1
|
Owonikoko SB, Suleiman JBA, Maibaka WK, Tasiu N. "What a man can do, a woman can do better": women farmers, livelihood and drug abuse in Adamawa State, northeastern Nigeria. J Ethn Subst Abuse 2023; 22:3-28. [PMID: 33511921 DOI: 10.1080/15332640.2021.1871694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Drug and substance abuse among female population is on the rise but yet to be given adequate scholarly attention. This study examines how women farmers in Adamawa State are engaging in drug and substance abuse to enhance their farming livelihood practices and the implications of their action for health and social cohesion around their communities. Using data collected from interviews and observations, the study discovered that rising female-breadwinning in the study area put a lot of pressure on women to engage in farming as owners, hired or eclectic farmers. To be able to withstand the stress of farming, some engage in the use of psychotropic stimulant substances to enhance their performance. The study also discovered that the most abused substances are cannabis and tramadol due to affordability and availability. On the other hand however, the study found out that increasing indulgence of women in substance abuse is already impacting on spousal relationship between the women indulging in substance abuse and their husbands. The study recommended that government of Adamawa State should enforce in full, the Adamawa State Unclassified (Local Substances) Abuse Law 2015 by establishing a rehabilitation center for correction and reformation of addicts in the state. Furthermore, it is also recommended that all stakeholders should give empowerment of women in the state serious attention.
Collapse
Affiliation(s)
| | | | | | - Nafisa Tasiu
- Modibbo Adama University of Technology, Yola, Nigeria.,Federal College of Education, Yola, Nigeria
| |
Collapse
|
2
|
Ong JJ, Xiong M, Tucker JD, Wang Y, Smith MK, Tang W, Fu H, Zheng H, Yang B, Wang C. Sexualized Drug Use Among Female Sex Workers from Eight Cities in China: A Cross-Sectional Study. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2689-2698. [PMID: 34786656 PMCID: PMC8594644 DOI: 10.1007/s10508-021-02117-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
There is a rich literature on sexualized drug use (i.e., drug use before or during sex) for men who have sex with men but less data from female sex workers (FSW), particularly from low- and middle-income countries. We describe the sexual and reproductive health outcomes in FSW reporting sexualized drug use. In 2019, we conducted a cross-sectional study in eight cities from seven provinces in China. We recruited FSW through community organizations working with sex workers and included those aged 18 years or above, exchanged sex at least once for money or goods in the past three months, and had traded sex for longer than a year. Multivariable logistic regression models were used. In total, 650 women participated: average age was 38.8 years (SD 10.2), 57.1% reported a monthly income over 5000 RMB ($USD 707), and 12.8% completed high school or above. Among participants, 65 (10.0%, 95% confidence interval (CI) 7.8-12.6) reported a history of sexualized drug use. Compared to FSW who never reported a history of sexualized drug use, FSW who reported a history of sexualized drug use had greater odds of working for a manager compared to being self-employed (adjusted odds ratio (AOR) 4.04, 95% CI 2.12-7.69), work in a sauna (AOR 2.43, 95% CI 1.09-5.41), charging a higher price for vaginal sex (AOR 2.15, 95% CI 1.14-4.06), and ever diagnosed with STIs (AOR 4.51, 95% CI 2.61-7.80). One in ten FSW reported sexualized drug use. Although they had similar risk profiles in terms of consistency of condom use and reproductive health outcomes, these women were more likely to report past STIs than those who reported no sexualized drug use. Health workers who work with substance users should devote attention to the sexual practices of their clients to make sure that they have safer sex.
Collapse
Affiliation(s)
- Jason J Ong
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mingzhou Xiong
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Yajie Wang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota, Twin Cities, MN, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China.
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.
| |
Collapse
|
3
|
Ogden SN, Harris MT, Childs E, Valente PK, Edeza A, Collins AB, Drainoni ML, Mimiaga MJ, Biello KB, Bazzi AR. "You need money to get high, and that's the easiest and fastest way:" A typology of sex work and health behaviours among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103285. [PMID: 33985886 DOI: 10.1016/j.drugpo.2021.103285] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the United States, the criminalization and stigmatization of drug use and sex work contribute to infectious disease transmission and healthcare disengagement. People who inject drugs (PWID) and engage in sex work experience exacerbated HIV risk. In the context of the ongoing HIV and overdose epidemics little research describes why PWID engage in sex work and its relative HIV risk. To inform intervention needs, we aimed to create a typology of sex work among PWID with a focus on HIV risk and healthcare utilization behaviours. METHODS We drew from in-depth interviews conducted across Massachusetts and Rhode Island from 2016-2019. Participants were ≥18 years old and self-reported past-month injection drug use and HIV-negative status. Using data from individuals reporting sex work experience (n=33/78), we utilized the framework method to develop a typology of perspectives on sex work engagement and attributes pertaining to HIV risk and healthcare utilization behaviours. RESULTS We uncovered varying perspectives on sex work and associated HIV risks and prevention needs. A typology included three groups who viewed their sex work engagement as a (1) consistent job, (2) income supplement, or (3) survival method to abate withdrawal symptoms. The first group described more consistent sexual and injection behaviours to mitigate HIV risk than the second group. The third group appeared particularly vulnerable to HIV, describing inconsistent condom use and frequent sharing of injection equipment, low healthcare utilization, and limited disclosure of sex work and injection drug use to healthcare providers. CONCLUSION Findings highlight distinct perspectives on sex work among PWID involved in it and corresponding perceptions of HIV risk and healthcare utilization behaviours. Understanding the nuances in sex work engagement among PWID can inform interventions to prevent infectious disease transmission, including efforts to further connect this marginalized population to harm reduction, health, and low barrier opioid treatment services.
Collapse
Affiliation(s)
- Shannon N Ogden
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Miriam Th Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston MA, USA; Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | | | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
| | - Matthew J Mimiaga
- UCLA Center for LGBTQ Advocacy, Research, and Health, Los Angeles, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
| |
Collapse
|
4
|
Tavakoli F, Khezri M, Tam M, Bazrafshan A, Sharifi H, Shokoohi M. Injection and non-injection drug use among female sex workers in Iran: A systematic review and meta-analysis. Drug Alcohol Depend 2021; 221:108655. [PMID: 33689969 DOI: 10.1016/j.drugalcdep.2021.108655] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Illicit drug use is a prevalent risk behavior among female sex workers (FSWs) as it increases the vulnerability of this marginalized population to negative health outcomes, including HIV infection. This systematic review and meta-analysis aimed to estimate the prevalence of injection and non-injection drug use among FSWs in Iran. METHODS Systematic searches of PubMed, Embase, Web of Science, Scopus, and PsycINFO (for English records), along with Iranian databases including IranMedex, Iran Psych Magiran, Scientific Information Database, and Irandoc (for Farsi records) were conducted for studies published from inception through to July 2020. We included quantitative studies on injection and non-injection drug use among FSWs. The pooled prevalence and 95% confidence intervals (CI) of recent and lifetime drug injection and non-injection were estimated using random-effects meta-analysis. RESULTS Of 458 screened records, 19 met the inclusion criteria. The pooled prevalence of recent non-injection drug use and injection drug use was 56.94% (95% CI: 44.68, 68.78) and 5.67% (95% CI: 2.09, 10.73), respectively. Opium (33.00%, 95% CI: 24.53, 42.05) and crystal methamphetamine (20.68%, 95% CI: 13.59, 28.79) were the most prevalent recent non-injection drugs used. Additionally, the pooled prevalence of lifetime non-injection drug use was 76.08% (95% CI: 66.81, 84.27) and injection drug use was 10.72% (95% CI: 7.02, 15.07). CONCLUSIONS This systematic review shows that drug use, both injection and non-injection, is prevalent among FSWs in Iran. These findings highlight the importance of evidence-based harm reduction and treatment programs to reduce the burdens of drug use and its associated potential consequences among these underserved women.
Collapse
Affiliation(s)
- Fatemeh Tavakoli
- 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
| | - Mehrdad Khezri
- 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
| | - Michelle Tam
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Azam Bazrafshan
- 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
| | - 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
| | - 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; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
5
|
Du Bois SN, Kannout L, Ramos SD. Examining partnership-health associations among full-service sex workers. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2021.1896697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Steve N. Du Bois
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Lynn Kannout
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Stephen D. Ramos
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| |
Collapse
|
6
|
Felker-Kantor E, Polanco C, Perez M, Donastorg Y, Andrinopoulos K, Kendall C, Kerrigan D, Theall K. Daily activity spaces and drug use among female sex workers living with HIV in the Dominican Republic. Health Place 2021; 68:102527. [PMID: 33588303 PMCID: PMC10768855 DOI: 10.1016/j.healthplace.2021.102527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to explore the daily activity spaces of female sex workers living with HIV in the Dominican Republic and assess the relationship between activity path and location-based risk exposure measures and daily drug use. The study employed a micro-longitudinal observational study design using an innovative 7-day travel diary to capture daily activity routes and a 7-day mobile health (mHealth) daily diary to collect daily substance use behaviors among 51 female sex workers. To estimate between-subject variability, a series of crude and adjusted modified log-Poisson repeated measures regression models with generalized estimating equations, clustering by individual with a compound symmetry working correlation structure were fit to estimate the relative risks and 95% confidence intervals. Controlling for individual level factors, findings showed that female sex workers exposed to a higher number of risk outlets (e.g., liquor stores, bars, hotels, nightclubs, brothels, etc.) within 200 and 100-meters of sex work locations were at an increased risk of daily drug use (RRadj: 1.03, 95%CI: 1.01, 1.05, RRadj: 1.05, 95%CI: 1.01, 1.09). No association was detected between activity path exposure and daily drug use. These findings illustrate the importance of moving beyond static residential neighborhood boundaries for measuring risk exposures and highlight the significant role that daily work environments have on drug harms among a highly stigmatized and vulnerable population.
Collapse
Affiliation(s)
| | - Caluz Polanco
- La Universidad Autónoma de Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatológico Dominicano y Cirugía de Piel, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Instituto Dermatológico Dominicano y Cirugía de Piel, Santo Domingo, Dominican Republic
| | | | - Carl Kendall
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Deanna Kerrigan
- George Washington University, Departments of Prevention and Community Health, Washington, DC, USA
| | - Katherine Theall
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| |
Collapse
|
7
|
Fan X, Lau JTF, Cai Y, Li J, Ma T, Gu J, Wang Z. Prevalence and associated factors of sexualized drug use in sex work among transgender women sex workers in China. AIDS Care 2020; 33:1098-1106. [PMID: 33258694 DOI: 10.1080/09540121.2020.1851017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sexualized drug use (SDU) is associated with a higher risk of HIV transmission. There is a dearth of study investigating the association between sex work characteristics and SDU in sex work among transgender women sex workers. To address these gaps, we conducted a secondary analysis of a cross-sectional study among 220 transgender women sex workers in Shenyang, China. The prevalence of SDU in sex work was 20.9% in the past month. After adjustment for age, HIV status, education, monthly income and duration of stay in Shenyang, performing sex work mainly in hotel rooms, charging higher per episode of commercial sex, depressive symptoms and anxiety symptoms were associated with higher likelihood of SDU in sex work. Future SDU prevention programmes SDU targeting transgender women sex workers should focus on those who charged higher and performed sex work in hotel rooms, and integrate mental health promotion as an essential component.
Collapse
Affiliation(s)
- Xiaoyan Fan
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Joseph T F Lau
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, People's Republic of China
| | - Yong Cai
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Tiecheng Ma
- Shenyang Consultation Centre of AIDS Aid and Health Service, Shenyang, People's Republic of China
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, People's Republic of China
| |
Collapse
|
8
|
Drug use, sexual risk, and structural vulnerability among female sex workers in two urban centers of the Dominican Republic: The EPIC study. Drug Alcohol Depend 2020; 212:108039. [PMID: 32428789 DOI: 10.1016/j.drugalcdep.2020.108039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evidence in different countries suggest an association between sex work and drug use. In the Dominican Republic an estimated 60,000-100,000 women work in the sex industry. However, little is known about their drug use behaviors. OBJECTIVE To characterize the burden of drug use and examine correlates of these behaviors among female sex workers in the Dominican Republic. METHODS Data for this analysis comes from a cross-sectional study among key populations at risk for HIV. A community sample of female sex workers (N = 389) was recruited using passive and active recruitment strategies. Participants completed a behavioral survey between 2015 and 2016. Logistic regression models were constructed to examine predictors of drug use. RESULTS Protective factors against marijuana and crack or cocaine use included being heterosexual, having a higher level of education, regular employment, and fewer male sexual partners. Increased odds of crack or cocaine use were associated with incarceration, having slept in a place not meant for human habitation in the last six months, and having ever lived in a batey (a community around a sugar mill where workers and their families live). Participants that used marijuana were generally younger, while those that used crack or cocaine were older. CONCLUSIONS Our findings highlight characteristics of the social and economic environment that require further research to optimize prevention and care strategies for this population. Public health interventions are needed that address drug use, sexual risk-taking, and helping female sex workers and their families achieve a healthy life.
Collapse
|
9
|
Allen ST, White RH, O’Rourke A, Ahmad NJ, Hazelett T, Kilkenny ME, Sherman SG. Correlates of Transactional Sex Among a Rural Population of People Who Inject Drugs. AIDS Behav 2020; 24:775-781. [PMID: 31407213 DOI: 10.1007/s10461-019-02612-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the United States, high rates of HIV infection among persons who engage in transactional sex are partially driven by substance use. Little is known about transactional sex among rural populations of people who inject drugs (PWID). Using data from a 2018 survey of 420 rural PWID in West Virginia, we used logistic regression to identify correlates of recent transactional sex (past 6 months). Most study participants were male (61.2%), white (83.6%), and reported having injected heroin (81.0%) in the past 6 months. Nearly one-fifth (18.3%) reported engaging in recent transactional sex. Independent correlates of transactional sex were: being female [adjusted odds ratio (aOR) 3.90; 95% CI 2.12-7.16]; being a sexual minority (aOR 3.07; 95% CI 1.60-5.87); being single (aOR 3.22; 95% CI 1.73-6.01); receptive syringe sharing (aOR 3.13; 95% CI 1.73-5.66); and number of injections per day (aOR 1.08; 95% CI 1.01-1.15). Rural PWID who engage in transactional sex are characterized by multiple vulnerabilities that increase their HIV risk.
Collapse
|
10
|
Parmley L, Rao A, Kose Z, Lambert A, Max R, Phaswana-Mafuya N, Mcingana M, Hausler H, Baral S, Schwartz S. Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa. Reprod Health 2019; 16:63. [PMID: 31138313 PMCID: PMC6538548 DOI: 10.1186/s12978-019-0716-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Late presentation combined with limited engagement in antenatal care (ANC) increases risk of vertical transmission among mothers living with HIV. Female sex workers (FSW) have more than four times greater burden of HIV than other women of reproductive age in South Africa and the majority of FSW are mothers. For mothers who sell sex and are at increased HIV acquisition risk, timely and routine ANC seeking is especially vital for prevention of vertical transmission. This study represents a mixed-methods study with FSW in Port Elizabeth, South Africa, to characterize factors influencing ANC seeking behaviors in a high HIV prevalence context. METHODS FSW (n = 410) were recruited into a cross-sectional study through respondent-driven sampling between October 2014 and April 2015 and tested for HIV and pregnancy. A sub-sample of pregnant and postpartum women (n = 30) were invited to participate in in-depth interviews (IDIs) to explore their current or most recent pregnancy experiences. IDIs were coded using a modified grounded theory approach and descriptive analyses assessed the frequency of themes explored in the qualitative analysis among the quantitative sample. RESULTS In the quantitative survey, 77% of FSW were mothers (313/410); of these, two-thirds were living with HIV (212/313) and 40% reported being on antiretroviral therapy (ART) (84/212). FSW in the qualitative sub-sample reported unintended pregnancies with clients due to inconsistent contraceptive use; many reported discovering their unintended pregnancies between 4 and 7 months of gestation. FSW attributed delayed ANC seeking and ART initiation in the second or third trimesters to late pregnancy detection. Other factors limiting engagement in ANC included substance and alcohol use and discontent with previous healthcare-related experiences. CONCLUSIONS Late pregnancy discovery, primarily because pregnancies were unplanned, contributed to late ANC presentation and delayed ART initiation, increasing risks of vertical HIV transmission. Given limited ART coverage among participants, addressing the broader sexual and reproductive health and rights needs of mothers who sell sex has important implications for preventing vertical transmission of HIV. Integrating comprehensive family planning services into FSW programming, as well as providing active linkage to ANC services may reduce barriers to accessing timely ANC, decreasing risks of vertical transmission.
Collapse
Affiliation(s)
- Lauren Parmley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Zamakayise Kose
- Human Sciences Research Council, 1st Floor Office 103 Fairview Office Park Greenacres, Port Elizabeth, 6057 South Africa
| | - Andy Lambert
- TB/HIV Care, 25 St Georges Mall, Cape Town City Centre, Cape Town, 8000 South Africa
| | - Ryan Max
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Nancy Phaswana-Mafuya
- Human Sciences Research Council, 1st Floor Office 103 Fairview Office Park Greenacres, Port Elizabeth, 6057 South Africa
| | - Mfezi Mcingana
- TB/HIV Care, Office 207 A.A. House, Corner Rink & Park Drive, Central, Port Elizabeth, South Africa
| | - Harry Hausler
- TB/HIV Care, 25 St Georges Mall, Cape Town City Centre, Cape Town, 8000 South Africa
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| |
Collapse
|
11
|
Duong HT, Jarlais DD, Khuat OHT, Arasteh K, Feelemyer J, Khue PM, Giang HT, Laureillard D, Hai VV, Vallo R, Michel L, Moles JP, Nagot N. Risk Behaviors for HIV and HCV Infection Among People Who Inject Drugs in Hai Phong, Viet Nam, 2014. AIDS Behav 2018; 22:2161-2171. [PMID: 28612212 DOI: 10.1007/s10461-017-1814-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined the potential for HIV and hepatitis C (HCV) transmission across persons who inject drugs (PWID), men-who-have-sex-with-men (MSM) and female commercial sex workers (CSW) PWID and the potential for sexual transmission of HIV from PWID to the general population in Hai Phong, Viet Nam. Using respondent driven and convenience sampling we recruited 603 participants in 2014. All participants used heroin; 24% used non-injected methamphetamine. HIV prevalence was 25%; HCV prevalence was 67%. HIV infection was associated with HCV prevalence and both infections were associated with length of injecting career. Reported injecting risk behaviors were low; unsafe sexual behavior was high among MSM-PWID and CSW-PWID. There is strong possibility of sexual transmission to primary partners facilitated by methamphetamine use. We would suggest future HIV prevention programs utilize multiple interventions including "treatment as prevention" to potential sexual transmission of HIV among MSM and CSW-PWID and from PWID to the general population.
Collapse
Affiliation(s)
- Huong Thi Duong
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Hai Phong, Viet Nam.
| | | | | | - Kamyar Arasteh
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Pham Minh Khue
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Hai Phong, Viet Nam
| | - Hoang Thi Giang
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Hai Phong, Viet Nam
| | - Didier Laureillard
- Inserm U1058, Etablissement Français du Sang, University of Montpellier, Montpellier, France
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | - Vinh Vu Hai
- Infectious Diseases Department, Viet Tiep Hospital, Hai Phong, Viet Nam
| | - Roselyne Vallo
- Inserm U1058, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Laurent Michel
- CESP/Inserm1018, Pierre Nicole Centre, French Red Cross, 27 Pierre Nicole Street, Paris, 75005, France
| | - Jean Pierre Moles
- Inserm U1058, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Nicolas Nagot
- Inserm U1058, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| |
Collapse
|
12
|
Colby DJ, Oldenburg CE, Nguyen T, Closson EF, Biello KB, Mayer KH, Mimiaga MJ. HIV, Hepatitis C, and Other Sexually Transmitted Infections Among Male Sex Workers in Ho Chi Minh City, Vietnam. AIDS Behav 2016; 20:768-75. [PMID: 26563761 DOI: 10.1007/s10461-015-1247-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is little data on the burden of HIV and other infections that affect male sex workers (MSW) in Vietnam. We conducted behavioral and biological sexual health surveys with 300 MSW in Ho Chi Minh City. Generalized estimating equation models were built to assess factors associated with HIV, hepatitis C, and other sexually transmitted infections (STI). Of 300 MSW, 19 (6.3 %) were diagnosed seropositive for HIV, 11 (3.7 %) had hepatitis C, and 26 (8.7 %) had at least one prevalent STI. In a multivariable model, opiate use was significantly associated with HIV infection (aOR 6.46, 95 % CI 1.28-32.7) and hepatitis C (aOR = 19.6, 95 % CI 2.35-163.6). Alcohol dependency was associated with increased odds of hepatitis C (aOR = 4.79, 95 % CI 1.02-22.5) and decreased odds of other STI (aOR = 0.30, 95 % CI 0.10-0.97). These findings suggest that MSW in Vietnam would benefit from regular HIV and STI testing, as well as linkage to care and substance use rehabilitation services.
Collapse
Affiliation(s)
- Donn J Colby
- SEARCH, Thai Red Cross AIDS Research Centre, 104 Rajdamri Road, Pathumwan, Bangkok, 10330, Thailand.
- Center for Applied Research on Men and Health, Ho Chi Minh City, Vietnam.
| | - Catherine E Oldenburg
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
| | - Thi Nguyen
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam
| | | | - Katie B Biello
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Global Health and Population, Harvard Chan School of Public Health, Boston, MA, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
13
|
Loeliger KB, Marcus R, Wickersham JA, Pillai V, Kamarulzaman A, Altice FL. The syndemic of HIV, HIV-related risk and multiple co-morbidities among women who use drugs in Malaysia: Important targets for intervention. Addict Behav 2016; 53:31-9. [PMID: 26436520 DOI: 10.1016/j.addbeh.2015.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 07/30/2015] [Accepted: 09/22/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Substance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders. OBJECTIVES To explore HIV risk behaviors, substance use, and social factors associated with poor health outcomes among women who use drugs in Malaysia. METHODS A cross-sectional survey of 103 drug-using women in Kuala Lumpur, Malaysia were recruited to assess their medical, psychiatric and social comorbidity as well as their engagement in nationally recommended HIV testing and monitoring activities. RESULTS One-third reported having ever injected drugs, with most (68.2%) having recently shared injection paraphernalia. Sex work (44.7%) and infrequent condom use (42.4%) were common as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women (62.1%) had unstable living situations and suffered from an unmet need for social support and health services. HIV prevalence was high (20%) with only two thirds of women eligible for antiretroviral therapy having received it. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence (AOR 2.73; 95% CI 1.04-7.14) and negatively associated with drug injection (AOR 0.28; 95% CI 0.10-0.77). CONCLUSIONS/IMPORTANCE Women who use drugs in Malaysia demonstrate considerable medical, psychiatric and social co-morbidity, which negatively contributes to optimal and crucial engagement in HIV treatment-as-prevention strategies. Mental health and social support may be key targets for future public health interventions aimed at drug-using women in Malaysia.
Collapse
|
14
|
High HIV Prevalence and Associated Risk Factors Among Female Sexual Partners of Male Injection Drug Users (MWID) in Ho Chi Minh City, Vietnam. AIDS Behav 2016; 20:395-404. [PMID: 26271814 DOI: 10.1007/s10461-015-1156-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Injection drug use is a major factor in acquiring and transmitting HIV in Vietnam. This analysis aims to present estimates of HIV infection and factors associated with HIV infection among female sex partners (FSP) of MWID in Ho Chi Minh City (HCMC), Vietnam. Cross-sectional surveys were conducted in 2011 and 2013 among males who inject drugs (MWID) who then referred their FSP for a behavioral and biologic survey. In total, 445 MWID and FSPs were enrolled. HIV prevalence among MWID was 50 and 35 % among FSPs. Among FSPs, 60.3 % reported ever using illegal drugs and among those, 72.7 % reported ever injecting illicit drugs. Among FSP, injection drug for >1 year [adjusted Odds Ratio (aOR), 95 % CI 2.94, 1.19-7.26), p value = <0.001] and having a male partner infected with HIV [(aOR 3.35: 1.97-5.69), p value = <0.001] were associated with HIV infection. The prevalence of HIV infection is high among FSP of MWID in HCMC and is highly associated with the injection drug use behavior of the FSP. Harm-reduction intervention programs that focus on the MWID-FSP couple or directly on the FSPs are required.
Collapse
|
15
|
Le LVN, Nguyen TA, Tran HV, Gupta N, Duong TC, Tran HTT, Nadol P, Sabin K, Maher L, Kaldor JM. Correlates of HIV infection among female sex workers in Vietnam: injection drug use remains a key risk factor. Drug Alcohol Depend 2015; 150:46-53. [PMID: 25765480 PMCID: PMC10774074 DOI: 10.1016/j.drugalcdep.2015.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
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.
Collapse
Affiliation(s)
- Linh-Vi N Le
- U.S. Centers for Disease Control and Prevention, Vietnam; Kirby Institute for Infection and Immunity, UNSW, Australia.
| | - Tuan A Nguyen
- National Institute of Hygiene and Epidemiology, Vietnam
| | | | - Nisha Gupta
- U.S. Centers for Disease Control and Prevention, Vietnam
| | - Thanh C Duong
- National Institute of Hygiene and Epidemiology, Vietnam
| | | | - Patrick Nadol
- U.S. Centers for Disease Control and Prevention, Vietnam
| | - Keith Sabin
- World Health Organization, Vietnam, currently UN Joint Programme on HIV/AIDS, Switzerland
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW, Australia
| | - John M Kaldor
- Kirby Institute for Infection and Immunity, UNSW, Australia
| |
Collapse
|
16
|
Oldenburg CE, Biello KB, Colby D, Closson EF, Mai T, Nguyen T, Nguyen NA, Mimiaga MJ. Stigma related to sex work among men who engage in transactional sex with men in Ho Chi Minh City, Vietnam. Int J Public Health 2014; 59:833-40. [PMID: 24858522 DOI: 10.1007/s00038-014-0562-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 03/24/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Male sex workers (MSW) in Vietnam face high levels of stigma related to sex work, which may be associated with depression and increased vulnerability to HIV. METHODS In 2010, 300 MSW completed a behavioral and psychosocial survey. Multivariable models assessed factors associated with sex work-related stigma and the association between stigma and depression. RESULTS Factors associated with increased stigma included having disclosed sexual orientation to healthcare workers (b 1.75, 95 % CI 0.69-2.80), meeting clients in the street/park (b 1.42, 95 % CI 0.32-2.52), and having been forced to have sex without a condom (b 2.36, 95 % CI 1.27-3.45). Factors associated with decreased stigma included meeting clients via the telephone or internet (b -1.26, 95 % CI -2.39 to -0.12) and receiving financial support from family or friends (b -1.31, 95 % CI -2.46 to -0.17). Stigma was significantly associated with increased odds of depression (AOR 1.07, 95 % CI 1.01-1.15). CONCLUSIONS Addressing stigma and depression in HIV prevention interventions is crucial for tailoring these programs to MSWs' needs, and may result in decreased HIV spread.
Collapse
|
17
|
Decker MR, Pearson E, Illangasekare SL, Clark E, Sherman SG. Violence against women in sex work and HIV risk implications differ qualitatively by perpetrator. BMC Public Health 2013; 13:876. [PMID: 24060235 PMCID: PMC3852292 DOI: 10.1186/1471-2458-13-876] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/11/2013] [Indexed: 11/14/2022] Open
Abstract
Background Physical and sexual violence heighten STI/HIV risk for women in sex work. Against this backdrop, we describe the nature of abuse against women in sex work, and its STI/HIV implications, across perpetrators. Methods Adult women involved in sex work (n = 35) in Baltimore, MD participated in an in-depth interview and brief survey. Results Physical and sexual violence were prevalent, with 43% reporting past-month abuse. Clients were the primary perpetrators; their violence was severe, compromised women’s condom and sexual negotiation, and included forced and coerced anal intercourse. Sex work was a factor in intimate partner violence. Police abuse was largely an exploitation of power imbalances for coerced sex. Conclusions Findings affirm the need to address physical and sexual violence, particularly that perpetrated by clients, as a social determinant of health for women in sex work, as well as a threat to safety and wellbeing, and a contextual barrier to HIV risk reduction.
Collapse
Affiliation(s)
- Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N, Wolfe St,, E4142, Baltimore, MD 21205, USA.
| | | | | | | | | |
Collapse
|
18
|
Morris MD, Lemus H, Wagner KD, Martinez G, Lozada R, Gómez RMG, Strathdee SA. Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in northern Mexico. Addiction 2013; 108:161-70. [PMID: 22775475 PMCID: PMC3481016 DOI: 10.1111/j.1360-0443.2012.04016.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/06/2012] [Accepted: 07/02/2012] [Indexed: 11/28/2022]
Abstract
AIMS To identify factors associated with time to initiation of (i) sex work prior to injecting drugs initiation; (ii) injection drug use prior to sex work initiation; and (iii) concurrent sex work and injection drug use (i.e. initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). DESIGN Parametric survival analysis of baseline data for time to initiation event. SETTING Tijuana and Ciudad Juarez situated on the Mexico-US border. PARTICIPANTS A total of 557 FSW-IDUs aged ≥18 years. MEASUREMENTS Interview-administered surveys assessing context of sex work and injection drug use initiation. FINDINGS Nearly half (n = 258) initiated sex work prior to beginning to inject, a third (n = 163) initiated injection first and a quarter (n = 136) initiated both sex work and injection drug use concurrently. Low education and living in Ciudad Juarez accelerated time to sex work initiation. Being from a southern Mexican state and initiating drug use with inhalants delayed the time to first injection drug use. Having an intimate partner encourage entry into sex work and first injecting drugs to deal with depression accelerated time to initiating sex work and injection concurrently. Early physical abuse accelerated time to initiating sex work and injection, and substantially accelerated time to initiation of both behaviors concurrently. CONCLUSIONS Among female sex workers who currently inject drugs in two Mexican-US border cities, nearly half appear to initiate sex work prior to beginning to inject, nearly one-third initiate injection drug use before beginning sex work and one-quarter initiate both behaviors concurrently. Predictors of these three trajectories differ, and this provides possible modifiable targets for prevention.
Collapse
Affiliation(s)
- Meghan D. Morris
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Hector Lemus
- School of Public Health, San Diego State University, San Diego, CA
| | - Karla D. Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA
| | | | | | | | - Steffanie A. Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA
| |
Collapse
|
19
|
Abstract
Maternity for opiate users in Vietnam is challenging due to the criminalization of drug use, stigmatization, and poor specialist knowledge among health providers. This article outlines action research conducted among Vietnamese women who had experienced pregnancy while opiate-dependent. Misguided fears that their baby would be a “monstrosity” drove some women to seek out abortion. For those who chose to continue with their pregnancy, communication with health professionals was poor and misinformation concerning advised maternal practices and newborn care was common. Often women made intuitive decisions; few attempted to go “cold turkey” and withdrew suddenly from opiates while pregnant, and most new mothers chose to breastfeed—a healthy choice—despite being advised against this. The study revealed the importance of support provided outside of state services and culminated in new information for female drug users and training materials for peer counselors. The participatory process by which these outputs were developed is outlined.
Collapse
Affiliation(s)
- Joanna White
- Independent Researcher, Hanoi, Vietnam
- Centre for Research in Anthropology, Instituto Universitário de Lisboa, Portugal
| | - Pauline Oosterhoff
- Medical Committee Netherlands–Vietnam, Hanoi, Vietnam
- Royal Tropical Institute, Amsterdam, Netherlands
| |
Collapse
|
20
|
Li Y, Detels R, Lin P, Fu X, Deng Z, Liu Y, Huang G, Li J, Tan Y. Difference in risk behaviors and STD prevalence between street-based and establishment-based FSWs in Guangdong Province, China. AIDS Behav 2012; 16:943-51. [PMID: 22228068 DOI: 10.1007/s10461-011-0102-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The major mode of HIV/AIDS transmission in China is now heterosexual activities, but risk for HIV and sexually transmitted diseases (STDs) may differ among different strata of female sex workers (FSWs). Respondent-driven sampling was used to recruit 320 FSWs in Guangdong Province, China. The respondents were interviewed using a structured questionnaire, and tested for HIV, syphilis, gonorrhea, and Chlamydia. The street-based FSWs had lower education levels, a higher proportion supporting their families, charged less for their services, and had engaged in commercial sex for a longer period of time than establishment-based FSWs. The proportion consistently using condoms with clients and with regular non-paying partners was also lower. The prevalence of syphilis, gonorrhea, and Chlamydia was higher among street-based sex workers. Being a street-based sex worker, having regular non-paying sex partners, and having non-regular non-paying partners were independent risk factors for inconsistent condom. Street-based FSWs had more risk behaviors than establishment-based FSWs, and should therefore be specifically targeted for HIV as well as STD intervention programs.
Collapse
|
21
|
Medhi GK, Mahanta J, Kermode M, Paranjape RS, Adhikary R, Phukan SK, Ngully P. Factors associated with history of drug use among female sex workers (FSW) in a high HIV prevalence state of India. BMC Public Health 2012; 12:273. [PMID: 22480208 PMCID: PMC3412737 DOI: 10.1186/1471-2458-12-273] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/05/2012] [Indexed: 11/30/2022] Open
Abstract
Background The intersection between illicit drug use and female commercial sex work has been identified as an important factor responsible for rising HIV prevalence among female sex workers (FSW) in several northeastern states of India. But, little is know about the factors associated with the use of drugs among FSWs in this region. The objective of the paper was to describe the factors associated with history of drug use among FSWs in Dimapur, an important commercial hub of Nagaland, which is a high HIV prevalence state of India. Methods FSWs were recruited using respondent driven sampling (RDS), and were interviewed to collect data on socio-demographic characteristics and HIV risk behaviours. Biological samples were tested for HIV, syphilis gonorrhea and Chlamydia. Logistic regression analysis was performed to identify factors associated with drug use. Results Among the 426 FSWs in the study, about 25% (n = 107) reported having ever used illicit drugs. Among 107 illicit drug users, 83 (77.6%) were non-injecting and 24 (22.4%) were injecting drug users. Drug-using FSWs were significantly more likely to test positive for one or more STIs (59% vs. 33.5%), active syphilis (27.1% vs. 11.4%) and Chlamydia infection (30% vs. 19.9%) compared to their non-drug using peers. Drug-using FSWs were also significantly more likely to be currently married, widowed or separated compared with non-drug-using FSWs. In multiple logistic regression analysis, being an alcohol user, being married, having a larger volume of clients, and having sexual partners who have ever used or shared injecting drugs were found to be independently associated with illicit drug use. Conclusions Drug-using FSWs were more vulnerable to STIs including HIV compared to their non-drug using peers. Several important factors associated with being an FSW who uses drugs were identified in this study and this knowledge can be used to plan more effectively targeted harm reduction strategies and programs.
Collapse
Affiliation(s)
- Gajendra Kumar Medhi
- Regional Medical Research Centre (RMRC), N.E. Region (ICMR), Dibrugarh, Assam, India.
| | | | | | | | | | | | | |
Collapse
|
22
|
Wang H, Brown KS, Wang G, Ding G, Zang C, Wang J, Reilly KH, Chen H, Wang N. Knowledge of HIV seropositivity is a predictor for initiation of illicit drug use: incidence of drug use initiation among female sex workers in a high HIV-prevalence area of China. Drug Alcohol Depend 2011; 117:226-32. [PMID: 21402453 PMCID: PMC3434868 DOI: 10.1016/j.drugalcdep.2011.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 02/07/2011] [Accepted: 02/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Drug use and sex work have had facilitative roles in the transmission of HIV/AIDS in China. Stopping drug use among sex workers may help to control the growth of the HIV/AIDS epidemic among Chinese sex workers. METHODS From March 2006 to November 2009, female sex workers (FSW) in Kaiyuan City, Yunnan, China were recruited into an open cohort study. Participants were interviewed and tested for drug use and HIV/sexually transmitted infection (STI) prevalence. Follow-up surveys were conducted every six months. Multivariate Cox proportional hazards regression model with time dependent variables was used to measure the associations between independent variables and drug initiation. RESULTS During the course of the study, 66 (8.8%) FSWs initiated drug use yielding an overall incidence of 6.0 per 100 person years (PY) (95% confidence interval [CI], 4.67-7.58). In the multivariate Cox proportional hazards regression model, being HIV-positive and aware of positive serostatus (adjusted hazard ratio [AHR] 2.6, 95% CI 1.24-5.55), age at initiation of commercial sex work <20 years (AHR 1.8, 95% CI 1.12-3.01), and working in a high-risk establishment (AHR 1.9, 95% CI 1.14-3.04) were associated with illicit drug initiation. CONCLUSIONS Being HIV-positive and aware of positive serostatus was the most salient predictor for the initiation of illicit drug use. Interventions offering sources of education, treatment, support, and counseling to HIV-positive FSWs need to be implemented in order to help promote self-efficacy and safe behaviors among this group of high-risk women.
Collapse
Affiliation(s)
- Haibo Wang
- Chinese Center for Disease Control and Prevention, Beijing,National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Katherine S. Brown
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Guixiang Wang
- Kaiyuan Center for Disease Control and Prevention, Yunnan
| | - Guowei Ding
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Chunpeng Zang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Junjie Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Kathleen H. Reilly
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing,Tulane University Health Sciences Center, School of Public Health and Tropical Medicine
| | - Helen Chen
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| |
Collapse
|
23
|
Gu J, Lau JT, Chen H, Tsui H, Ling W. Prevalence and factors related to syringe sharing behaviours among female injecting drug users who are also sex workers in China. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:26-33. [DOI: 10.1016/j.drugpo.2010.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 06/02/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
|
24
|
Le MN, D'Onofrio CN, Rogers JD. HIV risk behaviors among three classes of female sex workers in Vietnam. JOURNAL OF SEX RESEARCH 2010; 47:38-48. [PMID: 19499456 DOI: 10.1080/00224490902999278] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Increases in the rate of HIV infection in Vietnam among female sex workers and their clients require more effective preventive interventions based on a better understanding of this population and important subgroups within it. Because little was known about women in the hospitality sex industry, this study compared demographic and work characteristics, history of sexually transmitted infections (STIs), and condom use among a sample of 310 female sex workers in low-, middle-, and high-class hospitality businesses in Ho Chi Minh City (mean age = 26.77 years, SD = 6.17). Data were collected through individual, face-to-face, semistructured interviews. Logistic regression models were used to identify demographic predictors of the incidence of STIs and reported condom use. Low occupational status was most strongly associated with a history of STIs, and use of condoms with new and regular clients also differed by occupational class. Implications are discussed.
Collapse
Affiliation(s)
- Mai-Nhung Le
- Asian American Studies Department, School of Ethnic Studies, San Francisco State University, San Francisco, CA 94132, USA.
| | | | | |
Collapse
|
25
|
Thanh DC, Hien NT, Tuan NA, Thang BD, Long NT, Fylkesnes K. HIV risk behaviours and determinants among people living with HIV/AIDS in Vietnam. AIDS Behav 2009; 13:1151-9. [PMID: 18787940 DOI: 10.1007/s10461-008-9451-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 08/19/2008] [Indexed: 10/21/2022]
Abstract
There is a potentially high risk of HIV spreading from people living with HIV/AIDS. We conducted a cross-sectional study to examine HIV risk behaviours and their determinants among people living with HIV/AIDS. Eighty-two percent had been sexually active. Sex with multiple partners was reported by 20% and consistent condom use by about one third. More than half of the participants (52%) reported having injected drugs during the previous month, and 35% of those had shared needles and syringes. Voluntary HIV testing and having received condoms or injection equipment from the local HIV prevention program, were found to be significantly associated with fewer HIV risk behaviours. Having learned recently about personal HIV status, multiple sex partners, low educational attainment and young age were found to be associated with higher HIV risk behaviours. Giving high priority to targeted preventive and support programmes is likely to be a highly cost-effective strategy.
Collapse
|
26
|
Clients of female sex workers as a bridging population in Vietnam. AIDS Behav 2009; 13:881-91. [PMID: 18830814 DOI: 10.1007/s10461-008-9463-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 09/12/2008] [Indexed: 10/21/2022]
Abstract
Understanding bridging behaviors of clients of female sex workers (FSWs) is important for projecting and intervening in the spread of sexually transmitted infections in Vietnam. The goals of the study were to determine HIV/STI prevalence amongst different bridging groups, identify factors associated with being potential and active bridgers, and assess the association of drug use and unsafe sex with HIV and/or STI prevalence. In April, 2007, 292 clients were anonymously interviewed at sex venues in a two-stage time-location cluster sampling survey, followed by HIV, syphilis, and HSV-2 testing. Based on condom use with both high-risk (FSWs) and low-risk (wives/girlfriends) sexual partners, clients were classified as unlikely, potential, or active bridgers. The majority of clients were potential or active bridgers (55.8%) who had a significantly higher prevalence of herpes simplex type 2 (HSV-2) (21% and 33%, respectively) than unlikely bridgers (8.7%). HIV seropositivity was 4.4-fold (95% CI 1.1-17.1) higher among those who were HSV-2-positive. Clients of FSWs may be playing a major bridging role in transmitting HIV and sexually transmitted infections (STIs) in Vietnam. An observed synergistic interaction between drug use and condom slippage/breakage emphasizes the importance of proper condom use, particularly among drug users.
Collapse
|
27
|
Correlation between HIV and sexual behavior, drug use, trichomoniasis and candidiasis among female sex workers in a Mekong Delta province of Vietnam. AIDS Behav 2009; 13:873-80. [PMID: 19085101 DOI: 10.1007/s10461-008-9499-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 11/25/2008] [Indexed: 10/21/2022]
Abstract
To determine the prevalence of HIV and correlates of HIV infection among female sex workers (FSWs) in Soc Trang province, Vietnam, a survey of 406 FSWs in Soc Trang province was conducted between May and August, 2003. The participants were interviewed, using a standardized interview, to obtain information about socio-demographic and behavioral characteristics, and gynecologic and sexually transmitted infection (STI) history. The prevalence of HIV was 3.3%. An increased risk for HIV was associated with ever using illicit drugs, direct sex work, early sexual debut, age of FSWs, and infection with candidiasis and trichomoniasis. Reduced likelihood of HIV was only associated with withdrawal as a contraceptive method. A strong association of HIV with drug use and candidiasis and trichomoniasis infection among FSWs was found. Needle/syringe exchange, STI treatment, and methadone programs targeting FSWs should be implemented, and should include 100% condom use promotion.
Collapse
|
28
|
Giang LM, Huong NTM. 'New bottle, but old wine': from family planning to HIV/AIDS in post-Doi Moi Vietnam. Glob Public Health 2009; 3 Suppl 2:76-91. [PMID: 19288354 DOI: 10.1080/17441690801980995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper begins with an observation that during the past two decades HIV/AIDS has emerged as a new public health priority in Vietnam and has commanded increasing attention and resources from both the government and the donor community. By juxtaposing HIV/AIDS with family planning, another social and health priority that preceded, and overlapped with, HIV/AIDS for a large part of the 1990s, we show two major gaps that have undermined both programmes. One is the lack of a strong civil society, that could have served as advocates for change, especially outside the government and the donor community. The other is the desire for control of women's bodies and sexuality that has been driven by the ever shifting project of nation building. We argue that these two major gaps represent more continuity than discontinuity in the way sexual and reproductive health issues are approached in Vietnam despite the seeming shift in priority that the emergence of HIV/AIDS suggests.
Collapse
Affiliation(s)
- L M Giang
- Centre for Research and Training on HIV/AIDS, Hanoi Medical University, New York, USA.
| | | |
Collapse
|
29
|
Ishizaki A, Cuong NH, Thuc PV, Trung NV, Saijoh K, Kageyama S, Ishigaki K, Tanuma J, Oka S, Ichimura H. Profile of HIV type 1 infection and genotypic resistance mutations to antiretroviral drugs in treatment-naive HIV type 1-infected individuals in Hai Phong, Viet Nam. AIDS Res Hum Retroviruses 2009; 25:175-82. [PMID: 19239356 DOI: 10.1089/aid.2008.0193] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We evaluated the prevalence and profile of antiretroviral treatment (ART)-associated resistance mutations among HIV-1 strains in northern Vietnam by genotypically analyzing strains isolated from ART-naive individuals in Hai Phong, a city in which HIV-1 is highly prevalent. Plasma samples were collected from injecting drug users (IDU, n = 760), female sex workers (FSW, n = 91), seafarers (n = 94), pregnant women (n = 200), and blood donors (n = 210), and screened for HIV-1 antibodies. Plasma viral RNA was extracted from HIV-1-positive samples, amplified by reverse transcriptase (RT)-PCR of protease and RT genes, and analyzed for genotypes and ART-associated resistance mutations. HIV-1 prevalence among IDU, FSW, seafarers, pregnant women, and blood donors was 35.9%, 23.1%, 0%, 0.5%, and 2.9%, respectively. Phylogenetic analyses revealed that the most prevalent HIV-1 subtype was CRF01_AE (98.3%), similar to strains prevalent in southern China. Four (1.4%) subtype B strains and one (0.3%) unique recombinant between subtypes B and C were also identified. We found protease inhibitor-associated major resistance mutations in one of the 294 cases analyzed (0.3%; mutation M46I). We found RT inhibitor-associated major resistance mutations in 7/273 cases (2.6%; one occurrence each of L74I, M184I, and K219E; three cases of K103N; and two cases of G190E). One CRF01_AE strain harboring a protease codon 35 insertion was first identified in Vietnam. Thus, monitoring of drug-resistant HIV-1 and establishment of a database are required for the proper selection of ART in Vietnam.
Collapse
Affiliation(s)
- Azumi Ishizaki
- Department of Hygiene, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
- Department of Viral Infection and International Health, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | | | | | - Nguyen Vu Trung
- Department of Medical microbiology, Hanoi Medical University, Hanoi, Viet Nam
| | - Kiyofumi Saijoh
- Department of Hygiene, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Seiji Kageyama
- Department of Viral Infection and International Health, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Kyoko Ishigaki
- AIDS Research and Clinical Center, International Medical Center of Japan, Tokyo, Japan
| | - Junko Tanuma
- AIDS Research and Clinical Center, International Medical Center of Japan, Tokyo, Japan
| | - Shinichi Oka
- AIDS Research and Clinical Center, International Medical Center of Japan, Tokyo, Japan
| | - Hiroshi Ichimura
- Department of Viral Infection and International Health, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| |
Collapse
|
30
|
Oosterhoff P, Hardon AP, Nguyen TA, Pham NY, Wright P. Dealing with a positive result: routine HIV testing of pregnant women in Vietnam. AIDS Care 2008; 20:654-9. [PMID: 18576166 DOI: 10.1080/09540120701687026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV testing is an essential component of PMTCT. It can be offered to pregnant women through different testing models, ranging from voluntary counseling and testing (VCT) to routine and mandatory testing. This study was conducted in Hanoi, Vietnam, where HIV-prevalence is low among the general population, but high among young, urban, sexually active, male intravenous drug users. Women who want to deliver in a state hospital are routinely tested for HIV in the absence of well-defined opt-out procedures. In-depth interviews with a convenience sample of 38 seropositive pregnant women and mothers and 53 health workers explored the acceptability of routine testing. Patients and healthcare workers appeared to accept routine 'blood' tests (including HIV tests) because they feel uncomfortable discussing issues specific to HIV/AIDS. To avoid having to inform women directly about their HIV status, health workers at routine testing sites rely on the official notification system, shifting the responsibility from the hospitals to district and commune health staff. The notification system in Hanoi informs these local officials about the HIV status of people living in their catchment area without patients' consent. Our study shows that this non-confidential process can have serious social, economic and health consequences for the HIV-positive women and their children.
Collapse
Affiliation(s)
- P Oosterhoff
- Medical Committee Netherlands Vietnam, Hanoi, Vietnam.
| | | | | | | | | |
Collapse
|
31
|
Schumacher CM, Go VF, Nam LV, Latkin CA, Bergenstrom A, Celentano DD, Quan VM. Social injecting and other correlates of high-risk sexual activity among injecting drug users in northern Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 20:352-6. [PMID: 19010656 DOI: 10.1016/j.drugpo.2008.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 09/02/2008] [Accepted: 09/08/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sexual risk and STDs are relatively high among injecting drug users (IDUs) in Vietnam. We sought to determine characteristics of sexually active IDUs and correlates of high-risk sexual practices among IDUs in Bac Ninh province in northern Vietnam. METHODS We used data collected for a community-based cross-sectional pilot study to identify correlates of recent high-risk sex (>1 sex partner and inconsistent/no condom use in the past year). Factors associated with high-risk sex were identified using logistic regression. RESULTS Among 216 sexually active male IDUs, one third (n=72) had engaged in high-risk sex within the last year. IDUs who reported injecting with others more frequently, having someone else inject their drugs at last injection, sharing needles or sharing any injection equipment were more likely to have reported recent high-risk sex. Factors independently associated with high-risk sexual activity were not injecting oneself [AOR: 2.22; 95% CI (1.09-4.51)], and sharing needles in the past 12 months [AOR: 2.57; 95% CI (1.10-5.99)]. CONCLUSIONS IDUs who inject socially and IDUs who share needles are likely to engage in high-risk sexual behaviours and may serve as an important bridge group for epidemic HIV transmission in Vietnam. In addition to messages regarding the dangers of sharing needles and other injection equipment, preventive interventions among newly initiated IDUs should also focus on reducing sexual risk.
Collapse
Affiliation(s)
- Christina M Schumacher
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | | | | | | | | | | | | |
Collapse
|
32
|
Nemoto T, Iwamoto M, Colby D, Witt S, Pishori A, Le MN, Vinh DTN, Giang LT. HIV-related risk behaviors among female sex workers in Ho Chi Minh City, Vietnam. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2008; 20:435-453. [PMID: 18956984 DOI: 10.1521/aeap.2008.20.5.435] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study quantitatively and qualitatively described HIV risk behaviors among Vietnamese female sex workers (FSWs) who work at three distinct venues in Ho Chi Minh City: street, massage parlors, and bars/clubs. Although 35% of the participants had never been tested for HIV, 18% of street and 7% of bar/club FSWs reported being positive. Almost all massage parlor FSWs had never used a condom for oral sex. Inconsistent condom use for vaginal sex with customers was more prevalent among bar/club FSWs (85%) than massage parlor (72%) and street FSWs (68%). Many participants reported difficulties in negotiating condom use with customers because of economic pressure, maintaining relationships, and lack of bargaining power. Bar/club FSWs revealed a difficult situation where drinking is part of their work. Thirty percent of street FSWs had injected drugs and reported addiction to heroin in relation to their helpless condition as FSWs. Street FSWs had the lowest levels of self-esteem and norms toward practicing safe sex and the highest levels of economic pressure. This study recommends future HIV prevention programs for FSWs in Vietnam that target their specific risk behaviors and work environments.
Collapse
Affiliation(s)
- Tooru Nemoto
- Public Health Institute, 180 Grand Ave., Suite 750, Oakland, CA 94612, USA.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Duong CT, Nguyen TH, Hoang TTH, Nguyen VV, Do TMN, Pham VH, Detels R. Sexual risk and bridging behaviors among young people in Hai Phong, Vietnam. AIDS Behav 2008; 12:643-51. [PMID: 17636375 PMCID: PMC2938170 DOI: 10.1007/s10461-007-9265-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Accepted: 05/30/2007] [Indexed: 11/28/2022]
Abstract
The risk of the HIV epidemic spreading from high-risk groups to the general population in Vietnam depends on sexual risk and bridging behaviors between high- and low-risk individuals. A cross-sectional study was used to describe sexual activities of youth aged 18-29 years. Nearly half (41.4%) were sexually active. Premarital sex was reported by 43.3% of them; 78.3% of sexually active males and 13.5% of sexually active females. Multiple sex partners were reported by 31.0%; 56.7% of males and 9.2% of females. Almost 27% of males and 5% of females engaged in sexual bridging behaviors. Being unmarried was significantly associated with having sex with non-regular partners. Being unmarried and early age at first intercourse were associated with having sex with a sex worker. Consistent condom use was high with commercial sex workers but low with regular partners. Education to delay early sexual debut, increased employment, and strategies to inform young sexually active people to adopt safer behaviors are urgently needed.
Collapse
Affiliation(s)
- Cong Thanh Duong
- National Institute of Hygiene and Epidemiology, No. 1, Yersin Street, Ha Noi 10000, Vietnam
| | - Tran Hien Nguyen
- National Institute of Hygiene and Epidemiology, No. 1, Yersin Street, Ha Noi 10000, Vietnam
| | - Thi Thanh Ha Hoang
- National Institute of Hygiene and Epidemiology, No. 1, Yersin Street, Ha Noi 10000, Vietnam
| | - Van Vi Nguyen
- Hai Phong Service of Health, No. 20 Le Dai Hanh Street, Hai Phong, Vietnam
| | - Thi Minh Nguyet Do
- Hai Phong Service of Health, No. 20 Le Dai Hanh Street, Hai Phong, Vietnam
| | - Van Han Pham
- Hai Phong Medical School, Lach Tray Street, Hai Phong, Vietnam
| | - Roger Detels
- Department of Epidemiology, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, USA
| |
Collapse
|
34
|
Nguyen VT, Scannapieco M. Drug abuse in Vietnam: a critical review of the literature and implications for future research. Addiction 2008; 103:535-43. [PMID: 18261190 DOI: 10.1111/j.1360-0443.2007.02122.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To provide an overall picture of drug abuse in Vietnam, its prevalence, correlates and patterns. METHODS Studies addressing the drug abuse problem in Vietnam are reviewed. Attention is paid to studies conducted from 1993 onwards. The reviewed studies were collected from both refereed and non-refereed sources. RESULTS Drug abuse is rising sharply in Vietnam: almost threefold over the past 10 years. From a predominantly rural-mountainous phenomenon, illicit drug abuse spread rapidly to urban areas. Meanwhile, the average age of drug users has declined and more women have been engaging in drug consumption. At the same time, heroin has replaced opium as the most preferred drug in the country's illicit drug market, especially among young users in urban areas. At the national level, the second main route of drug administration, injecting, has exceeded smoking and taken precedence in the country's drug abuse culture, especially among heroin users. CONCLUSION Drug abuse in Vietnam has changed radically over the past decade, which has implications for the national and international community and requires further research to fill the knowledge gap and to inform intervention policy for better drug control policy.
Collapse
Affiliation(s)
- Van T Nguyen
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA.
| | | |
Collapse
|
35
|
A rapid situation and response assessment of the female regular sex partners of male drug users in South Asia: Factors associated with condom use during the last sexual intercourse. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:148-58. [DOI: 10.1016/j.drugpo.2007.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 11/28/2007] [Accepted: 12/05/2007] [Indexed: 11/18/2022]
|
36
|
Ngo AD, Ratliff EA, McCurdy SA, Ross MW, Markham C, Pham HTB. Health-seeking behaviour for sexually transmitted infections and HIV testing among female sex workers in Vietnam. AIDS Care 2008; 19:878-87. [PMID: 17712691 DOI: 10.1080/09540120601163078] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This qualitative study was conducted to explore health-seeking behaviour for sexually transmitted infections (STIs) and HIV testing among female sex workers (FSWs) in the cities of Hanoi and Da Nang, Vietnam. Data were gathered from in-depth interviews, focus groups and participant observation. Results suggest that women's decision to seek STI treatment and HIV testing is influenced by the complex interplay of personal risk perceptions, social relationships and community discourse. The women exhibited adequate knowledge of HIV while their knowledge of STIs was limited. They demonstrated high-risk perceptions of HIV, but they showed little concern for STIs. Most women sought treatment at pharmacies when they noticed symptoms of the genital tract. Their decision to seek care in health facilities and HIV testing was hampered by the high costs of treatment, judgmental attitudes of service providers, and a lack of information on testing services. Future interventions need to focus on strengthening knowledge of STIs and the STI-HIV association, and increasing awareness of HIV counselling and testing services. Training for STI service providers including pharmacies and private practitioners on sex-worker friendly and non-judgmental services and counselling skills should be emphasized to provide timely diagnosis and treatment of STIs, and to refer women to HIV testing.
Collapse
Affiliation(s)
- A D Ngo
- School of Population Health, University of Queensland, Australia.
| | | | | | | | | | | |
Collapse
|
37
|
Tran TMT, Nguyen HT, Yatsuya H, Hamajima N, Nishimura A, Ito K. HIV prevalence and factors associated with HIV infection among male injection drug users under 30: a cross-sectional study in Long An, Vietnam. BMC Public Health 2006; 6:248. [PMID: 17029648 PMCID: PMC1633741 DOI: 10.1186/1471-2458-6-248] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Accepted: 10/10/2006] [Indexed: 02/25/2023] Open
Abstract
Background Sufficient targeted HIV prevention activities aiming at reducing HIV transmission within and from an extremely marginalized population of injection drug users (IDUs) must urgently and efficiently be implemented in Vietnam. This study was conducted to facilitate the development of such activities by describing transmission risks of young IDUs and evaluating factors in association with HIV infection. Methods Thirty clusters were selected from 29 hotspot communes in Long An province by probability proportional to size (PPS) sampling method. The snowball technique was used for enrolling participants in each cluster. The cross-sectional association of factors obtained during direct structured interviews to 248 male IDUs aged 14 to 29 years old and with their HIV test results were examined. Results The HIV prevalence among the studied IDUs was 32%. Age range of 18–20 years old, low educational level, sharing injection equipment or injection drug use in the other cities were independently associated with HIV serostatus in the multivariate analysis. Sexual behaviors did not differ between HIV-positive and -negative IDUs. Among HIV seropositive IDUs who had sexual contact with primary (n = 37), casual (n = 6), and commercial (n = 15) partners, only 5.4% (n = 2), 33.3% (n = 2), and 46.7% (n = 7), respectively, responded that they had used condoms every time. Conclusion About one-third of young IDUs aged less than 30 identified in the hotspot communes in Long An, Vietnam was found to be infected with HIV, and socio-demographic and injection-related factors might account for the infection risk. Prevailing risky sexual behavior of this extremely marginalized population highlights the need to reduce their high transmission risks as a public health priority.
Collapse
Affiliation(s)
- Thu Minh T Tran
- Planning Department, National Institute of Hygiene and Epidemiology, 1 Yersin Hai Ba Trung, Hanoi, Vietnam.
| | | | | | | | | | | |
Collapse
|
38
|
Go VF, Quan VM, Voytek C, Celentano D, Nam LV. Intra-couple communication dynamics of HIV risk behavior among injecting drug users and their sexual partners in Northern Vietnam. Drug Alcohol Depend 2006; 84:69-76. [PMID: 16413145 DOI: 10.1016/j.drugalcdep.2005.12.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 10/24/2005] [Accepted: 12/06/2005] [Indexed: 11/30/2022]
Abstract
This paper elucidates the social context of HIV risk behavior and intra-couple risk communication among injecting drug users (IDUs) and their main sex partner. Data on shared injection equipment, unprotected sex with multiple partners, unprotected sex with a main partner and couples' dynamics and risk communication were gathered through separate in-depth interviews with 11 active male IDUs and 11 of their primary female sex partners in Northern Vietnam. The majority of IDUs' sex partners does not inject drugs and is monogamous. In contrast, most IDUs reported a wide range of risky practices including needle sharing and unprotected sex with multiple, often concurrent, sex partners. Men rarely used condoms with primary partners. Many IDUs worried about their HIV-status, but none disclosed their injecting or sexual practices to their sex partners, leaving their partners unaware of their HIV risk. Among women who worried about HIV/AIDS, the vast majority was unable to influence their partner's needle sharing or extramarital affairs and most would not initiate condom use because they feared their partner's reaction. Couple-based interventions to facilitate risk communication combined with programs to promote condom use among male IDUs, may help to reduce HIV transmission from IDUs to their primary partners.
Collapse
Affiliation(s)
- Vivian F Go
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | | | | | | |
Collapse
|
39
|
Thao LTL, Lindan CP, Brickley DB, Giang LT. Changes in high-risk behaviors over time among young drug users in South Vietnam: a three-province study. AIDS Behav 2006; 10:S47-56. [PMID: 16855868 DOI: 10.1007/s10461-006-9138-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vietnam is in the midst of an expanding HIV epidemic, primarily driven by an increase in injection drug use in young people. This study was conducted to understand the patterns and initiation of drug use, and the sexual risk behavior among youth in three provinces in southern Vietnam. A cross-sectional survey was conducted among male and female drug users under age 25 recruited from drug treatment centers (N = 560) and the community (N = 240) in Ho Chi Minh City, Dong Nai and Ba Ria-Vung Tau. The majority of those surveyed (82%) began by smoking heroin; after a year, 57% were injecting heroin and/or opium. Initiation of drug use frequently occurred in entertainment venues. Among injectors, 23% shared needles; 71% of all users were sexually active of whom 77% had unprotected sex. More than half of those recruited from treatment centers had previously been in drug treatment. Public health programs to prevent and treat the dual epidemics of HIV and drug abuse must be able to access and respond to the needs of youth, many of whom are unemployed and exposed to drug traffic.
Collapse
Affiliation(s)
- Le Thuy Lan Thao
- Ho Chi Minh City Provincial AIDS Committee, Ho Chi Minh City, Vietnam
| | | | | | | |
Collapse
|
40
|
Go VF, Frangakis C, Nam LV, Bergenstrom A, Sripaipan T, Zenilman JM, Celentano DD, Quan VM. High HIV sexual risk behaviors and sexually transmitted disease prevalence among injection drug users in Northern Vietnam: implications for a generalized HIV epidemic. J Acquir Immune Defic Syndr 2006; 42:108-15. [PMID: 16763499 DOI: 10.1097/01.qai.0000199354.88607.2f] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV prevalence in Vietnam is currently concentrated among injection drug users (IDUs). The extent to which this core risk group represents a potential for broader HIV transmission to the general population is currently unknown. METHODS A community-based cross-sectional study among IDUs in Vietnam assessed sexually transmitted disease (STD) prevalence and behavioral risk factors. Qualitative interview data enhanced quantitative findings. RESULTS The prevalence of any STDs among 272 IDUs was 30% (chlamydia, 9%; herpes simplex virus type 2 [HSV-2], 22%; gonorrhea, 0%; and syphilis, 1%). Part-time work or unemployment (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 1.1 to 6.9), sex with > or =2 sex workers in the past year (OR = 4.9, 95% CI: 1.91 to 12.6), having ever smoked heroin (OR = 4.5, 95% CI: 1.1 to 18.3), and injecting less frequently than daily (OR = 3.9, 95% CI: 1.43 to 10.6) were independently associated with chlamydial infection. Urban residency (OR = 4.0, 95% CI: 1.4 to 11.0) and daily injecting (OR = 2.2, 95% CI: 1.1 to 4.4) were independently associated with HSV-2. Odds of HSV-2 among older (> or =28 years of age) IDUs who had sex with <2 sex workers in the past year was higher than among younger IDUs who had sex with more sex workers (OR = 6.4, 95% CI: 2.1 to 18.4). CONCLUSIONS High STD prevalence and high-risk sexual and parenteral behaviors among IDUs indicate the potential for HIV/STD transmission to the general Vietnamese population.
Collapse
Affiliation(s)
- Vivian F Go
- Infectious Diseases Program, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Semaan S, Des Jarlais DC, Malow R. Behavior change and health-related interventions for heterosexual risk reduction among drug users. Subst Use Misuse 2006; 41:1349-78. [PMID: 17002987 PMCID: PMC2601640 DOI: 10.1080/10826080600838018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resource-constrained settings and to address relevant contextual factors.
Collapse
Affiliation(s)
- Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | |
Collapse
|