title: Sexual and reproductive health risks amongst female adolescents who use amphetamine-type stimulants and sell sex: a qualitative inquiry in Yunnan, China.
abstract: BACKGROUND
  China, as other Southeast Asian countries, has witnessed an increased use in amphetamine-type stimulants (ATS) amongst urban youth. Amongst female adolescents who both sell sex and use ATS, risk behaviours are compounded resulting in even poorer health outcomes. However, limited knowledge exists on ATS use patterns and ATS-related risk behaviours, particularly in this context. This research aimed to improve the understanding of these issues amongst female adolescents who use ATS and sell sex, and to inform future programming.
  
  
  METHODS
  This study utilised monthly focus group discussions (four in total) with the same study participants in Yunnan, China. From within a drug-treatment programme, female adolescents who reported both a history of drug use and selling sex were purposively enrolled in the study.
  
  
  RESULTS
  Participating adolescent females were aged 17-19 years and were all internal-migrants with low literacy. All reported polydrug use (mainly methamphetamine and heroin, whereas ecstasy and ketamine have been infrequently employed). Being less informed about risks of drug use and lack of sexual and reproductive health knowledge seemed to contribute to problematic drug use, rough and prolonged sexual intercourse, inconsistent condom use and ineffective contraceptive practice. For their income, participants largely relied on selling sex, which was frequently coupled with drug sharing services to clients. However, despite the practices, women did not self-identify as sex workers, and therefore did not think that existing intervention services targeting female sex workers were relevant to them. Moreover, criminalization and stigmatisation of drug use and selling sex impeded their access to care services.
  
  
  CONCLUSIONS
  Current harm reduction and HIV/sexually transmitted infection (STI) prevention services are unlikely to address the demand of female adolescents engaged in drug use and commercial sex. Our findings highlight that a comprehensive and coordinated harm reduction and sexual and reproductive health response should be conducted involving these most vulnerable adolescents.
authors.affiliation: International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium. Xudong.Zhang@UGent.be.|Centre for International Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia. Xudong.Zhang@UGent.be.
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Zhang
authors.affiliation: International HIV Research Group, School of Public Health and Community Medicine, UNSW, Sydney, 2052, Australia. a.kelly@unsw.edu.au.|Sexual & Reproductive Health Unit, Institute of Medical Research, PO Box 60, Goroka, EHP, Papua New Guinea. a.kelly@unsw.edu.au.
authors.forename: Angela
authors.initials: A
authors.lastname: Kelly-Hanku
authors.affiliation: City College, Kunming University of Science and Technology, East Ring Road 50, 650051, Kunming, China. christycjj128@hotmail.com.
authors.forename: Jia-Jia
authors.initials: JJ
authors.lastname: Chai
authors.affiliation: Department of Prevention and Education, Yunnan Institute for Drug Abuse, Xi Hu Lu 300, 650228, Kunming, China. luojiankm@126.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Luo
authors.affiliation: International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium. Marleen.Temmerman@UGent.be.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium. sluchters@burnet.edu.au.|Centre for International Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia. sluchters@burnet.edu.au.|Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne, Victoria, 3004, Australia. sluchters@burnet.edu.au.
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
mesh_terms: D000293:Adolescent; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D060728:Reproductive Health / Q000706:statistics & numerical data; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D055815:Young Adult