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

Abstract

Background Female injecting drug users (IDUs) who are also sex workers (FSW-IDUs) is an important bridge population transmitting HIV from the IDU population to clients of FSWs. Little is known about the relationships between severity of drug dependence, economic pressure and relevant HIV-related risk behaviors. Methods 281 non-institutionalized participants were recruited using snowball sampling methods. Anonymous face-to-face interviews were administered by trained doctors. Results 64.1% of participants used condoms inconsistently with their clients in the past 6 months; 28.5% served at least 2 clients per day and 48.4% practiced at least one of the three studied needle sharing behaviors. Severity of drug dependence (adjusted OR = 1.05, p < 0.01) and economic pressure (adjusted OR = 1.07 to 2.52, p < 0.05) were significantly associated with inconsistent condom use with clients in the last 6 months. Severity of drug dependence (adjusted OR = 1.15, p < 0.01) and variables related to perceived economic pressure (adjusted OR = 1.09–3.05, p < 0.05) were significantly associated with higher frequency of commercial sex transaction. Severity of drug dependence (adjusted OR = 1.07, p < 0.01) were also associated with needle sharing behaviors. In summary models, severity of drug dependence (OR = 1.17, p < 0.001), economic pressure (OR = 1.39, p < 0.001) and their interaction term (OR = 0.98, p < 0.001) were all associated with inconsistent condom use with clients in the last 6 months. Conclusions Prevalence of unprotected commercial sex was high and was independently associated with severity of drug dependence and economic pressure; severity of drug dependence was also associated with needle sharing behaviors. Such issues need to be fully considered when planning research studies and interventions.