title: Correlates of HIV infection among female sex workers in Vietnam: injection drug use remains a key risk factor.
abstract: OBJECTIVE
  Women who sell sex and use drugs have dual risks for HIV infection. Despite increasing reports of drug use among female sex workers (FSW) in Vietnam, FSW HIV interventions remain focused mainly on sexual risk reduction. We assessed the impact of drug use and inconsistent condom use on HIV infection among FSW in Vietnam, which few studies have quantified.
  
  
  METHODS
  We surveyed 5298 women aged ≥18 years who had sold sex in the past month from ten geographically dispersed provinces. We performed multivariate logistic regression on data from provinces with high (≥10%) or low (<10%) HIV prevalence among FSW.
  
  
  RESULTS
  Compared to FSW who never used illicit drugs, the odds of HIV infection among FSW who had ever injected drugs and those who reported non-injection drug use were 3.44 (CI 2.32-5.09) and 1.76 (CI 1.14-2.71), respectively, in high-prevalence provinces. FSW who always used condoms with clients had lower odds of HIV infection than those who did not (AOR=0.71; CI 0.52-0.98). In low-prevalence provinces lifetime injection drug use (AOR 22.05, CI 12.00-40.49), but not non-injecting drug use or inconsistent condom use, was significantly associated with HIV infection.
  
  
  CONCLUSIONS
  Because injection drug use and inconsistent condom use were key risk factors for HIV infection in high-prevalence provinces, drug injection risk reduction should be as much a focus of HIV prevention as sexual risk reduction. Where HIV prevalence remains low in FSW, a more general emphasis on harm reduction for all drug users will benefit FSW.
authors.affiliation: U.S. Centers for Disease Control and Prevention, Vietnam; Kirby Institute for Infection and Immunity, UNSW, Australia. Electronic address: leli@wpro.who.int.
authors.forename: Linh-Vi N
authors.initials: LV
authors.lastname: Le
authors.affiliation: National Institute of Hygiene and Epidemiology, Vietnam.
authors.forename: Tuan A
authors.initials: TA
authors.lastname: Nguyen
authors.affiliation: Partners in Health Research, Vietnam.
authors.forename: Hoang V
authors.initials: HV
authors.lastname: Tran
authors.affiliation: U.S. Centers for Disease Control and Prevention, Vietnam.
authors.forename: Nisha
authors.initials: N
authors.lastname: Gupta
authors.affiliation: National Institute of Hygiene and Epidemiology, Vietnam.
authors.forename: Thanh C
authors.initials: TC
authors.lastname: Duong
authors.affiliation: Family Health International 360, Vietnam.
authors.forename: Ha T T
authors.initials: HT
authors.lastname: Tran
authors.affiliation: U.S. Centers for Disease Control and Prevention, Vietnam.
authors.forename: Patrick
authors.initials: P
authors.lastname: Nadol
authors.affiliation: World Health Organization, Vietnam, currently UN Joint Programme on HIV/AIDS, Switzerland.
authors.forename: Keith
authors.initials: K
authors.lastname: Sabin
authors.affiliation: Kirby Institute for Infection and Immunity, UNSW, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
authors.affiliation: Kirby Institute for Infection and Immunity, UNSW, Australia.
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms; D055030:Drug Users / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D060386:Sex Workers / Q000523:psychology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D047568:Unsafe Sex / Q000706:statistics & numerical data; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult
keywords: Drug use; Female sex workers; HIV; Harm reduction; Risk factors; Vietnam