title: Unprotected sex among HIV-positive treatment-seeking opioid-dependent adults in China: a cross-sectional study.
abstract: BACKGROUND
  We set out to identify factors associated with unprotected sex among HIV-positive patients on methadone maintenance therapy (MMT) in China.
  
  
  METHODS
  We conducted a cross-sectional study in 60 MMT clinics in Yunnan, Sichuan, Guizhou, Guangxi, and Xinjiang provinces, China, with a total of 2742 participants.
  
  
  RESULTS
  The median age of participants was 35 years (range, 19-63 years), and 78.3% were male. More than half (1471/2742; 53.6%) were married, 6.4% (176/2742) had a regular sex partner, and 3.5% (95/2742) had 1 or more occasional sex partners. Among married participants, 64.6% (950/1471) had a spouse who was HIV negative or of unknown HIV status. Among them, 62.8% (597/950) reported sex in the past 30 days, and 31.0% (185/597) reported unprotected sex in the past 30 days. Multivariate logistic regression identified 3 factors associated with an increased risk of unprotected sex: receiving MMT in Guangxi (odds ratio [OR], 3.72 [2.05-6.75]; P < 0.001) or Xinjiang (OR, 2.23 [1.33-3.73]; P < 0.01), having a spouse that is a current or former drug user (OR, 1.80 [1.12-2.90]; P < 0.05), and having dropped out of MMT in the past 6 months (OR, 3.05 [1.63-5.71]; P < 0.001); it also identified 2 factors associated with a decreased risk of unprotected sex: being male (OR, 0.46 [0.26-0.79]; P < 0.01) and being aware of one's own HIV serostatus (OR, 0.16 [0.10-0.27]; P < 0.001).
  
  
  CONCLUSIONS
  Many HIV-positive opioid-dependent individuals attending MMT continue to engage in high-risk sexual behaviors. Future efforts should focus on increasing awareness of HIV serostatus, retaining patients in MMT, and addressing the specific needs of female patients on MMT.
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Zhenghong
authors.initials: Z
authors.lastname: Zhang
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Poundstone
authors.forename: Wenyuan
authors.initials: W
authors.lastname: Yin
authors.forename: Lin
authors.initials: L
authors.lastname: Pang
authors.forename: Keming
authors.initials: K
authors.lastname: Rou
authors.forename: Wei
authors.initials: W
authors.lastname: Luo
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Cao
authors.forename: Changhe
authors.initials: C
authors.lastname: Wang
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006078:Government Programs; D006679:HIV Seropositivity / Q000453:epidemiology / Q000635:transmission*; D015438:Health Behavior; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D008297:Male; D008691:Methadone; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology; D047568:Unsafe Sex / Q000517:prevention & control / Q000706:statistics & numerical data
chemical_list: D008691:Methadone