Drug Use and Sex Work: Competing Risk Factors for Newly Acquired HIV in Yunnan, China

Junjie Xu,Qinghua Li,Jennifer Chu,Yan Jiang,Guowei Ding,Dongfang Chang,Hong Shang,M Kumi Smith,Haibo Wang,Guixiang Wang,Ning Wang

doi:10.1371/journal.pone.0059050

Abstract

ObjectiveTo investigate the HIV incidence and its related factors among female sex workers (FSWs) in a high prevalence area where injection drug use is also widely documented.MethodA cross-sectional study of 1642 female sex workers (FSWs) was conducted in Honghe Prefecture of Yunnan Province. Interviewed-questionnaires were administrated to collect information on sexual partnerships, condom use and illicit drug using behaviors etc. Blood samples were collected to test for HIV antibodies, and all HIV seropositive specimens were tested with the BED IgG capture-based enzyme immunosorbent assay (BED-CEIA) to distinguish between new and established HIV infection (<153 days).Results15.9% (261/1642) of participants reported ever having used drugs, and 7.4% had injected in recent 3 months. The overall HIV prevalence was 10.2% (168/1642), among which 16.7% (28/168) were identified as recent infections using BED-CEIA. The crude HIV incidence estimated from BED-CEIA results was 4.4 (95%CI 2.8–6.0) /100 person years (PY). Multivariate logistic analysis showed that an illicit drug using history (by either self-reporting or urine opiates testing) was both significant risk factors both for HIV established and recent infection (each p<0.05). Drug using FSWs (DU-FSW) reported more male clients in the previous week, and had significantly higher prevalence of HIV, chlamydia trachomatis and HSV-2 as compared to non DU-FSW (each p<0.05).ConclusionOur results show that a history of drug use poses significant risks for both new and established HIV infection among FSWs, and that HIV-incidence among Honghe FSWs is relatively high compared to similar populations. Comprehensive interventions targeted at DU-FSWs' injection drug using and high risk sexual behaviors are urgently needed to reduce the rapid spread of HIV epidemic.

Highlights

Our results show that a history of drug use poses significant risks for both new and established HIV infection among female sex workers (FSWs), and that HIV-incidence among Honghe FSWs is relatively high compared to similar populations
Comprehensive interventions targeted at Drug using FSWs (DU-FSW)’ injection drug using and high risk sexual behaviors are urgently needed to reduce the rapid spread of HIV epidemic
Worldwide estimated number of people living with HIV or AIDS (PLWHs) is about 34 million, among which unprotected heterosexual intercourse is the predominant mode of HIV transmission [1,2]

Summary

Introduction

Worldwide estimated number of people living with HIV or AIDS (PLWHs) is about 34 million, among which unprotected heterosexual intercourse is the predominant mode of HIV transmission [1,2]. Female sex workers (FSWs) and their male clients have been identified as core populations for the rapid spread of HIV epidemic in various epidemic settings including East Asia [3,4] and some African countries [5,6]. Throughout the 1990’s and early 2000’s injection drug remained the dominant mode of HIV transmission in China [7] in 2007 heterosexual contact replaced injection drug use as the dominant route of HIV transmission. While overall HIV prevalence among FSWs has remained relatively low at a median of 0.6% [10], prevalence rates as high as 10.3–13.0% [11,12,13] have been reported in ‘‘hot spot’’ areas

Methods

Results

Conclusion