(3 Suppl 2) 20800.
[20] Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977; 1 385–401.
| The CES-D scale: a self-report depression scale for research in the general population.Crossref | GoogleScholarGoogle Scholar |
[21] Chin WY, Choi EP, Chan KT, Wong CK. The psychometric properties of the Center for Epidemiologic Studies Depression Scale in Chinese primary care patients: factor structure, construct validity, reliability, sensitivity and responsiveness. PLoS One 2015; 10 e0135131
| The psychometric properties of the Center for Epidemiologic Studies Depression Scale in Chinese primary care patients: factor structure, construct validity, reliability, sensitivity and responsiveness.Crossref | GoogleScholarGoogle Scholar | 26252739PubMed |
[22] Cheung CK, Bagley C. Validating an American scale in Hong Kong: The Center for Epidemiological Studies Depression Scale (CES-D). J Psychol 1998; 132 169–86.
| Validating an American scale in Hong Kong: The Center for Epidemiological Studies Depression Scale (CES-D).Crossref | GoogleScholarGoogle Scholar | 9529665PubMed |
[23] Lam TH, Stewart SM, Yip PS, Leung GM, Ho LM, Ho SY, et al. Suicidality and cultural values among Hong Kong adolescents. Soc Sci Med 2004; 58 487–98.
| Suicidality and cultural values among Hong Kong adolescents.Crossref | GoogleScholarGoogle Scholar | 14652046PubMed |
[24] Hays RD, DiMatteo MR. A short-form measure of loneliness. J Pers Assess 1987; 51 69–81.
| A short-form measure of loneliness.Crossref | GoogleScholarGoogle Scholar | 3572711PubMed |
[25] Russell D, Peplau LA, Cutrona CE. The revised UCLA loneliness scale: concurrent and discriminant validity evidence. J Pers Soc Psychol 1980; 39 472–80.
| The revised UCLA loneliness scale: concurrent and discriminant validity evidence.Crossref | GoogleScholarGoogle Scholar | 7431205PubMed |
[26] Zhou L, Li Z, Hu M, Xiao S. Reliability and validity of ULS-8 loneliness scale in elderly samples in a rural community. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2012; 37 1124–8. [In Chinese]
| 23202622PubMed |
[27] Wu CH, Yao G. Psychometric analysis of the short-form UCLA loneliness scale (ULS-8) in Taiwanese undergraduate students. Pers Individ Dif 2008; 44 1762–71.
| Psychometric analysis of the short-form UCLA loneliness scale (ULS-8) in Taiwanese undergraduate students.Crossref | GoogleScholarGoogle Scholar |
[28] Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press; 1965.
[29] Cheng ST, Hamid PN. An error in the use of translated scales: the Rosenberg Self-Esteem Scale for Chinese. Percept Mot Skills 1995; 81 431–4.
| An error in the use of translated scales: the Rosenberg Self-Esteem Scale for Chinese.Crossref | GoogleScholarGoogle Scholar |
[30] Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. J Pers Assess 1988; 52 30–41.
| The Multidimensional Scale of Perceived Social Support.Crossref | GoogleScholarGoogle Scholar |
[31] Guan NC, Seng LH, Hway Ann AY, Hui KO. Factorial validity and reliability of the Malaysian simplified Chinese version of Multidimensional Scale of Perceived Social Support (MSPSS-SCV) among a group of university students. Asia Pac J Public Health 2015; 27 225–31.
| Factorial validity and reliability of the Malaysian simplified Chinese version of Multidimensional Scale of Perceived Social Support (MSPSS-SCV) among a group of university students.Crossref | GoogleScholarGoogle Scholar | 23449622PubMed |
[32] Hosmer D, Lemeshow S, Sturdivant RX. Applied logistic regression. 3rd edn. New York, NY: John Wiley & Sons Inc.; 2013.
[33] Maney DW. Predicting university students’ use of alcoholic beverages. JCSD 1990; 31 23–32.
[34] Pullen LM. The relationships among alcohol abuse in college students and selected psychological/demographic variables. J Alcohol Drug Educ 1994; 40 36–50.
[35] Andrews JA, Duncan SC. Examining the reciprocal relation between academic motivation and substance use: effects of family relationships, self-esteem, and general deviance. J Behav Med 1997; 20 523–49.
| Examining the reciprocal relation between academic motivation and substance use: effects of family relationships, self-esteem, and general deviance.Crossref | GoogleScholarGoogle Scholar | 9429987PubMed |
[36] Luhtanen RK, Crocker J. Alcohol use in college students: effects of level of self-esteem, narcissism, and contingencies of self-worth. Psychol Addict Behav 2005; 19 99–103.
| Alcohol use in college students: effects of level of self-esteem, narcissism, and contingencies of self-worth.Crossref | GoogleScholarGoogle Scholar | 15783284PubMed |
[37] McGee R, Williams S. Does low self-esteem predict health compromising behaviours among adolescents? J Adolesc 2000; 23 569–82.
| Does low self-esteem predict health compromising behaviours among adolescents?Crossref | GoogleScholarGoogle Scholar | 11073698PubMed |
[38] Seeman M, Seeman AZ. Life strains, alienation, and drinking behavior. Alcohol Clin Exp Res 1992; 16 199–205.
| Life strains, alienation, and drinking behavior.Crossref | GoogleScholarGoogle Scholar | 1590540PubMed |
[39] Trzesniewski KH, Donnellan MB, Moffitt TE, Robins RW, Poulton R, Caspi A. Low self-esteem during adolescence predicts poor health, criminal behavior, and limited economic prospects during adulthood. Dev Psychol 2006; 42 381–90.
| Low self-esteem during adolescence predicts poor health, criminal behavior, and limited economic prospects during adulthood.Crossref | GoogleScholarGoogle Scholar | 16569175PubMed |
[40] DeSimone A, Murray P, Lester D. Alcohol use, self-esteem, depression, and suicidality in high school students. Adolescence 1994; 29 939–42.
| 7892803PubMed |
[41] Glendinning A. Family life, health and lifestyles in rural areas: the role of self-esteem. Health Educ 1998; 98 59–68.
| Family life, health and lifestyles in rural areas: the role of self-esteem.Crossref | GoogleScholarGoogle Scholar |
[42] Sharp MJ, Getz JG. Substance use as impression management. Pers Soc Psychol Bull 1996; 22 60–7.
| Substance use as impression management.Crossref | GoogleScholarGoogle Scholar |
[43] Cournoyer DE, Malcolm BP. Evaluating claims for universals: a method analysis approach. Cross-Cultural Res 2004; 38 319–42.
| Evaluating claims for universals: a method analysis approach.Crossref | GoogleScholarGoogle Scholar |
[44] Ghindia DJ, Kola LA. Cofactors affecting substance abuse among homosexual men: an investigation within a midwestern gay community. Drug Alcohol Depend 1996; 41 167–77.
| Cofactors affecting substance abuse among homosexual men: an investigation within a midwestern gay community.Crossref | GoogleScholarGoogle Scholar | 8842629PubMed |
[45] Clements K, Wilkinson W, Kitano K, Marx R. HIV prevention and health service needs of the transgender community in San Francisco. IJT 1999; 3 2–17.
[46] Newcomb ME, Heinz AJ, Mustanski B. Examining risk and protective factors for alcohol use in lesbian, gay, bisexual, and transgender youth: a longitudinal multilevel analysis. J Stud Alcohol Drugs 2012; 73 783–93.
| Examining risk and protective factors for alcohol use in lesbian, gay, bisexual, and transgender youth: a longitudinal multilevel analysis.Crossref | GoogleScholarGoogle Scholar | 22846242PubMed |
[47] King KM, Chassin L. Mediating and moderated effects of adolescent behavioral undercontrol and parenting in the prediction of drug use disorders in emerging adulthood. Psychol Addict Behav 2004; 18 239–49.
| Mediating and moderated effects of adolescent behavioral undercontrol and parenting in the prediction of drug use disorders in emerging adulthood.Crossref | GoogleScholarGoogle Scholar | 15482079PubMed |
[48] Essau CA, Hutchinson D. Adolescent addiction: epidemiology, assessment, and treatment. Burlington, MA: Academic Press; 2008.
[49] Page RM, Dennis M, Lindsay GB, Merrill RM. Psychosocial distress and substance use among adolescents in four countries: Philippines, China, Chile, and Namibia. Youth Soc 2011; 43 900–30.
| Psychosocial distress and substance use among adolescents in four countries: Philippines, China, Chile, and Namibia.Crossref | GoogleScholarGoogle Scholar |
[50] McKay MT, Konowalczyk S, Andretta JR, Cole JC. The direct and indirect effect of loneliness on the development of adolescent alcohol use in the United Kingdom. Addict Behav Rep 2017; 6 65–70.
| The direct and indirect effect of loneliness on the development of adolescent alcohol use in the United Kingdom.Crossref | GoogleScholarGoogle Scholar | 29450238PubMed |
[51] Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychol Aging 2006; 21 140–51.
| Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses.Crossref | GoogleScholarGoogle Scholar | 16594799PubMed |
[52] Cacioppo JT, Hawkley LC, Ernst JM, Burleson M, Berntson GG, Nouriani B, et al. Loneliness with a nomological net: an evolutionary perspective. J Res Pers 2006; 40 1054–85.
| Loneliness with a nomological net: an evolutionary perspective.Crossref | GoogleScholarGoogle Scholar |
[53] Miller NS, Klamen D, Hoffmann NG, Flaherty JA. Prevalence of depression and alcohol and other drug dependence in addictions treatment populations. J Psychoactive Drugs 1996; 28 111–24.
| Prevalence of depression and alcohol and other drug dependence in addictions treatment populations.Crossref | GoogleScholarGoogle Scholar | 8811580PubMed |
[54] Hartka E, Johnstone B, Leino EV, Motoyoshi M, Temple MT, Fillmore KM. A meta-analysis of depressive symptomatology and alcohol consumption over time. Br J Addict 1991; 86 1283–98.
| A meta-analysis of depressive symptomatology and alcohol consumption over time.Crossref | GoogleScholarGoogle Scholar | 1836410PubMed |
[55] Holt M, Bryant J, Newman C, Paquette DM, Mao L, Kidd MR, et al. Patterns of alcohol and other drug use associated with major depression among gay men attending general practices in Australia. Int J Ment Health Addict 2012; 10 141–51.
| Patterns of alcohol and other drug use associated with major depression among gay men attending general practices in Australia.Crossref | GoogleScholarGoogle Scholar |
[56] Rowe C, Santos GM, McFarland W, Wilson EC. Prevalence and correlates of substance use among trans*female youth ages 16–24 years in the San Francisco Bay Area. Drug Alcohol Depend 2015; 147 160–6.
| Prevalence and correlates of substance use among trans*female youth ages 16–24 years in the San Francisco Bay Area.Crossref | GoogleScholarGoogle Scholar | 25548025PubMed |
[57] Mayer KH, Wang L, Koblin B, Mannheimer S, Magnus M, del Rio C, et al. Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among Black men who have sex with men in 6 U.S. cities. PLoS One 2014; 9 e87298
| Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among Black men who have sex with men in 6 U.S. cities.Crossref | GoogleScholarGoogle Scholar | 25493916PubMed |
[58] Hess KL, Chavez PR, Kanny D, DiNenno E, Lansky A, Paz-Bailey G. Binge drinking and risky sexual behavior among HIV-negative and unknown HIV status men who have sex with men, 20 US cities. Drug Alcohol Depend 2015; 147 46–52.
| Binge drinking and risky sexual behavior among HIV-negative and unknown HIV status men who have sex with men, 20 US cities.Crossref | GoogleScholarGoogle Scholar | 25555622PubMed |
[59] Morris L, Kouya F, Kwalar R, Pilapil M, Saito K, Palmer N, et al. Factors associated with inconsistent condom use in adolescents with negative or unknown HIV status in Northwest Cameroon. AIDS Care 2014; 26 1440–5.
| Factors associated with inconsistent condom use in adolescents with negative or unknown HIV status in Northwest Cameroon.Crossref | GoogleScholarGoogle Scholar | 24865769PubMed |
[60] Volkow ND, Montaner J. The urgency of providing comprehensive and integrated treatment for substance abusers with HIV. Health Aff (Millwood) 2011; 30 1411–9.
| The urgency of providing comprehensive and integrated treatment for substance abusers with HIV.Crossref | GoogleScholarGoogle Scholar | 21821558PubMed |