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Palmer L, Maviglia F, Wickersham JA, Khati A, Kennedy O, Copenhaver NM, Uyer C, Halim MAA, Ikhtiaruddin WM, Azwa I, Gautam K, Shrestha R. Chemsex and Harm Reduction Practices Among Men Who Have Sex with Men in Malaysia: Findings from a Qualitative Study. J Psychoactive Drugs 2023:1-10. [PMID: 37610135 PMCID: PMC10884347 DOI: 10.1080/02791072.2023.2250342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
Chemsex is a form of sexualized drug use commonly practiced among MSM with psychoactive substances, such as methamphetamine. While this phenomenon has gained global attention in the past two decades, there is a dearth of empirical data to inform culturally competent interventions. The current work investigates the socio-contextual factors related to chemsex and harm reduction practices among Malaysian MSM. Between February and August 2022, we conducted six online focus group sessions with Malaysian MSM who had engaged in chemsex during the previous 6 months (N = 22). We queried participants about perceived benefits and harms, harm reduction practices, and informational needs. Most participants' first chemsex experience occurred in a casual sexual encounter, often facilitated by mobile technology. Participants reported engaging in harm reduction practices before (e.g. medication reminders), during (e.g. peer support), and after (e.g. rest) chemsex. These findings have implications for future efforts to develop and implement tailored interventions to address the specific and acute needs of Malaysian MSM engaging in chemsex.
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Affiliation(s)
- Lindsay Palmer
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Francesca Maviglia
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Olivia Kennedy
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Christopher Uyer
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Mohd Akbar Ab Halim
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Mohd Ikhtiaruddin
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Mortalities of methamphetamine, opioid, and ketamine abusers in Shanghai and Wuhan, China. Forensic Sci Int 2020; 306:110093. [DOI: 10.1016/j.forsciint.2019.110093] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/20/2022]
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Liu L, Chai X. Pleasure and Risk: A Qualitative Study of Sexual Behaviors Among Chinese Methamphetamine Users. JOURNAL OF SEX RESEARCH 2020; 57:119-128. [PMID: 30004801 DOI: 10.1080/00224499.2018.1493083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In China, the number of methamphetamine (meth) users has increased dramatically in recent years. This issue has caused researchers to consider the association of meth use with public health concerns, such as the spread of sexually transmitted infections (STIs). Despite the potential outcomes of meth use, qualitative research has not as yet explored Chinese meth users' sexual experiences and feelings associated with meth use. To contribute to the literature, this study employed semistructured interviews to collect data from 19 female and 16 male Chinese meth users (mean age = 31) who were predominantly heterosexual and were recruited from seven compulsory drug treatment institutions in Eastern China. Most participants had completed nine or fewer years of education. Gender similarities and differences were observed in the participants' pursuits of sexual pleasure while using meth. Meth use can enhance the likelihood of high-risk sexual behaviors in both genders and therefore increases the number of public health issues. Men largely dominated the discussion of unprotected sex, while women reported transactional sex in their interviews. Based on research findings, we suggest policymakers strengthen safer-sex educational programs. Policymakers should also enhance prevention methods targeting meth use among women who may engage in transactional sex.
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Affiliation(s)
- Liu Liu
- School of Social and Behavioral Sciences, Nanjing University
| | - Xiangnan Chai
- Department of Sociology, Social Science Centre, University of Western Ontario
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Shokoohi M, Karamouzian M, Sharifi H, Rahimi-Movaghar A, Carrico AW, Hosseini Hooshyar S, Mirzazadeh A. Crystal methamphetamine use and its correlates in women engaged in sex work in a developing country setting. Drug Alcohol Depend 2018; 185:260-265. [PMID: 29477085 DOI: 10.1016/j.drugalcdep.2017.12.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/22/2017] [Accepted: 12/09/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Worldwide, crystal methamphetamine (CM) use and associated high-risk sexual behaviors are a concern, but they are less studied among female sex workers (FSW) in developing countries. This study aimed to characterize the prevalence and individual, interpersonal, and structural correlates of self-reported past-month CM use among FSW in Iran. METHODS FSW aged ≥ 18 years who reported penetrative sex with more than one client in the last year were recruited (analytic sample: 1295). Data were collected in one-on-one interviews using a standardized behavioral questionnaire. Poisson regression model was used to assess the correlated of past-month self-reported CM use by crude and adjusted prevalence ratio (APR) and 95% confidence intervals (CI). RESULTS Non-injecting and injecting CM use was reported by 15.0% (95% CI: 8.7, 24.7) and 0.9% (95% CI: 0.4, 2.1) of participants. CM use was positively associated with concurrent use of opioids (APR from 2.08 to 3.84, P-value < 0.01), higher number of sexual partners (APR: 2.05, P-value: 0.018), housing instability (APR: 3.54, P-value: 0.001), and history of forced sex (APR: 1.47, P-value: 0.050). CONCLUSIONS A considerable number of FSWs use CM along with opioids, have a higher number of sexual partners, forced sex, and housing instability. Both prevention strategies as well as strategies to reduce harm associated with CM need to be added to current programs that predominantly focus on opioid dependency and male drug injectors.
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Affiliation(s)
- Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1151 Richmond St., London, ON, Canada.
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada.
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, 1120 NW 14th St., Miami, FL, USA.
| | - Samira Hosseini Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California San Francisco, 550 16th St., San Francisco, CA, USA.
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Dual Epidemics of Club Drug Use and Sexually Transmitted Infections among Chinese Female Sex Workers: New Challenges to STI Prevention. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28638824 PMCID: PMC5468568 DOI: 10.1155/2017/2093421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To evaluate club drug use and its potential association with STI among female sex workers (FSWs) in China. Methods From November 2008 to January 2009, participants were recruited at sex work venues in five cities for a questionnaire survey. Free testing for syphilis, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) was provided. Logistic regression models were used to assess factors associated with club drug use and its association with STI. Results A total of 1604 eligible FSWs were included. The overall prevalence of any STI infection and club drug use in the past 12 months was 22.6% and 7.4%, respectively. STI prevalence was significantly higher among club drug users (33.1%) than among nonusers (21.7%, P < 0.05). Multivariable logistic regression found that club drug use was associated with younger age (AOR 2.4, 95% CI 1.0, 6.0), higher education, having injected drugs (AOR 24.4, 95% CI 6.2, 96.8), and having had STI symptoms (AOR 2.2, 95% CI 1.4, 3.4). Conclusions Club drug use and STI were highly prevalent among FSWs in China, especially among young FSWs. Club drug users had more risk behaviors and higher STI rates. A coordinated risk reduction framework is urgently needed to address the dual epidemic of drug use and STI.
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Liu D, Jiang Z, Xiu C, Li Z, Song Q, Wang Z. Sexually transmitted infection prevalence and related risk factors among heterosexual male methamphetamine users in China. Int J STD AIDS 2017; 28:1208-1214. [PMID: 28178893 DOI: 10.1177/0956462417693165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Few studies have examined the association between methamphetamine (MA) abuse and sexually transmitted infection (STI) risk among heterosexual male MA users in China. A total of 288 heterosexual male MA users who met our inclusion criteria were recruited from nightclubs, KTVs, bars, bath centres and an STI clinic. STIs were screened among the participants, and the risk factors related to STIs were analysed by multivariate logistic regression in SPSS 11.0. Among the 288 heterosexual male MA users, 51 (17.7%) had syphilis, 36 (12.5%) had genital warts, 2 (0.7%) had genital herpes, 3 (1.0%) had HIV infection and 41 (14.2%) had urethritis. STIs were associated with the following variates: 'MA has the function of anti-inebriation' (OR = 2.522, 95%CI = 1.337-4.756), 'I am addicted to MA' (OR = 4.030, 95%CI = 2.194-7.401), 'It occurred to me to abstain from MA' (OR = 2.939, 95%CI = 1.246-6.934), 'Years of MA abuse' (OR = 2.622, 95%CI = 1.318-5.215), 'Times of MA abuse per week' (OR = 5.275, 95%CI = 1.988-14.002), 'Number of persons using MA together' (OR = 2.579, 95%CI = 1.246-5.340) and 'Number of female sex workers as sex partners per MA abuse' (OR = 4.004, 95%CI = 1.526-10.508). Our findings show that MA users belong to the high-risk group for STI in China. STIs, except for HIV, have spread widely among heterosexual male MA users. Thus, specific interventions must be conducted to prevent the spread of STIs in this population in China.
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Affiliation(s)
- Dianchang Liu
- 1 Department of STD and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Zhenxia Jiang
- 2 Department of HIV/STD Prevention and Control, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - Cuizhen Xiu
- 2 Department of HIV/STD Prevention and Control, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - Zhizhi Li
- 3 Department of HIV/STD Prevention and Control, Chengyang Centers for Disease Control and Prevention, Qingdao, China
| | - Qing Song
- 3 Department of HIV/STD Prevention and Control, Chengyang Centers for Disease Control and Prevention, Qingdao, China
| | - Zhenhong Wang
- 4 Department of Dermatology, The Third hospital of Chengyang, Qingdao, China
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Guo Y, Xu X, Fu G, Huan X, Jiang N, Yin Y, Chen X. Risk behaviours and prevalences of HIV and sexually transmitted infections among female sex workers in various venues in Changzhou, China. Int J STD AIDS 2017; 28:1135-1142. [PMID: 28120644 DOI: 10.1177/0956462416689763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Female sex workers (FSWs) play an important role in the heterosexual transmission of HIV and sexually transmitted infections (STIs) in China. We conducted a cross-sectional study of 609 FSWs from various venues in Changzhou to investigate risk behaviours and prevalences of HIV and STIs among FSW subgroups. Structured questionnaires were used in face-to-face interviews to collect information. Blood and cervical specimens were collected to test for HIV, syphilis, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections. The overall prevalences of syphilis, NG and CT were 5.6, 2.3 and 17.0%, respectively. The highest prevalence of syphilis (13.8%, P < 0.001) was observed among FSWs in low-class (LC) venues. No case of HIV infection was found. Less than half of all FSWs (40.7%) reported consistent condom use with clients during the last month. A multivariate analysis revealed a 13-fold increased risk for FSWs with NG infection to be infected with syphilis and a four-fold increased risk for FSWs aged 30-39 years to have a CT infection relative to FSWs aged 15-20 years. The prevalences of STIs were high, and risky sexual behaviours were common, especially among FSWs in LC venues. More tailored and comprehensive prevention programmes should be developed for specific FSW subgroups.
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Affiliation(s)
- Yanli Guo
- 1 Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Xiaoguo Xu
- 1 Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Gengfeng Fu
- 2 Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiping Huan
- 2 Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ning Jiang
- 3 National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China
| | - Yueping Yin
- 3 National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China
| | - Xiangsheng Chen
- 3 National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China
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Liao M, Su S, Yan K, Zhu X, Huang P, Li J, Jiang Z, Zhang X, Zhang N, Tao X, Kang D, Zhao J. Dual Epidemics of Drug Use and Syphilis Among Chinese Female Sex Workers: Results of Eight Consecutive Cross-Sectional Surveys from 2006 to 2013 in Qingdao, China. AIDS Behav 2016; 20:655-66. [PMID: 26696263 DOI: 10.1007/s10461-015-1229-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Eight consecutive annual cross-sectional surveys were conducted to examine the trend of the prevalence of HIV, syphilis, drug use and their correlates among female sex workers (FSWs) in Qingdao, China. Among sampled FSWs over the 8 years, a higher proportion of older, married or cohabited, higher education levels and more on-call FSWs were observed in recent years. The syphilis prevalence increased significantly from 1.0 % in 2006 to 13.5 % in 2013, with illicit drug use rate ranging from 21.8 % in 2007 to 55.5 % in 2010. Multivariate logistic regression analyses showed that drug use, syphilis and unprotected vaginal sex predicted each other. The dual epidemics of illicit drug use and syphilis among FSWs underscore the urgency to implement a tailored intervention to curb the dual epidemics while also preventing an HIV epidemic in the context of diversified commercial sex dynamic.
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Zhang XD, Kelly-Hanku A, Chai JJ, Luo J, Temmerman M, Luchters S. Sexual and reproductive health risks amongst female adolescents who use amphetamine-type stimulants and sell sex: a qualitative inquiry in Yunnan, China. Harm Reduct J 2015; 12:34. [PMID: 26472221 PMCID: PMC4608054 DOI: 10.1186/s12954-015-0065-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 09/15/2015] [Indexed: 11/10/2022] Open
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. METHOD 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. CONCLUSION 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.
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Affiliation(s)
- Xu-Dong Zhang
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium.
- Centre for International Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Angela Kelly-Hanku
- International HIV Research Group, School of Public Health and Community Medicine, UNSW, Sydney, 2052, Australia.
- Sexual & Reproductive Health Unit, Institute of Medical Research, PO Box 60, Goroka, EHP, Papua New Guinea.
| | - Jia-Jia Chai
- City College, Kunming University of Science and Technology, East Ring Road 50, 650051, Kunming, China.
| | - Jian Luo
- Department of Prevention and Education, Yunnan Institute for Drug Abuse, Xi Hu Lu 300, 650228, Kunming, China.
| | - Marleen Temmerman
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium.
| | - Stanley Luchters
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium.
- Centre for International Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne, Victoria, 3004, Australia.
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Zhao Y, Luo T, Tucker JD, Wong WCW. Risk Factors of HIV and Other Sexually Transmitted Infections in China: A Systematic Review of Reviews. PLoS One 2015; 10:e0140426. [PMID: 26468650 PMCID: PMC4607362 DOI: 10.1371/journal.pone.0140426] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/26/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sexually Transmitted Infections (STIs) are a global challenge. China, once said to have eradicated STIs, is now facing a rapid rise in the prevalence of HIV/STIs. This review of reviews aims to map HIV/STI risk factors among the Chinese population, with the objective of identifying risk factors to inform the formulation of effective prevention strategies. METHODS A systematic search using key terms related to HIV/STIs, risk factors and the Chinese population in both English and Chinese databases (PubMed, PsycINFO, the Cochrane Library; Wanfang data, CNKI, VIP and SINOMED) was conducted, and peer-reviewed systematic reviews on the topic from 1991 to 2014 were selected. Identified risk factors were grouped into different level determinants based on the HIV Social Epidemiology Model, and then evaluated and reported based on the PRISMA checklist. FINDINGS Of the twenty-eight reviews included, the majority were focused on well-established, individual level risk factors within key populations, with some highlighting the complexity of interacting factors (e.g., alcohol use and higher income in male migrants). While twenty-two reviews covered individual factors, only ten mentioned social factors and five had contents on structural factors. There are gaps in the evidence on social and structural level impacts of HIV/STIs, such as on stigma, discrimination, health policy, access to care, and illicit drug control policies. Migration and social expectation appear to pose a significant threat in aggravating the HIV/STI situation in China; for example, incarceration patterns indicated a significant risk of HIV/STIs for female sex workers. CONCLUSIONS Since international guidelines recommend an integrated and multi-level approach to HIV/STI prevention, a comprehensive approach targeting interventions at all levels along the continuum of care is needed to effectively curtail HIV/STI transmission in China. More research is needed to better understand the impact of socio-political interventions within a Chinese context.
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Affiliation(s)
- Yanping Zhao
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China
| | - Tongyong Luo
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong S.A.R., China
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, Guangdong Province, China
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - William Chi Wai Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China
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Shen WW, Zhang YS, Li LH, Liu Y, Huang XN, Chen LH, Zhou W. Long-term use of methamphetamine disrupts the menstrual cycles and hypothalamic-pituitary-ovarian axis. J Addict Med 2015; 8:183-8. [PMID: 24695019 DOI: 10.1097/adm.0000000000000021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Long-term use of methamphetamine (MA) induces the neuron damage and leads to multiple neuropsychiatric disorders. However, the effect of MA on the female reproductive functions has not yet been evaluated. The objective of this study was to determine the prevalence of abnormal menstrual cycling in female MA users. METHODS Female MA users (N = 113) were recruited from the Zhangjiang Isolated Compulsory Detoxification Center. Gynecologic history and drug use history were recorded, and serum levels of follicle-stimulating hormone, luteinizing hormone, prolactin, estrogen, progesterone, and testosterone were measured. RESULTS Long-term use of MA significantly altered the menstrual cycle, and 33.6% women suffered from abnormal uterine bleeding while using MA. Deregulation of sex hormones was observed in 73.3% of participants during abstinence. The most common patterns were simple anovular menstruation, which was caused mainly by a hypothalamic deregulation and pituitary suppression with or without ovarian suppression. Normal hormone levels were observed more frequently in participants abstinent for more than 10 months (39.5%) than in participants who were abstinent for less than 10 months (18.6%). However, no relationship was found between hormone deregulation and age or history of MA use. CONCLUSIONS The present data demonstrate that long-term use of MA results in the disruption of menstrual cycles and dysfunction of hypothalamic-pituitary-gonadal axis in women.
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Affiliation(s)
- Wen-Wen Shen
- From the Ningbo Addiction Research and Treatment Center, School of Medicine (WWS, LHL, YL, XNH, LHC, WZ), Ningbo University, Ningbo 315010, People's Republic of China; and Department of Gynecology (YSZ), the No. 1 People's Hospital of Ningbo, Ningbo 315010, People's Republic of China
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Abstract
BACKGROUND This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka "money boys") in China. OBJECTIVES Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs. METHODS The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM. RESULTS MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex. CONCLUSIONS It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.
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Affiliation(s)
- Eric J Nehl
- 1Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
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Prevalence and correlates of HIV infection and sexually transmitted infections in female sex workers (FSWs) in Shanghai, China. Epidemiol Infect 2014; 143:258-66. [PMID: 24759515 DOI: 10.1017/s0950268814000892] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In 2009, we examined HIV and sexually transmitted infections (STIs) in 750 female sex workers (FSWs) in Shanghai using a cross-sectional survey. Participants (mean age 27 years) were interviewed and tested for HIV and selected STIs. Prevalence was: HIV 0·13%, chlamydia 14·7%, gonorrhoea 3·5% and syphilis 1·3%. In a demographic multivariate model, younger age, higher income and originating from provinces other than Zhejiang and Shanghai were independently associated with STI. In a social and sexual behavioural model, women working in small venues with fewer clients per week, use of drugs, and higher price charged per sex act indicated a greater risk for STI. Although HIV appears rare in Shanghai FSWs, chlamydial infection is common, especially in women aged <25 years (prevalence 19·6%). Since STI and HIV share similar risk factors, preventive intervention measures should be implemented immediately based on the venues and characteristics of FSWs to prevent future spread of HIV.
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Syndemics of syphilis, HCV infection, and methamphetamine use along the east coast of China. BMC Public Health 2014; 14:172. [PMID: 24533587 PMCID: PMC3936988 DOI: 10.1186/1471-2458-14-172] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 02/07/2014] [Indexed: 11/10/2022] Open
Abstract
Background An upsurge in club drug use has been observed in recent years in some cities of China, especially methamphetamine, which is quickly replacing heroin to become the most widespread drug across the nation. This study investigated the type of drugs used, syphilis and hepatitis C virus (HCV) infection and the correlates for syphilis, HCV and unprotected commercial sex behavior among drug users in two cities along the east coast of China. Methods A cross-sectional survey conducted in 2010 provided demographics, sexual and drug use behaviors, HIV knowledge and the utilization of intervention services among drug users. Blood samples were tested for HIV, syphilis, and HCV infection. Results Of 805 eligible participants, 0.2% were infected with HIV, 3.7% with HCV, and 9.6% with syphilis. Of the participants, 96.6% were methamphetamine users, 11.9% reported ever having used ≥2 types of these drugs, and 11.4% reported ever injecting drugs. In the multivariable logistic regression analysis, participants infected with syphilis were more likely to be female (adjusted odds ratio (AOR)=2.8, 95% confidence interval (CI): 1.2-6.5), have ever had commercial sex in the past 12 months (AOR=2.0, 95% CI: 1.0-3.9), be infected with HCV (AOR=12.1, 95% CI: 4.1-20.3) and less likely to have ever had sex with regular partners in the past 12 months (AOR=0.2, 95% CI: 0.1-0.6). Participants infected with HCV were more likely to have ever injected drugs (AOR=2.7, 95% CI: 1.1-6.5) and be infected with syphilis (AOR=8.0, 95% CI: 3.5-18.0). Participants who had unprotected sex with commercial sex partners in the last sexual encounter were more likely to be female (AOR=2.9, 95% CI:1.7-4.9), have middle school or lower level education (AOR=3.4, 95% CI:2.0-5.5), never have received intervention in the last year (AOR=2.1, 95%CI:1.2-3.6) and be infected with syphilis (AOR=4.2, 95% CI:2.4-7.4). Conclusions Methamphetamine is the predominant drug used among the drug users, the prevalence of syphilis and HCV infection are alarmingly high, and unprotected commercial sex was common among this group. The findings highlight the need for effective, multifaceted interventions addressing sexual and drug use-related risky behaviors among this group. Further research is needed to better understand the causal pathway of the syndemics.
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Rawson RA. Current research on the epidemiology, medical and psychiatric effects, and treatment of methamphetamine use. J Food Drug Anal 2013; 21:S77-S81. [PMID: 25214749 DOI: 10.1016/j.jfda.2013.09.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Methamphetamine (MA) is a drug that is widely used in many parts of the world. It has multiple neurobiological impacts on the nervous system, some of which are transitory and some more long lasting. MA activates the reward system of the brain and produces effects that are highly reinforcing, which can lead to abuse and dependence. Routes of administration that produce rapid onset of the drug's effects (i.e., smoking and injection) are likely to lead to more rapid addiction and more medical and psychiatric effects. The medical effects of MA use are extensive, and chronic use of MA can produce significant neurological damage as well as damage to cardiovascular, pulmonary, and other organ systems. Both acute and chronic MA use can lead to extreme paranoia, anxiety, and depression, and following discontinuation of MA use, cognitive deficits and anhedonia can persist for months. No effective pharmacotherapies have been developed for the treatment of MA dependence, although this is an area of very active research. Several behavioral treatments have been shown to reduce MA use, but better treatments are needed. The research agenda for MA is substantial, with development of effective pharmacotherapies as one of the most important priorities.
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Affiliation(s)
- Richard A Rawson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA
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Cai R, Tan JG, Chen L, Richardus JH, de Vlas SJ. Prevalence and risk factors of syphilis infection among female sex workers in Shenzhen, China: an observational study (2009-2012). Trop Med Int Health 2013; 18:1531-8. [PMID: 24118535 DOI: 10.1111/tmi.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate prevalence and risk factors of syphilis infection among female sex workers (FSWs) in Shenzhen, China. METHODS Observational study among (2009-2012) 1653 FSWs recruited by venue-based sampling using questionnaire-based interviews for socio-demographics, behaviours and syphilis testing results. Logistic regression was used to assess risk factors of syphilis infection. RESULTS The overall syphilis prevalence was 4.7%, showing a slightly decreasing trend. Factors significantly associated with syphilis infection were inconsistent condom use (OR = 1.87, P = 0.015), illicit drug use (OR = 5.45, P < 0.001) and older age in years (OR = 1.08, P < 0.001). Venues where FSWs were recruited and duration of commercial sex work were not significantly associated with syphilis infection (P > 0.05). CONCLUSIONS Syphilis is still common among FSWs in Shenzhen, China. Current comprehensive prevention programmes (e.g. condom promotion and peer education) should be continued to maintain and increase safe sexual practices and to reduce illicit drug use among FSWs. Expanding point-of-care syphilis screening programmes may be an important strategy for early diagnosis. We recommend timely and effective treatment programmes to be linked to such screening programmes.
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Affiliation(s)
- R Cai
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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Liao M, Kang D, Tao X, Li J, Qian Y, Wang G, Jiang B, Bi Z, Jia Y. Dual epidemics of syphilis and methamphetamine use among drug users in Shandong Province of China. AIDS Care 2013; 25:1236-44. [DOI: 10.1080/09540121.2013.764384] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kang D, Tao X, Liao M, Li J, Zhang N, Zhu X, Sun X, Lin B, Su S, Hao L, Jia Y. An integrated individual, community, and structural intervention to reduce HIV/STI risks among female sex workers in China. BMC Public Health 2013; 13:717. [PMID: 23914824 PMCID: PMC3737083 DOI: 10.1186/1471-2458-13-717] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 07/30/2013] [Indexed: 11/17/2022] Open
Abstract
Background We assessed the effectiveness of an integrated individual, community, and structural intervention to reduce risks of HIV and sexually transmitted infections (STIs) among female sex workers (FSWs). Methods The integration individual, community, and structural intervention was implemented from 2004 to 2009 in six counties of Shandong Province. Post-intervention cross-sectional surveys were conducted in six intervention counties and 10 control counties. Results Of 3326 female sex workers were recruited and analyzed in the post-intervention survey with 1157 from intervention sites and 2169 from control sites. No HIV positive was found in both intervention and control counties. The rate of syphilis was 0.17% for intervention sites and 1.89% for control sites (OR = 11.1, 95% CI: 2.7, 46.1). After adjusted for age, marital status, education, economic condition, recruitment venues, the rates of condom use in the last sex with clients(AOR = 2.7; 95% CI: 1.9, 3.8), with regular sex partners(AOR = 1.5; 95% CI: 1.1, 1.9) and consistent condom use in the last month with clients (AOR = 3.3; 95% CI: 2.6, 4.1) and regular sex partners (AOR = 1.7; 95% CI: 1.3, 2.3) were significantly higher in intervention sites than that in control sites. The proportion of participants correctly answered at least six out of eight HIV-related questions (83.3%) in intervention sites is significant higher than that (21.9%) in control sites (AOR = 24.7; 95% CI: 2.5, 42.7), the five indicators related to HIV-related intervention services ever received in the last year including HIV testing(AOR = 4.9; 95% CI: 2.8, 6.7), STD examination and/or treatment(AOR = 5.1; 95% CI: 4.2, 6.4), free condom(AOR = 20.3; 95% CI: 14.3, 28.9), peer education(AOR = 4.3; 95% CI: 3.5, 5.4), education materials(AOR = 19.8; 95%CI: 13.1, 29.8) were significantly higher in intervention sites than that in control sites, the participants in the intervention sites are more likely to seek medical treatment when they had any disorders (AOR = 3.2; 95% CI: 2.5, 4.2). Conclusion This study found that the integrated individual, community, and structural intervention showed positive impact in reducing HIV and STI risks among FSWs.
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Affiliation(s)
- Dianmin Kang
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, PR China.
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Kelly BC, Liu T, Zhang G, Hao W, Wang J. Perceptions of HIV risk among methamphetamine users in China. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 39:99-102. [PMID: 23421570 DOI: 10.3109/00952990.2012.762371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Methamphetamine use has emerged in China over the past decade. With the growth in methamphetamine use, it remains uncertain how users in China perceive its association with the HIV epidemic. METHODS The authors utilize qualitative and survey data from a mixed-methods study on methamphetamine use and HIV risk in China to assess the extent to which users perceive a risk for HIV transmission as well as how they conceive of the drug's links to HIV. RESULTS Data indicate that a considerable majority (82.2%) perceived themselves to have zero risk for HIV infection. Qualitative interviews highlight the lack of information about HIV possessed by methamphetamine users given the confusion and disbelief often expressed. Others acknowledged that while there was an intertwining of risk, they were not personally at risk. CONCLUSION Given the known association between methamphetamine use and HIV risk, health promotion initiatives in China should target methamphetamine users to build HIV-related knowledge and inhibit self-exempting beliefs. In particular, educational efforts regarding the association of methamphetamine use with HIV may inhibit risk behaviors.
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Affiliation(s)
- Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, IN 47907, USA.
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Liu D, Wang Z, Chu T, Chen S. Gender difference in the characteristics of and high-risk behaviours among non-injecting heterosexual methamphetamine users in Qingdao, Shandong Province, China. BMC Public Health 2013; 13:30. [PMID: 23311624 PMCID: PMC3585885 DOI: 10.1186/1471-2458-13-30] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 01/10/2013] [Indexed: 11/27/2022] Open
Abstract
Background Despite the increasing risk of HIV infections, few studies concerning the characteristics of non-injecting heterosexual methamphetamine (MA) users and related risk behaviours have been conducted in China. Methods Gender differences in socio-demographic characteristics, perception of MA and STD/HIV, MA use practices, and sexual behaviours related to MA use were examined among 398 non-injecting heterosexual MA users (288 males, 110 females). Results Male MA users were more likely to be married, local, and self-employed; female MA users were more likely to be young, single, engaged in commercial service or unemployed. Female MA users usually start MA use at an earlier age than males (24.3 vs. 31.3 years old), with shorter abuse durations (2.6 vs. 2.9 years), higher frequency of MA use (3.6 vs. 2.4 times per week), and higher likelihood of using MA with heterosexual partners (100% vs. 78.1%). More male MA users have had multiple sex partners (96.9% vs. 77.3%) and sex exchanges (72.9% vs. 46.4%). Among 277 males who had had sex with commercial sex workers (CSW), 69.4% never used condoms, and among 77 males who had had sex with multiple partners who are commercial sex workers and always or usually used condoms, 87.0% never changed condoms when changing partners. Conclusion There may be gender difference in the characteristics of high-risk behaviours among non-injecting heterosexual MA users. The findings suggest the integration of specific risk reduction strategies into intervention programs for non-injecting heterosexual MA user populations may significantly improve program goals.
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Affiliation(s)
- Dianchang Liu
- Shandong Clinical College of Skin Diseases, Anhui Medical University, 27397, Jingshi Lu, Jinan, Shandong, 250022, China
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Meade CS, Watt MH, Sikkema KJ, Deng LX, Ranby KW, Skinner D, Pieterse D, Kalichmann SC. Methamphetamine use is associated with childhood sexual abuse and HIV sexual risk behaviors among patrons of alcohol-serving venues in Cape Town, South Africa. Drug Alcohol Depend 2012; 126:232-9. [PMID: 22717338 PMCID: PMC3465508 DOI: 10.1016/j.drugalcdep.2012.05.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 05/10/2012] [Accepted: 05/18/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND South Africa's Western Cape has experienced a dramatic increase in methamphetamine ("meth") use over the past decade. There is concern that meth may further fuel the HIV epidemic in this country because of its association with risky sexual behaviors. This study describes the prevalence of meth use and its relation to HIV sexual risk behaviors among patrons of alcohol-serving venues. METHODS Participants (N=3328) were surveyed in 12 venues in a mixed race township. Logistic regression models were used to examine the relations between meth use and sexual risk behaviors, and structural equation models were used to test whether meth use mediates the relationship between childhood sexual abuse and current sexual risk. RESULTS Meth use in the past 4 months was more common among Coloured than Black persons (10.5% vs. 3.5%). Meth users were more likely than non users to use marijuana, inhalants, and injection drugs, have a history of childhood sexual and/or physical abuse, and experience and/or perpetrate intimate partner violence. Among both men and women, meth use was associated with greater odds of engaging in sexual risk behaviors, and meth use partially mediated the relationships between childhood sexual abuse and all sexual risk behaviors. CONCLUSIONS Meth users in this setting are at increased risk for HIV due to their greater likelihood of engaging in sexual risk behaviors and being in violent relationships. There is an urgent need to provide targeted HIV prevention and substance abuse treatment to meth users living in townships in Cape Town.
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Couture MC, Page K, Stein ES, Sansothy N, Sichan K, Kaldor J, Evans JL, Maher L, Palefsky J. Cervical human papillomavirus infection among young women engaged in sex work in Phnom Penh, Cambodia: prevalence, genotypes, risk factors and association with HIV infection. BMC Infect Dis 2012; 12:166. [PMID: 22839728 PMCID: PMC3436768 DOI: 10.1186/1471-2334-12-166] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 06/29/2012] [Indexed: 01/09/2023] Open
Abstract
Background Although cervical cancer is the leading cancer in Cambodia, most women receive no routine screening for cervical cancer and few treatment options exist. Moreover, nothing is known regarding the prevalence of cervical HPV or the genotypes present among women in the country. Young sexually active women, especially those with multiple sex partners are at highest risk of HPV infection. We examine the prevalence and genotypes of cervical HPV, as well as the associated risk factors among young women engaged in sex work in Phnom Penh, Cambodia. Methods We conducted a cross-sectional study among 220 young women (15–29 years) engaged in sex work in different venues including brothels or entertainment establishments, and on a freelance basis in streets, parks and private apartments. Cervical specimens were collected using standard cytobrush technique. HPV DNA was tested for by polymerase chain reaction (PCR) and genotyping using type-specific probes for 29 individual HPV types, as well as for a mixture of 10 less common HPV types. All participants were also screened for HIV status using blood samples. Multivariate logistic regression analyses were conducted to assess risk factors for any or multiple HPV infection. Results The prevalence of cervical HPV 41.1%. HPV 51 and 70 were the most common (5.0%), followed by 16 (4.6%), 71 (4.1%) and 81 (3.7%). Thirty-six women (16.4%) were infected with multiple genotypes and 23.3% were infected with at least one oncogenic HPV type. In multivariate analyses, having HIV infection and a higher number of sexual partners were associated with cervical HPV infection. Risk factors for infection with multiple genotypes included working as freelance female sex workers (FSW) or in brothels, recent binge use of drugs, high number of sexual partners, and HIV infection. Conclusions This is the first Cambodian study on cervical HPV prevalence and genotypes. We found that HPV infection was common among young FSW, especially among women infected with HIV. These results underscore the urgent need for accessible cervical cancer screening and treatment, as well as for a prophylactic vaccine that covers the HPV subtypes present in Cambodia.
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Affiliation(s)
- Marie-Claude Couture
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco, CA 94105, USA.
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Liao M, Nie X, Pan R, Wang C, Ruan S, Zhang C, Kang D, Fu J, Qian Y, Tao X, Zhao J. Consistently low prevalence of syphilis among female sex workers in Jinan, China: findings from two consecutive respondent driven sampling surveys. PLoS One 2012; 7:e34085. [PMID: 22539944 PMCID: PMC3335128 DOI: 10.1371/journal.pone.0034085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 02/21/2012] [Indexed: 11/19/2022] Open
Abstract
Background Routine surveillance using convenient sampling found low prevalence of HIV and syphilis among female sex workers in China. Two consecutive surveys using respondent driven sampling were conducted in 2008 and 2009 to examine the prevalence of HIV and syphilis among female sex workers in Jinan, China. Methods A face-to-face interview was conducted to collect demographic, behavioral and service utilization information using a structured questionnaire. Blood samples were drawn for serological tests of HIV-1 antibody and syphilis antibody. Respondent Driven Sampling Analysis Tool was used to generate population level estimates. Results In 2008 and in 2009, 363 and 432 subjects were recruited and surveyed respectively. Prevalence of syphilis was 2.8% in 2008 and 2.2% in 2009, while no HIV case was found in both years. Results are comparable to those from routine sentinel surveillance system in the city. Only 60.8% subjects in 2008 and 48.3% in 2009 reported a consistent condom use with clients during the past month. Over 50% subjects had not been covered by any HIV-related services in the past year, with only 15.6% subjects in 2008 and 13.1% in 2009 ever tested for HIV. Conclusions Despite the low prevalence of syphilis and HIV, risk behaviors are common. Targeted interventions to promote the safe sex and utilization of existing intervention services are still needed to keep the epidemic from growing.
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Affiliation(s)
- Meizhen Liao
- Institute for AIDS/STD Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Xijuan Nie
- Institute for AIDS/STD Control and Prevention, Licheng District Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Rongjian Pan
- Institute for AIDS/STD Control and Prevention, Licheng District Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Chuangxin Wang
- Institute for AIDS/STD Control and Prevention, Licheng District Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Shiman Ruan
- Institute for AIDS/STD Control and Prevention, Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Changqing Zhang
- Institute for AIDS/STD Control and Prevention, Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Dianming Kang
- Institute for AIDS/STD Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Jihua Fu
- Institute for AIDS/STD Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Yuesheng Qian
- Institute for AIDS/STD Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Xiaorun Tao
- Institute for AIDS/STD Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Jinkou Zhao
- Monitoring and Evaluation Unit, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
- * E-mail:
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Chen XS, Wang QQ, Yin YP, Liang GJ, Jiang N, Yang LG, Liu Q, Zhou YJ, Huan XP, Wei WH, Wang B. Prevalence of syphilis infection in different tiers of female sex workers in China: implications for surveillance and interventions. BMC Infect Dis 2012; 12:84. [PMID: 22475187 PMCID: PMC3352076 DOI: 10.1186/1471-2334-12-84] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 04/04/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syphilis has made a dramatic resurgence in China during the past two decades and become the third most prevalent notifiable infectious disease in China. Female sex workers (FSWs) have become one of key populations for the epidemic. In order to investigate syphilis infection among different tiers of FSWs, a cross-sectional study was conducted in 8 sites in China. METHODS Serum specimens (n = 7,118) were collected to test for syphilis and questionnaire interviews were conducted to obtain socio-demographic and behavioral information among FSWs recruited from different types of venues. FSWs were categorized into three tiers (high-, middle- and low-tier FSWs) based on the venues where they solicited clients. Serum specimens were screened with enzyme-linked immunosorbent assay (ELISA) for treponemal antibody followed by confirmation with non-treponemal toluidine red unheated serum test (TRUST) for positive ELISA specimens to determine syphilis infection. A logistic regression model was used to determine factors associated with syphilis infection. RESULTS Overall syphilis prevalence was 5.0% (95%CI, 4.5-5.5%). Low-tier FSWs had the highest prevalence (9.7%; 95%CI, 8.3-11.1%), followed by middle-tier (4.3%; 95%CI, 3.6-5.0%, P < 0.001) and high-tier FSWs (2.2%; 95%CI, 1.6-2.9%, P < 0.001). Factors independently associated with syphilis infection included older age, lower education level, geographic location, lower tier of typology, and injection drug use. CONCLUSIONS This multi-site survey showed a high prevalence of syphilis infection among FSWs and substantial disparities in syphilis prevalence by the tier of FSWs. The difference in syphilis prevalence is substantial between different tiers of FSWs, with the highest rate among low-tier FSWs. Thus, current surveillance and intervention activities, which have low coverage in low-tier FSWs in China, should be further examined.
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Affiliation(s)
- Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, 12 Jiangwangmiao Street, Nanjing 210042, China.
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Couture MC, Evans JL, Sothy NS, Stein ES, Sichan K, Maher L, Page K. Correlates of amphetamine-type stimulant use and associations with HIV-related risks among young women engaged in sex work in Phnom Penh, Cambodia. Drug Alcohol Depend 2012; 120:119-26. [PMID: 21820251 PMCID: PMC3226861 DOI: 10.1016/j.drugalcdep.2011.07.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/25/2011] [Accepted: 07/09/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Amphetamine-type stimulant (ATS) use has increased in Cambodia and emerged as a significant problem among female sex workers (FSWs), potentially contributing to increased risk of HIV. We examined the prevalence of ATS use and its effect on sexual risk behaviors, and sexually transmitted infections (STI) among FSWs in Phnom Penh, Cambodia. METHODS A one-year prospective study among young women engaged in sex work in brothels, entertainment establishments and on a freelance basis. Socio-demographics, sexual risks, and recent ATS use were assessed by self-report. Blood and urine samples were collected to detect HIV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Bivariate and multivariate longitudinal analyses were conducted to assess the effects of ATS use on number of sex partners, inconsistent condom use with paying partners and incident STI. RESULTS ATS use was higher among women working freelance (35.6%) and in brothels (34.8%) compared to women working in entertainment establishments (17.7%) or in multiple venues (14.8%). ATS users reported more sex partners and days drunk in the previous month. In multivariate longitudinal analysis, ATS use was associated with having a higher number of sex partners (adjusted relative ratio 1.49; 95% CI: 1.00-2.21) and incident STI (adjusted odds ratio 5.41; 95% CI: 1.15-25.48), but not inconsistent condom use with paying partner. CONCLUSION ATS users had more sex partners, high level of alcohol use, and were at increased risk of STI. Our findings underscore ATS use as an important emerging risk exposure that should be integrated into HIV prevention interventions targeting this population.
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Affiliation(s)
- Marie-Claude Couture
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA
| | | | - Neth San Sothy
- National Center for HIV/AIDS, Dermatology and STD. #245H, Sreet 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia
| | - Ellen S. Stein
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA
| | - Keo Sichan
- Cambodian Women’s development Agengy, #19, Street 242, Sangkat Boeng Prolit, Khan 7 Makara, Phnom Penh, Cambodia
| | - Lisa Maher
- University of New South Wales, National Centre in HIV Epidemiology and Clinical Research, CFI Building, Corner Boundary and West Streets, Darlinghurst NSW 2010, Australia
| | - Kimberly Page
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA,Corresponding author: K. Page, University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco CA 94105, USA., , Phone: 415-597-4954., Fax: 415-597-8299
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Liao M, Kang D, Jiang B, Tao X, Qian Y, Wang T, Bi Z, Xiao Y, Li C, Wu P, Vermund SH, Jia Y. Bisexual behavior and infection with HIV and syphilis among men who have sex with men along the east coast of China. AIDS Patient Care STDS 2011; 25:683-91. [PMID: 21923416 DOI: 10.1089/apc.2010.0371] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined the correlates of bisexual behavior and infection with HIV/syphilis among men who have sex with men only (MSM-only) and those who have sex with both men and women (MSMW) in Shandong, China. Cross-sectional surveys probed sociodemographic information, sexual and drug use behaviors, knowledge, and use of prevention services; blood samples were tested for HIV/syphilis status. Of 2996 participants, 39.5% acknowledged being MSMW; 60.5% being MSM-only; 2.5% were HIV-infected with similar rates for MSMW (2.5%) and MSM-only (2.6%); 5.5% syphilis-infected with comparable rates for MSMW (5.6%) and MSM-only (5.5%). In multivariable models, MSMW were more likely than MSM-only to be older, local residents, recruited from outdoor cruising area, drug users, and less likely to have used a condom during last anal sex with a male partner. HIV-infected MSMW were more likely to have syphilis and other sexually transmitted diseases (STDs) and less likely to have received peer education. HIV-infected MSM-only were more likely to be older, nonlocal residents, and have syphilis and other STDs. MSMW with syphilis were more likely to be recruited from Jinan, Qingdao, and Zibo (versus Yantai), infected with HIV, and less likely to have received lubricant promotion. MSM-only with syphilis were more likely to be recruited from Jinan and Qingdao (versus Yantai), drug users, infected with HIV, and have had sex with male partners in the past 6 months. High prevalence of bisexual behavior and HIV/other STDs with common unprotected sex and multiple sexual partners among Shandong's gay community revealed in this study highlighted the importance of bisexuals as a potential epidemiologic bridge. Further research is needed to investigate the impact of bisexual behaviors on population transmission.
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Affiliation(s)
- Meizhen Liao
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Dianming Kang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Baofa Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong Province, P.R. China
| | - Xiaorun Tao
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Yueshen Qian
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Tongzhan Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Zhenqiang Bi
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Yan Xiao
- National AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, P.R. China
| | - Chunmei Li
- National AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, P.R. China
| | - Pingsheng Wu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Sten H. Vermund
- Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee
- Department of Institute for Global Health, Vanderbilt University, Nashville, Tennessee
| | - Yujiang Jia
- Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee
- Department of Institute for Global Health, Vanderbilt University, Nashville, Tennessee
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28
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Poon AN, Li Z, Wang N, Hong Y. Review of HIV and other sexually transmitted infections among female sex workers in China. AIDS Care 2011; 23 Suppl 1:5-25. [DOI: 10.1080/09540121.2011.554519] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Adrienne N. Poon
- a Association of Schools of Public Health , Washington , DC , USA
| | - Zhijun Li
- b National Center for AIDS/STD Prevention and Control , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Ning Wang
- b National Center for AIDS/STD Prevention and Control , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Yan Hong
- c Department of Social and Behavioral Health, School of Rural Public Health , Texas A&M Health Science Center , College Station , TX , USA
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29
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Kang D, Liao M, Jiang Z, Zhang X, Mao W, Zhang N, Tao X, Huang T, Bi Z, Aliyu M, Wu P, Jiang B, Jia Y. Commercial sex venues, syphilis and methamphetamine use among female sex workers. AIDS Care 2011; 23 Suppl 1:26-36. [DOI: 10.1080/09540121.2011.560930] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dianming Kang
- a Shandong Center for Disease Control and Prevention , Jinan , Shandong Province , P. R. China
| | - Meizhen Liao
- a Shandong Center for Disease Control and Prevention , Jinan , Shandong Province , P. R. China
| | - Zhenxia Jiang
- b Qingdao Center for Disease Control and Prevention , Qingdao , Shandong Province , P. R. China
| | - Xijiang Zhang
- b Qingdao Center for Disease Control and Prevention , Qingdao , Shandong Province , P. R. China
| | - Wenwen Mao
- c Department of Epidemiology and Biostatistics, School of Public Health , Shandong University , Jinan , Shandong Province , P. R. China
| | - Ning Zhang
- d Health Counseling Center , Qingdao , Shandong Province , P. R. China
| | - Xiaorun Tao
- a Shandong Center for Disease Control and Prevention , Jinan , Shandong Province , P. R. China
| | - Tao Huang
- a Shandong Center for Disease Control and Prevention , Jinan , Shandong Province , P. R. China
| | - Zhenqiang Bi
- a Shandong Center for Disease Control and Prevention , Jinan , Shandong Province , P. R. China
| | - Muktar Aliyu
- e Institute for Global Health , Vanderbilt University , Nashville , TN , USA
| | - Pingsheng Wu
- f Department of Biostatistics , Vanderbilt University , Nashville , TN , USA
| | - Baofa Jiang
- c Department of Epidemiology and Biostatistics, School of Public Health , Shandong University , Jinan , Shandong Province , P. R. China
| | - Yujiang Jia
- e Institute for Global Health , Vanderbilt University , Nashville , TN , USA
- g Department of Pediatrics , Vanderbilt University , Nashville , TN , USA
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