title: How likely are HIV-positive female sex workers in China to transmit HIV to others?
abstract: BACKGROUND
  Female sex workers (FSW) are highly marginalised and HIV-positive FSW are under a double stigma. No study has assessed the likelihood of secondary transmission via HIV-positive FSW in China.
  
  
  METHODS
  A total of 199 FSW who injected drugs were recruited by snowball sampling, and 158 non-injecting FSW were recruited from sex service establishments by convenience sampling in Dazhou, China. All participants were interviewed anonymously using a structured questionnaire.
  
  
  RESULTS
  If found to be HIV-positive, 11.7% of the participants would continue working as FSW, 24.6% would not care about transmitting HIV to others, 18.8% believed that they would eventually spread HIV to others and 9% would take revenge by spreading HIV to others. In multivariate models, factors associated with ≥ 1 of the four aforementioned perceptions (42.0%) included drug use (odds ratio (OR)=1.82-3.26, P<0.01), perceived discrimination towards people living with HIV and AIDS in China (OR=2.03, P<0.05) and perceived inaccessibility to medical treatments if diagnosed as HIV-positive (OR=2.30, P<0.01); the reverse was true for use of HIV-related services (OR=0.53, P<0.05) and suicidal intentions if found to be HIV-positive (OR=0.42, P<0.05).
  
  
  CONCLUSIONS
  Improvement of the social, care and medical environment of HIV-positive FSW is likely to reduce secondary transmission via HIV-positive FSW. Special attention should be given to FSW who inject drugs.
authors.affiliation: Centre for Health Behaviours Research, School of Public Health and Primary Care, the Chinese University of Hong Kong, 5/F., School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong, China. jlau@cuhk.edu.hk
authors.forename: Joseph T F
authors.initials: JT
authors.lastname: Lau
authors.forename: Jing
authors.initials: J
authors.lastname: Gu
authors.forename: Hiyi
authors.initials: H
authors.lastname: Tsui
authors.forename: Hongyao
authors.initials: H
authors.lastname: Chen
authors.forename: Renfan
authors.initials: R
authors.lastname: Wang
authors.forename: Xianyou
authors.initials: X
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000208:ethnology* / Q000523:psychology / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D011477:Sex Work / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data*; D057545:Social Stigma; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D014342:Truth Disclosure; D055815:Young Adult