Comparing Prevalence of Condom Use Among 15,379 Female Sex Workers Injecting or Not Injecting Drugs in China

Abstract

To compare the prevalence of condom use with clients and regular sex partners between female sex workers (FSWs) who were or were not injecting drug users (IDUs). Behavioral surveillance data (2002-2004) conducted in Sichuan, China were analyzed. Mapping exercises were done. About 250 to 400 FSWs were anonymously interviewed from selected establishments in 19 surveillance sites. Of all 15,379 FSWs studied, 3.2% were IDUs. This group, when compared with the non-IDU group, was less likely to have used condoms with clients (last episode: 71.1% vs. 81.2%, OR = 0.6, P < 0.01; consistent use in the last month: 26.7% vs. 40.4%, OR = 0.5, P < 0.01) or to possess a condom (68.7% vs. 77.8%, OR = 0.6, P < 0.01). The between-group difference in last month's consistent condom use with clients remained significant in the multivariate analyses, after adjusting for other significant factors [age, education level, age at first sex, having a regular sex partner, HIV-related knowledge and perceptions, HIV antibody testing (OR = 1.1-2.9, P < 0.05); STD symptoms, type of sex workers, longer duration of sex work, larger number of clients per week, and not having received HIV-related information (OR = 0.4-0.9)]. Comparable results were obtained for condom use with the last client. Such between-group differences were, however, not observed for condom use with regular sex partners (P > 0.05). Exposure to HIV-related services was associated with condom use with clients (OR = 1.3-2.8, P < 0.05). Higher sexual risk behaviors were found among FSWs who were also IDUs, when compared with those who were non-IUDs. A double-risk bridging population for HIV transmission thereby exists.