title: Knowledge of HIV seropositivity is a predictor for initiation of illicit drug use: incidence of drug use initiation among female sex workers in a high HIV-prevalence area of China.
abstract: BACKGROUND
  Drug use and sex work have had facilitative roles in the transmission of HIV/AIDS in China. Stopping drug use among sex workers may help to control the growth of the HIV/AIDS epidemic among Chinese sex workers.
  
  
  METHODS
  From March 2006 to November 2009, female sex workers (FSW) in Kaiyuan City, Yunnan, China were recruited into an open cohort study. Participants were interviewed and tested for drug use and HIV/sexually transmitted infection (STI) prevalence. Follow-up surveys were conducted every six months. Multivariate Cox proportional hazards regression model with time dependent variables was used to measure the associations between independent variables and drug initiation.
  
  
  RESULTS
  During the course of the study, 66 (8.8%) FSWs initiated drug use yielding an overall incidence of 6.0 per 100 person years (PY) (95% confidence interval [CI], 4.67-7.58). In the multivariate Cox proportional hazards regression model, being HIV-positive and aware of positive serostatus (adjusted hazard ratio [AHR] 2.6, 95% CI 1.24-5.55), age at initiation of commercial sex work <20 years (AHR 1.8, 95% CI 1.12-3.01), and working in a high-risk establishment (AHR 1.9, 95% CI 1.14-3.04) were associated with illicit drug initiation.
  
  
  CONCLUSIONS
  Being HIV-positive and aware of positive serostatus was the most salient predictor for the initiation of illicit drug use. Interventions offering sources of education, treatment, support, and counseling to HIV-positive FSWs need to be implemented in order to help promote self-efficacy and safe behaviors among this group of high-risk women.
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, PR China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Wang
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Brown
authors.forename: Guixiang
authors.initials: G
authors.lastname: Wang
authors.forename: Guowei
authors.initials: G
authors.lastname: Ding
authors.forename: Chunpeng
authors.initials: C
authors.lastname: Zang
authors.forename: Junjie
authors.initials: J
authors.lastname: Wang
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: Reilly
authors.forename: Helen
authors.initials: H
authors.lastname: Chen
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D004651:Employment; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D006801:Humans; D013287:Illicit Drugs; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data; D060386:Sex Workers / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult
chemical_list: D013287:Illicit Drugs