title: 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.
authors.affiliation: Centre for Epidemiology & Biostatistics, School of Public Health, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Gu
authors.forename: Hongyao
authors.initials: H
authors.lastname: Chen
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.forename: Joseph T F
authors.initials: JT
authors.lastname: Lau
authors.forename: Renfan
authors.initials: R
authors.lastname: Wang
authors.forename: Chuliang
authors.initials: C
authors.lastname: Liu
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Zhangquan
authors.initials: Z
authors.lastname: Lei
authors.forename: Zhenglin
authors.initials: Z
authors.lastname: Li
mesh_terms: D000328:Adult; D002391:Catchment Area, Health; D002681:China / Q000453:epidemiology; D003688:Deinstitutionalization / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D016485:Needle Sharing / Q000706:statistics & numerical data; D012309:Risk-Taking; D012720:Severity of Illness Index; D011477:Sex Work / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000453:epidemiology*; D047568:Unsafe Sex / Q000706:statistics & numerical data