Abstract
BackgroundSubstance use and adverse sexual and reproductive health (SRH) outcomes continue to be significant threats to female adolescents’ health and wellbeing, particularly to these marginalized subpopulations. Our research aimed to tackle knowledge gaps regarding the prevalence of concurrent substance use including alcohol, tobacco, illicit drug among Chinese adolescent female sex workers (AFSWs), while to assess the correlates between substance use and SRH risks; the needs for comprehensive SRH services were also examined in this study.MethodsA cross-sectional study enrolled 310 AFSWs aged 15–19 years by using cluster sampling method in Kunming, China. Descriptive analysis was employed to characterize the participants who were regular-alcohol users, regular-tobacco users, illicit drug users and polysubstance users. Multivariable logistic regression analysis was performed to detect the SRH correlates of regular-alcohol use, regular-tobacco use, illicit drugs and polysubstance use respectively.ResultsThere is a high prevalence of regular-alcohol drinking (83%, 257/310) among AFSWs, with 44% (136/310) smoking cigarettes regularly and 9% using illicit drug (27/310) in the past year. In multivariate analysis, AFSWs who had middle and high school education, had higher monthly income, experienced of sexual and gender based violence (SGBV) and prior abortion, and regular-tobacco smoking were associated with increased odds of regular-alcohol drinking; engaging in unprotected sex while drunk, having STIs symptoms and using illicit drugs were significantly associated with regular-tobacco smoking; while AFSWs who had an illicit drug using- intimate partner, experienced forced sexual initiation, accessed unsafe medical providers for STIs treatment were associate with increased odds of illicit drug use. Moreover, 35% (105/298) AFSWs sought unsafe medical care for STIs treatment, or no treatment at all, among them, majority were using polysubstance (87%; 91/105).ConclusionsOur findings reveal combined threats of substance use to AFSWs’ SRH and wellbeing in China, this study emphasises that the coordinated efforts are needed to integrate SRH promotion and harm reduction service across sectors, and not only fragmented measures. An effective response should include an agreed framework, indicators and targets supported by political will, solid leadership and policy reform to deal with AFSWs’ overlapping vulnerabilities in a systematic way.
Highlights
Substance use and adverse sexual and reproductive health (SRH) outcomes continue to be significant threats to female adolescents’ health and wellbeing, to these marginalized subpopulations
Our findings reveal combined threats of substance use to adolescent female sex workers (AFSWs)’ SRH and wellbeing in China, this study emphasises that the coordinated efforts are needed to integrate SRH promotion and harm reduction service across sectors, and fragmented measures
An effective response should include an agreed framework, indicators and targets supported by political will, solid leadership and policy reform to deal with AFSWs’ overlapping vulnerabilities in a systematic way
Summary
Substance use and adverse sexual and reproductive health (SRH) outcomes continue to be significant threats to female adolescents’ health and wellbeing, to these marginalized subpopulations. A critical new priority at the heart of the updated Global Strategy for Women’s Children’s and Adolescents’ Health (2016– 2030) is the focus on adolescents. This Global Strategy brings a broader concept of adolescent SRH by including HIV and other sexually transmitted infectious (STIs), non-communicable diseases (NCDs), and mental and substance use disorders [3]. Substance use among adolescents can lead to increased risk of STIs including HIV, vehicular fatalities, juvenile delinquency, and other NCDs problems associated with physical and mental health [4]. Adverse SRH consequences disproportionately affect female adolescents who use alcohol and tobacco [6], for example, maternal smoking during pregnancy is a particular risk factor for poor fetal growth as well as later-life illness in offspring [4]; alcohol use during puberty adversely affects the maturation of the reproductive system while greater use of alcohol in pregnancy has prominent intergenerational harms in the form of fetal alcohol syndrome [4]
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