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Gutierrez-Lanz E, Smith LB, Perry AM. Syphilis in Hematopathology Practice: A Diagnostic Challenge. Arch Pathol Lab Med 2024; 148:633-641. [PMID: 37535664 DOI: 10.5858/arpa.2023-0078-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 08/05/2023]
Abstract
CONTEXT.— Syphilis, a reemerging disease caused by the spirochete Treponema pallidum, is becoming more frequent in surgical pathology and hematopathology practices. Hematopathologists typically receive lymph node biopsies from patients with syphilis who have localized or diffuse lymphadenopathy. Occasionally, syphilis infection in the aerodigestive tract can show a prominent lymphoplasmacytic infiltrate and mimic lymphoma. Besides the varying and occasional atypical morphology, the fact that clinical suspicion tends to be low or absent when histologic evaluation is requested adds to the importance of making this diagnosis. OBJECTIVE.— To summarize histologic features of syphilitic lymphadenitis and syphilis lesions in the aerodigestive tract, and to review differential diagnosis and potential diagnostic pitfalls. DATA SOURCES.— Literature review via PubMed search. CONCLUSIONS.— Characteristic histologic findings in syphilitic lymphadenitis include thickened capsule with plasma cell-rich inflammatory infiltrate, reactive follicular and paracortical hyperplasia with prominent lymphoplasmacytic infiltrate, and vasculitis. Lymph nodes, however, can show a number of other nonspecific histologic features, which frequently makes the diagnosis quite challenging. In the aerodigestive tract, syphilis is characterized by plasma cell-rich infiltrates. Immunohistochemistry for T pallidum is the preferred method for detecting spirochetes; however, this immunohistochemical stain shows cross-reactivity with other treponemal and commensal spirochetes. Differential diagnosis of syphilis in lymph nodes and the aerodigestive tract is broad and includes reactive, infectious, and neoplastic entities. Pathologists should be aware of the histologic features of syphilis and keep this challenging entity in the differential diagnosis.
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Salazar M, Silverman JG, Rangel Gómez MG, Urada LA, Brouwer KC, Reed E. Substance use, economic vulnerability, and HIV/STI risk among female sex workers in Mexico. Int J STD AIDS 2024; 35:147-154. [PMID: 37934459 DOI: 10.1177/09564624231214287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Economic hardship (e.g., difficulty to pay for basic needs) has been associated with increased HIV/STI risk among female sex workers (FSW), and may be exacerbated by high levels of substance use. Few studies have assessed the intersection of economic hardship, substance use, and HIV/STI risk among FSW. METHODS Quantitative data were collected via questionnaires among 469 FSW residing in Tijuana and Ciudad Juarez, Mexico. Using logistic regression, we assessed the role of economic hardship on the association between substance use (past 30-days alcohol use, drug use, or injection drugs use with clients, and past 6-months drug use) and testing positive for an STI (also an indicator of HIV risk). RESULTS Drug use in the preceding six months was significantly associated with testing positive for an STI (AOR = 1.8, CI: 1.1 = 2.9, p = .02); no difference in this association was found by whether women reported economic hardship. Past 30-day drug use with clients was associated with STI infection, but only among those who did not report economic hardship (AOR = 1.5, 95% CI: 1.1-1.9, p < .01). CONCLUSIONS Findings suggest that economic hardship influences the association between substance use and increased risk for HIV/STI among FSW; however, these associations may be more complex than previously hypothesized.
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Affiliation(s)
- Marissa Salazar
- School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - María Gudelia Rangel Gómez
- US-Mexico Border Health Commission, Tijuana, Mexico
- El Colegio de la Frontera Norte (COLEF), Tijuana, Mexico
| | - Lianne A Urada
- School of Social Work, San Diego State University, San Diego, CA, USA
| | | | - Elizabeth Reed
- School of Public Health, San Diego State University, San Diego, CA, USA
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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.
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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.
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Dumchev K. Challenges of sexually transmitted infections and sexual health among people who inject drugs. Curr Opin Infect Dis 2022; 35:55-60. [PMID: 34799511 DOI: 10.1097/qco.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review provides a summary of recently published research on sexually transmitted infections (STI) and related behaviors among people who inject drugs (PWID), covering three major areas: sexual behavior and its role in STI transmission among PWID, multilevel factors associated with STI risk, and strategies addressing sexual health of PWID. This review is timely given the growing priority of combination prevention approaches and integrated care for PWID. RECENT FINDINGS Modern research improves the understanding that PWID have an increased risk of STI, which varies by gender, setting, type of substance used, and presence of mental disorders. Major socioeconomic and structural factors, specific and nonspecific to PWID, facilitate inequality and sexual risk behavior. Sexual transmission continues to contribute substantially to the spread of bloodborne infections among PWID, accounting for at least 10% of new HIV cases according to epidemiological modeling. Despite the substantial evidence that behavioral interventions can improve sexual health and reduce sex-related risks among PWID, there is a research-practice gap, reflected in the scarcity of implementation studies published recently. SUMMARY Integration of sexual health into prevention programs for PWID is essential to curb transmission of STI, including HIV, among PWID and their sexual partners.
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Sedeño-Monge V, Laguna-Meraz S, Santos-López G, Panduro A, Sosa-Jurado F, Jose-Abrego A, Meléndez-Mena D, Muñoz-Ramírez MA, Cosme-Chávez M, Roman S. A comprehensive update of the status of hepatitis C virus (HCV) infection in Mexico-A systematic review and meta-analysis (2008-2019). Ann Hepatol 2021; 20:100292. [PMID: 33259949 DOI: 10.1016/j.aohep.2020.100292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES HCV infection is targeted by the WHO's Global Health Sector Strategy on Viral Hepatitis to be reduced notably by 2030. However, renovated epidemiological data is needed to line up with such goals. Herein, we provide an updated review of incidence, prevalence, genotypes (GTs), and risk factors (RFs) of HCV infection in Mexico to build elimination strategies. MATERIAL AND METHODS HCV incidence was charted using the cumulative new cases/year at week 52. Prevalence, GTs, and RFs data from low-risk (LR-G) and high-risk (HR-Gs) groups were searched in PubMed/MEDLINE/Medigraphic/Scielo databases from January 2008 to December 2019 as per PRISMA guidelines. Weighted mean prevalence (WMP) was estimated; GTs and RFs were registered. RESULTS In this study, 25,247 new cases were reported. Ten states accumulated 76.32% of HCV incidence that peaked in men at 50-59 years and women at 60-64 years. Thirty-four studies revealed a WMP between 0.774%-2.5% in LR-Gs and 11.8%-39.6% in HR-Gs that included mainly prison inmates, drug users, and dialyzed patients. GT1 and GT2 were predominant; GT3a emerged. Subtypes 1a and 1b circulate differentially, whereas novel GT2 subtypes appeared. Unsafe blood transfusion was infrequent in younger groups, but parenteral/intravenous transmission through drug-related risk behaviors has arisen. CONCLUSIONS HCV transmission increased notably among LR-Gs and HR-Gs in Mexico. Novel genotypes/subtypes emerged as well as risky behavioral routes of transmission. A national elimination strategy will require pro-active screening in designated risk groups, research in molecular epidemiology, medical training, robust epidemiological databases, and antiviral treatment available to all eligible HCV-infected patients.
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Affiliation(s)
- Virginia Sedeño-Monge
- Decanato de Ciencias Médicas, Universidad Popular Autónoma del Estado de Puebla, Puebla, Puebla, Mexico
| | - Saul Laguna-Meraz
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Gerardo Santos-López
- Laboratorio de Biología Molecular y Virología, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Metepec, Atlixco, Puebla, Mexico
| | - Arturo Panduro
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Francisca Sosa-Jurado
- Laboratorio de Biología Molecular y Virología, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Metepec, Atlixco, Puebla, Mexico
| | - Alexis Jose-Abrego
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Daniel Meléndez-Mena
- Servicio de Gastroenterología, Unidad Médica de Alta Especialidad, Centro Médico Nacional "General de División Manuel Ávila Camacho", Instituto Mexicano del Seguro Social, Puebla, Puebla, Mexico; Centro Interdisciplinario de Posgrados, Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Mexico
| | - Marco A Muñoz-Ramírez
- Decanato de Ciencias Médicas, Universidad Popular Autónoma del Estado de Puebla, Puebla, Puebla, Mexico
| | - Monserrat Cosme-Chávez
- Decanato de Ciencias Médicas, Universidad Popular Autónoma del Estado de Puebla, Puebla, Puebla, Mexico
| | - Sonia Roman
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico.
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Strathdee SA, Bristow CC, Gaines T, Shoptaw S. Collateral Damage: A Narrative Review on Epidemics of Substance Use Disorders and Their Relationships to Sexually Transmitted Infections in the United States. Sex Transm Dis 2021; 48:466-473. [PMID: 33315749 PMCID: PMC8184578 DOI: 10.1097/olq.0000000000001341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Associations between substance use disorders and outbreaks of HIV and acute viral hepatitis have received considerable attention, but less research has focused on links between substance use disorders and sexually transmitted infections, apart from alcohol misuse. This narrative review describes the history of this public health crisis in the United States and direct and indirect effects opioids and specific stimulants have on high-risk sexual behaviors. We also review the epidemiology of sexually transmitted infections associated with opioids and stimulants in the United States and discuss opportunities for integrated interventions.
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Affiliation(s)
- Steffanie Ann Strathdee
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Claire C Bristow
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Tommi Gaines
- From the Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Steven Shoptaw
- Department of Family Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
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Magee LA, Fortenberry JD, Nelson T, Roth A, Arno J, Wiehe SE. Sexually Transmitted Infections in Association With Area-Level Prostitution and Drug-Related Arrests. Sex Transm Dis 2021; 48:508-514. [PMID: 33346589 PMCID: PMC8184564 DOI: 10.1097/olq.0000000000001345] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to examine the mediators and moderators of area-level prostitution arrests and sexually transmitted infections (STIs) using population-level data. METHODS Using justice and public health STI/HIV data in Marion County (Indianapolis), Indiana, during an 18-year period, we assessed the overall association of area-level prostitution and drug-related arrests and STI/HIV, and mediators and moderators of the relationship. Point-level arrests were geocoded and aggregated by a census block group. RESULTS Results indicate a positive relationship between numbers of prostitution arrests and area-level STI rates. There was a dose-response relationship between prostitution arrests and STI rates when accounting for drug-related arrests. The highest quintile block groups had significantly higher rates of reported chlamydia (incident rate ratio [IRR], 3.29; 95% confidence interval [CI], 2.82-3.84), gonorrhea (IRR, 4.73; 95% CI, 3.90-5.57), syphilis (IRR, 4.28; 95% CI, 3.47-5.29), and HIV (IRR, 2.76; 95% CI, 2.24-3.39) compared with the lowest quintile. When including drug arrests, the second (IRR, 1.19; 95% CI, 1.03-1.38) and the third (IRR, 1.20; 95% CI, 1.02-1.41) highest quintile block groups had lower IRR for reported rates of chlamydia, indicating that drug arrests mediated the prostitution arrest effect. CONCLUSIONS These findings inform public health agencies and community-based organizations that conduct outreach in these areas to expand their efforts to include harm reduction and HIV/STI testing for both sex workers and individuals experiencing substance use disorder. Another implication of these data is the importance of greater collaboration in public health and policing efforts to address overlapping epidemics that engage both health and legal interventions.
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Affiliation(s)
- Lauren A. Magee
- Indiana University Purdue University Indianapolis, O’Neill School of Public and Environmental Affairs, 801 W. Michigan Street, Indianapolis, IN, 46204
| | - J. Dennis Fortenberry
- Indiana University School of Medicine, Department of Adolescent Medicine, 410 W. 10 Street, Suite 1000, Indianapolis, IN, 46204
| | - Tammie Nelson
- Marion County Public Health Department, 3838 N. Rural Street, Indianapolis, IN 46205
| | - Alexis Roth
- Drexel University, Dornsife School of Public Health, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104
| | - Janet Arno
- Indiana University School of Medicine, Clinical Medicine, 640 Eskenazi Ave, Indianapolis, IN 46202
| | - Sarah E. Wiehe
- Indiana University School of Medicine, Department of Pediatrics, 410 W. 10 Street, Suite 2000, Indianapolis, IN, 46204
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8
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Silberzahn BE, Tomko CA, Clouse E, Haney K, Allen ST, Galai N, Footer KHA, Sherman SG. The EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) Study: Protocol for the Design, Implementation, and Evaluation of a Community-Based Combination HIV Prevention Intervention for Female Sex Workers in Baltimore, Maryland. JMIR Res Protoc 2021; 10:e23412. [PMID: 33861210 PMCID: PMC8087969 DOI: 10.2196/23412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 12/25/2022] Open
Abstract
Background Cisgender female sex workers (FSWs) experience high rates of HIV and sexually transmitted infections (STIs), including chlamydia and gonorrhea. Community empowerment–based responses to the risk environment of FSWs have been associated with significant reductions in HIV and STI risk and associated risk behaviors; however, evaluations of US-based interventions targeting FSWs are limited. Objective The objective of this study is to describe the design, implementation, and planned evaluation strategy of an ongoing comprehensive community-level intervention in Baltimore City, Maryland, which aims to improve HIV and STI risk and cumulative incidence among FSWs. The two intervention components are the SPARC (Sex Workers Promoting Action, Risk Reduction, and Community Mobilization) drop-in center and the accompanying comprehensive mobile outreach program. The mission of SPARC is to provide low-barrier harm reduction services to FSWs, with a special focus on women who sell sex and use drugs. Services are provided through a harm reduction framework and include reproductive health and sexual health care; medication-assisted treatment; legal aid; counseling; showers, lockers, and laundry; and the distribution of harm reduction tools, including naloxone and sterile drug use supplies (eg, cookers, cotton, syringes, and pipes). Methods The SPARC intervention is being evaluated through the EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) study, which consists of a prospective 2-group comparative nonrandomized trial (n=385), a cross-sectional survey (n=100), and in-depth interviews assessing SPARC implementation (n=45). Participants enrolled in the nonrandomized trial completed a survey and HIV and STI testing at 4 intervals (baseline and 6, 12, and 18 months). Participants recruited from predefined areas closest to SPARC comprised the intervention group, and participants from all other areas of Baltimore were included in the control group. Results We hypothesize that addressing structural drivers and more immediate medical needs, in combination with peer outreach, will improve the HIV and STI risk environment, leading to community empowerment, and reduce the HIV and STI cumulative incidence and behavioral risks of FSWs. Data collection is ongoing. A baseline description of the cohort is presented. Conclusions In the United States, structural interventions aimed at reducing HIV and STIs among FSWs are scarce; to our knowledge, this is the first intervention of its kind in the United States. The results of the EMERALD study can be used to inform the development of future interventions targeting FSWs and other at-risk populations. Trial Registration ClinicalTrials.gov NCT04413591; https://clinicaltrials.gov/ct2/show/NCT04413591. International Registered Report Identifier (IRRID) DERR1-10.2196/23412
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Affiliation(s)
- Bradley E Silberzahn
- Department of Sociology, The University of Texas at Austin, Austin, TX, United States
| | - Catherine A Tomko
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emily Clouse
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Haney
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sean T Allen
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine H A Footer
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Susan G Sherman
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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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.
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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
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10
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Glick JL, Russo R, Jivapong B, Rosman L, Pelaez D, Footer KHA, Sherman SG. The PrEP Care Continuum Among Cisgender Women Who Sell Sex and/or Use Drugs Globally: A Systematic Review. AIDS Behav 2020; 24:1312-1333. [PMID: 31807973 DOI: 10.1007/s10461-019-02733-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HIV prevalence among cisgender female sex workers (FSW) and/or women who use drugs (WWUD) is substantially higher compared to similarly aged women. Consistent with PRISMA guidelines, we conducted the first systematic review on the pre-exposure prophylaxis (PrEP) continuum among FSW and/or WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting a PrEP related result among FSW and/or WWUD aged 18 + ; peer-reviewed; and published in English between 2012 and 2018. Our search identified 1365 studies; 26 met eligibility requirements, across the following groups: FSW (n = 14), WWUD (n = 9) and FSW-WWUD (n = 3). Studies report on at least one PrEP outcome: awareness (n = 12), acceptability (n = 16), uptake (n = 4), and adherence (n = 8). Specific barriers span individual and structural levels and include challenges to daily adherence, cost, and stigma. Combining health services and long-acting PrEP formulas may facilitate better PrEP uptake and adherence. The limited number of studies indicates a need for more research.
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11
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Ibragimov U, Beane S, Friedman SR, Komro K, Adimora AA, Edwards JK, Williams LD, Tempalski B, Livingston MD, Stall RD, Wingood GM, Cooper HLF. States with higher minimum wages have lower STI rates among women: Results of an ecological study of 66 US metropolitan areas, 2003-2015. PLoS One 2019; 14:e0223579. [PMID: 31596890 PMCID: PMC6785113 DOI: 10.1371/journal.pone.0223579] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022] Open
Abstract
Prior research has found that places and people that are more economically disadvantaged have higher rates and risks, respectively, of sexually transmitted infections (STIs). Economic disadvantages at the level of places and people, however, are themselves influenced by economic policies. To enhance the policy relevance of STI research, we explore, for the first time, the relationship between state-level minimum wage policies and STI rates among women in a cohort of 66 large metropolitan statistical areas (MSAs) in the US spanning 2003-2015. Our annual state-level minimum wage measure was adjusted for inflation and cost of living. STI outcomes (rates of primary and secondary syphilis, gonorrhea and chlamydia per 100,000 women) were obtained from the CDC. We used multivariable hierarchical linear models to test the hypothesis that higher minimum wages would be associated with lower STI rates. We preliminarily explored possible socioeconomic mediators of the minimum wage/STI relationship (e.g., MSA-level rates of poverty, employment, and incarceration). We found that a $1 increase in the price-adjusted minimum wage over time was associated with a 19.7% decrease in syphilis rates among women and with an 8.5% drop in gonorrhea rates among women. The association between minimum wage and chlamydia rates did not meet our cutpoint for substantive significance. Preliminary mediation analyses suggest that MSA-level employment among women may mediate the relationship between minimum wage and gonorrhea. Consistent with an emerging body of research on minimum wage and health, our findings suggest that increasing the minimum wage may have a protective effect on STI rates among women. If other studies support this finding, public health strategies to reduce STIs among women should include advocating for a higher minimum wage.
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Affiliation(s)
- Umedjon Ibragimov
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- * E-mail:
| | - Stephanie Beane
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Samuel R. Friedman
- National Development and Research Institutes Inc, New York, NY, United States of America
| | - Kelli Komro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Adaora A. Adimora
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jessie K. Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States of America
| | - Barbara Tempalski
- National Development and Research Institutes Inc, New York, NY, United States of America
| | - Melvin D. Livingston
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Ronald D. Stall
- Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Gina M. Wingood
- Department of Sociomedical Sciences, Columbia University, New York, NY, United States of America
| | - Hannah L. F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Sherman SG, Park JN, Galai N, Allen ST, Huettner SS, Silberzahn BE, Decker MR, Poteat TC, Footer KHA. Drivers of HIV Infection Among Cisgender and Transgender Female Sex Worker Populations in Baltimore City: Results From the SAPPHIRE Study. J Acquir Immune Defic Syndr 2019; 80:513-521. [PMID: 30649029 DOI: 10.1097/qai.0000000000001959] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine and compare risk factors for HIV infection among cisgender female sex workers (CFSWs) and transgender female sex workers (TFSWs). DESIGN Baseline data from a cohort study (SAPPHIRE) of street-based CFSW and TFSW in Baltimore, MD. METHODS Women were queried about individual (eg, drug use), interpersonal (eg, sexual abuse), and structural (eg, housing) risk factors and questioned on their sex work risk environment. Women were tested for HIV/sexually transmitted infections. We used logistic regression to identify key risk factors for prevalent HIV in each population. RESULTS We recruited 262 CFSW and 62 TFSW between 2016 and 2017. Compared with TFSW, CFSW were more likely to be white (66% vs. 0%), recently homeless (62% vs. 23%, P < 0.001), regularly gone to sleep hungry (54% vs. 16%, P < 0.001), and to inject drugs (71% vs. 4%, P < 0.001). HIV prevalence was 8 times greater in TFSW than in CFSW (40% vs. 5%, P < 0.001). All participants reported high rates of lifetime physical and sexual violence. Cocaine injection [adjusted odds ratio (aOR) = 3.65, 95% confidence interval (CI): 1.12 to 11.88], food insecurity (aOR = 1.92, 95% CI: 1.22 to 3.04), and >5 years in sex work (aOR = 5.40, 95% CI: 2.10 to 13.90) were independently associated with HIV among CFSW. Childhood sexual abuse (aOR = 4.56, 95% CI: 1.20 to 17.32), being in sex work due to lack of opportunities (aOR = 4.81, 95% CI: 1.29 to 17.90), and >5 years in sex work (aOR = 5.62, 95% CI: 1.44 to 21.85) were independently associated with HIV among TFSW. CONCLUSIONS Although distinct, both populations share a history of extensive childhood abuse and later life structural vulnerability, which drive their engagement in street-based sex work and their HIV risk profiles.
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Affiliation(s)
- Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noya Galai
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, University of Haifa, Haifa, Israel
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Steve S Huettner
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Bradley E Silberzahn
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michele R Decker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tonia C Poteat
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine H A Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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13
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Salazar M, Brouwer KC, Rocha-Jimenez T, Boyce S, Staines-Orozco H, Silverman JG. Substance Use among Female Sex Workers in Two US-Mexico Border Cities: Associations with Age of Entry. Subst Use Misuse 2018; 54:868-871. [PMID: 30595074 PMCID: PMC6474790 DOI: 10.1080/10826084.2018.1517367] [Citation(s) in RCA: 2] [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] [Indexed: 10/27/2022]
Abstract
BACKGROUND Research has documented consistent associations between entry into sex work as a minor and sexual HIV risk. However, previous studies have not examined whether substance use and related HIV risk are elevated among those who enter sex work under age 18. METHODS Quantitative data were collected via time-location sampling of 603 female sex workers (FSWs) ages 18 years and older residing in two Mexico-US border cities. Age of entry into sex work (categorized as 15 years or younger, 16-17 years, or 18 years and older) was assessed as a predictor of substance use (forced and voluntary) within the first month post-entry and recent (past 30 days) substance use with clients. RESULTS Compared to those who entered as adults, participants who entered sex work at age 15 or younger were significantly more likely to report drug use (AOR = 5.2, CI = 2.9-8.9) and forced drug use within the first 30 days of entry (AOR= 6.0, CI = 1.9-18.9), as well as past month drug use with clients (AOR= 3.4, CI = 1.9-5.8). Similar results were found among participants who entered sex work at age 16-17. CONCLUSIONS Increased risk of recent substance use with clients indicates continuing elevated risk for those entering sex work at these early ages. Early and forced substance use at entry may underlie the elevated risk of HIV infection consistently observed among this population.
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Affiliation(s)
- Marissa Salazar
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
- Graduate School of Public Health, San Diego State University, 5500 Campanille Drive San Diego, CA, USA
- Center for Innovative Public Health Research, 555 N. El Camino Real #A347 San Clemente, CA, USA
| | - Kimberly C. Brouwer
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
| | - Teresita Rocha-Jimenez
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
- Graduate School of Public Health, San Diego State University, 5500 Campanille Drive San Diego, CA, USA
| | - Sabrina Boyce
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
| | - Hugo Staines-Orozco
- Universidad Autónoma de Ciudad Juárez, School of Medicine, Av. Plutarco Elías Calles 1210,Fovissste Chamizal, Ciudad Juárez, Chihuahua, México
| | - Jay G. Silverman
- Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA, USA
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Yu YJ, McCarty C, Wang B. Network and Individual Factors Associated with Drug Use among Female Sex Workers (FSWs) in Southern China: A Mixed-Method Approach. Subst Use Misuse 2018; 53:1763-1770. [PMID: 29461126 DOI: 10.1080/10826084.2018.1432650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Research on women who engage both in drug use and sex work has been limited, as most previous studies have focused on these risk behaviors separately. The current study examines the network properties as well as the demographic and behavioral factors associated with drug use among female sex workers (FSWs) in southern China. We collected survey data (n = 175) in the Hainan province during our 26 months of ethnographic fieldwork in China. Our analyses included Fisher's exact chi-square tests, independent-samples t-tests, Mann-Whitney U, binary logistic regression (LR), as well as ethnographic data analysis. Multivariate analysis showed that women who were younger age, single, more educated, and earning a higher income were more likely to use drugs. Pertaining to network properties, FSWs with a lower percentage of long-term clients (and men) in ego networks were more likely to use drugs; this would imply a mechanism by which drug-using FSWs are more at risk, as the women take a greater number of transient clients. In addition, FSWs who were influential network members (i.e., higher betweenness centrality) and were closely related to other network members (i.e., higher closeness centrality) were more likely to use drugs; this may suggest that drug use is a means of sustaining the high functionality of the workers. Our ethnographic data also showed that club drug use was easily accessible in entertainment venues and was often a means of socialization in FSW communities. Network characteristics correlated to HIV-related risks among FSWs should be further examined in future studies.
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Affiliation(s)
- Yeon Jung Yu
- a Department of Anthropology , Western Washington University , Bellingham , Washington , USA
| | - Christopher McCarty
- b Bureau of Economic and Business Research, University of Florida , Gainesville , Florida , USA
| | - Bo Wang
- c Departments of Quantitative Health Sciences and Emergency Medicine , The University of Massachusetts Medical School , Worcester , Massachusetts , USA
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15
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Roth A, Tran NK, Chavis M, Van Der Pol B. Examining unmet needs: a cross-sectional study exploring knowledge, attitudes and sexually transmitted infection screening preferences among persons who inject drugs in Camden, New Jersey. Sex Transm Infect 2018; 94:598-603. [PMID: 29960982 DOI: 10.1136/sextrans-2017-053498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/24/2018] [Accepted: 06/07/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To inform the development of targeted sexually transmitted infection (STI) control programmes for persons who inject drugs (PWID). METHODS We recruited 116 PWID (aged ≥ 18 years) from a community-based syringe exchange programme (SEP) and assessed their STI knowledge and screening preferences via technology assisted self-interview. We estimated prevalence of STI transmission knowledge, attitudes and screening preferences as well as the association between reported sexual behaviours (past 6 months) and willingness to self-collect specimens. RESULTS Participants were white (77%), female (51%) and heterosexual (77%). STI knowledge regarding transmission and testing was high among the sample. More than 70% of participants were aware extragenital infections were possible and were least likely to know urine tests do not detect rectal infections (40.9%). Site-specific specimen collection was highly reflective of reported sexual behaviour. PWID who reported receptive sex (36% vs 5%, p<0.01) and insertive anal sex (31% vs 6%, p=0.01) were more likely to collect rectal specimens than those who did not. A similar trend was seen for oral sex performance on men and self-collection of oropharyngeal swabs (15% vs 3%, p=0.04). In addition, participants preferred collecting their own sample to having a clinician collect it for them (69% vs 31%, p<0.01) and testing at the SEP compared with a STI clinic (86% vs 14%, p<0.01). CONCLUSION Our findings suggest site-specific specimen collection may be a proxy for risk behaviour engagement in this fairly knowledgeable high-risk population. To increase case finding, STI control programmes should educate patients about site-specific screening and pair outreach with the infrastructure provided by SEPs, in settings where these programmes exist.
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Affiliation(s)
- Alexis Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Nguyen Khai Tran
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Martha Chavis
- Camden Area Health Education Center, Camden, NJ, USA
| | - Barbara Van Der Pol
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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16
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Sherman SG, Hast M, Park JN, Decker MR, Flynn C, German D. Correlates of exchange sex among a population-based sample of low-income women who have heterosexual sex in Baltimore. AIDS Care 2018. [PMID: 29519143 DOI: 10.1080/09540121.2018.1447078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sex exchange is associated with HIV and other morbidities yet has received little research, surveillance, and programmatic attention in the U.S. This study identified correlates of exchange sex and among low-income women in Baltimore, Maryland. Participants were recruited into the National HIV Behavioral Surveillance (NHBS) system in 2013 using respondent driven sampling (RDS) and completed a survey and HIV testing. The analytic sample (n = 253) consisted of women aged ≥18 years who had recent (past year) heterosexual sex. Multivariable logistic regression identified correlates of recent exchange sex. Independently associated with recent exchange sex were history of injection drug use (adjusted odds ratio (AOR) = 3.4, 95% CI: 1.1-10.3), recent prescription painkiller use (AOR = 3.7, 95% CI: 1.4-9.9), recent crack/cocaine use (AOR = 6.6, 95% CI: 2.1-20.9), recent arrest (AOR = 4.1, 95% CI: 1.2-14.8), and recent consistent condom use (AOR 1.1; 95% CI: 1.0-1.3). Women who exchanged sex exhibited heightened social and structural vulnerability and substance use. These data demonstrate the need for further research examining the context of exchange sex among low-income women and synergies between substance use and HIV risk.
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Affiliation(s)
- Susan G Sherman
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Marisa Hast
- b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ju Nyeong Park
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Michele R Decker
- c Department of Population, Family and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Colin Flynn
- d Center for HIV Surveillance, Epidemiology and Evaluation, Maryland Department of Health , Baltimore , MD , USA
| | - Danielle German
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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17
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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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18
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Chen B, Zhu Y, Guo R, Ding S, Zhang Z, Cai H, Zhu H, Wen Y. HIV/AIDS-related knowledge awareness and risk behaviors among injection drug users in Maanshan, China: a cross-sectional study. BMC Public Health 2016; 16:97. [PMID: 26831139 PMCID: PMC4736619 DOI: 10.1186/s12889-016-2786-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/26/2016] [Indexed: 02/03/2023] Open
Abstract
Background Unsafe injection practices significantly increase the risk of human immunodeficiency virus (HIV) infection among injection drug users (IDUs). Little is known about how demographic characteristics of IDUs are linked to HIV-related risk behaviors in the central regions of China. Methods A cross-sectional survey was conducted at Mandatory Detoxification Centers (MDCs) and the community in Maanshan, China. Results Of the 916 IDUs, 96.4 % reported a history of heroin use during the past year, 93.4 % had HIV/AIDS knowledge, 16.8 % reported receptive syringe sharing and 12.2 % reported inconsistent condom use in commercial sex in the past year. Unsafe injection practice was associated with increased odds of minority ethnicity, lower level of education, and no peer education in the past year. Unsafe sex practice was associated with increased odds of being single, 18–30 years of age, non-local residence, and history of methamphetamine use in the past year. Conclusions Integrated interventions to promote safe injection and protected commercial sex practices targeting IDUs must also consider individual and socio-environmental factors.
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Affiliation(s)
- Baifeng Chen
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
| | - Yu Zhu
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
| | - Rui Guo
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
| | - Shushu Ding
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
| | - Zhen Zhang
- Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao, Maanshan, Anhui Province, 241000, China.
| | - Huaying Cai
- Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao, Maanshan, Anhui Province, 241000, China.
| | - Hongbin Zhu
- Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao, Maanshan, Anhui Province, 241000, China.
| | - Yufeng Wen
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
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Krasnoselskikh TV, Mikheev GN, Grigorian AE, Yastrebov VV, Sokolovskiy EV. A case of tertiary syphilis manifested with multiple skin gummas. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-2-84-93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The tertiary cutaneous syphilis has become extremely rare as a result of the effective treatment of early syphilis with penicillin and occasional antibiotic therapy for concomitant infections. We report a case of tertiary gummatous syphilis associated with asymptomatic neurosyphilis that was initially misdiagnosed as basal cell carcinoma of the skin. A 67-year-old woman presented with the 18-month history of multiple, firm, bluish-red asymptomatic nodes on the parietal scalp, chin and lateral part of the trunk that had developed without preceding trauma. One node on the trunk had small central ulceration covered with dry yellowish crust. On the left retroauricular area the brownish-purple atrophic scar was observed. Blood tests revealed reactive VDRL, ELISA and TPHA assays. Skin biopsy has showed endarteritis with endothelial swelling and caseating granulomas along with plasmocytic infiltrate in the dermis and subcutaneous tissue. Increased lymphocyte count and the positive VDRL test with cerebrospinal fluid have confirmed the diagnosis of asymptomatic syphilitic meningitis in this patient. The treatment with aqueous penicillin intravenously has lead to resolution of the skin infiltrates and progressive more than 4-fold reduction of follow-up serum VDRL titers. This case is reported as a reminder of the possibility of tertiary syphilis with misleading clinical patterns in patients infected during the epidemics of 1995-2000. We would like to emphasize the necessity to perform timely serological and pathomorphological study to prevent misdiagnosis and mistreatment.
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Shimelis T, Lemma K, Ambachew H, Tadesse E. Syphilis among people with HIV infection in southern Ethiopia: sero-prevalence and risk factors. BMC Infect Dis 2015; 15:189. [PMID: 25884178 PMCID: PMC4406018 DOI: 10.1186/s12879-015-0919-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/31/2015] [Indexed: 11/21/2022] Open
Abstract
Background Syphilis facilitates both HIV (human immunodeficiency virus) transmission and acquisition, reflecting the complex interplay between the two infections. Scarce information exists regarding syphilis epidemiology in Ethiopian context. Thus, this study determined the sero-prevalence of syphilis and associated risk factors in people with HIV infection. Methods A cross-sectional study was conducted at Hawassa Referral Hospital, southern Ethiopia from January to May, 2014. A consecutive 993 HIV–infected participants were studied; but individuals under 15 years of age or treated for syphilis or those with a CD4+ T–cell count below 50 cells/μl were excluded. Structured questionnaires were used to collect data on socio-demography and potential risk factors for syphilis. Moreover, blood samples were collected from all participants and screened for syphilis using rapid plasma reagin (RPR) test, and those found sero-positive were confirmed using treponema pallidum haemagglutination assay (TPHA). Results The sero-prevalence of syphilis was found to be 7.3% (95% CI 5.7– 9%). The rate of infection was significantly higher among participants who were ART (antiretroviral therapy) naive (odds ratio (OR) = 2.2; 95% CI 1.22 – 4.1), men (OR = 2.2; 95% CI 1.22 – 3.87), older than 50 years of age (OR = 3.9; 95% CI 1.45 – 6.94), had only primary school level education (OR = 7.8; 95% CI 2.63 – 23.2) and had a history of blood transfusion (OR = 3.9; 95% CI 1.5 – 10.4). Conclusion The high prevalence of syphilis among HIV-infected population warrants integrating syphilis screening with HIV care to limit the clinical consequences of untreated syphilis as well as its adverse impact on HIV transmission.
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Affiliation(s)
- Techalew Shimelis
- Department of Medical Laboratory Science, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
| | - Kinfe Lemma
- Department of Internal Medicine, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
| | - Henock Ambachew
- Department of Medical Laboratory Science, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
| | - Endale Tadesse
- Department of Medical Laboratory Science, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
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Pines HA, Rusch ML, Vera A, Rangel G, Magis-Rodriguez C, Strathdee SA. Incident syphilis infection among people who inject drugs in Tijuana, Mexico. Int J STD AIDS 2015; 26:1022-7. [PMID: 25614523 DOI: 10.1177/0956462414568394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/22/2014] [Indexed: 11/16/2022]
Abstract
Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via respondent-driven sampling and followed for 18 months. At semi-annual visits, participants were tested for syphilis and completed surveys, which collected information on socio-demographics, sexual behaviours, substance use and injection behaviours. Poisson regression was used to estimate syphilis incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Twenty-one participants acquired syphilis during follow-up (IR = 1.57 per 100 person-years, 95% CI: 1.02-2.41). In a multivariate analysis, syphilis incidence was higher among women (IRR = 3.90, 95% CI: 1.37-11.09), HIV-positive participants (IRR = 4.60, 95% CI: 1.58-13.39) and those who reported ever exchanging sex for drugs, money, or other goods (IRR = 2.74, 95% CI: 0.97-7.76), while syphilis incidence was lower among those living in Tijuana for a longer duration (IRR = 0.95 per year, 95% CI: 0.91-1.00) and those reporting at least daily injection drug use (past 6 months) (IRR = 0.22, 95% CI: 0.09-0.54). Our findings suggest interventions that address the destabilising conditions associated with migration and integrate sexual and drug-related risk reduction strategies may help reduce syphilis incidence among PWID along the Mexico-US border.
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Affiliation(s)
- Heather A Pines
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Melanie L Rusch
- University of Victoria, School of Public Health and Social Policy, Victoria, BC, Canada Vancouver Island Health Authority, Victoria, BC, Canada
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Gudelia Rangel
- Department of Population Studies, El Colegio de La Frontera Norte, Tijuana, Baja California, Mexico
| | - Carlos Magis-Rodriguez
- Research Center for Sexually Transmitted Infections, HIV/AIDS Program of Mexico City, Mexico
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
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Tang Z, Zhang C, Li X, Liu Y, Su S, Zhou Y, Shen Z. HIV risk among female sex workers with different patterns of drug use behaviors in Southwest China: a cross-sectional study. AIDS Care 2014; 27:293-300. [PMID: 25407357 DOI: 10.1080/09540121.2014.980214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although many researchers found that drug use behaviors significantly increased HIV risk, few of them investigated the association between HIV risk and different drug use behaviors among female sex workers (FSWs) in China. The current study examines demographic and behavioral risk factors as well as the infections of HIV, syphilis, and among a subgroup of FSWs who are injection drug users (IDU) or noninjection drug users (NIDU) in comparison to Hepatitis C Virus (HCV) nondrug users (non-DU). We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSWs recruited from Guangxi, China. The Guangxi 2010 NSS sample included 2.6% NIDU and 0.5% IDU. Compared to non-DU, IDU were more likely to report no condom use in the last sex act (aOR = 3.25, 95%CI = 1.65, 6.40), inconsistent condom use in the past month (aOR = 4.88, 95%CI = 2.66, 8.96), having an HIV testing (aOR = 2.48, 95%CI = 1.34, 4.58), infections of HIV (aOR = 42.60, 95%CI = 9.45, 192.06), syphilis (aOR = 4.13, 95%CI = 1.86, 9.16), and HCV (aOR = 74.54, 95%CI = 30.26, 183.61). NIDU had 2.89 times higher than non-DU to report a history of sexually transmitted disease and 26% less likely to report inconsistent condom use in the past month (p < 0.05). We called for tailored, accessible, and nonjudgmental drug treatments coupled with effective sexual risk reduction interventions to help FSWs with various drug use problems to reduce their vulnerability and susceptibility of HIV risk in China as well as other cultural settings.
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Affiliation(s)
- Zhenzhu Tang
- a Guangxi Center for Disease Control and Prevention , Nanning , China
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Servin AE, Strathdee S, Muñoz FA, Vera A, Rangel G, Silverman JG. Vulnerabilities faced by the children of sex workers in two Mexico-US border cities: a retrospective study on sexual violence, substance use and HIV risk. AIDS Care 2014; 27:1-5. [PMID: 25117749 PMCID: PMC4221409 DOI: 10.1080/09540121.2014.946384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Abstract
Most studies of female sex workers (FSWs) conducted in the Mexico-US border region have focused on individual HIV risk, centered on sexual behaviors and substance abuse patterns. Little attention has been drawn to the reality that sex workers are often parents whose children potentially face vulnerabilities unique to their family situation. The objective of the present study was to identify the vulnerabilities faced by the children of FSWs in two Mexican-US border cities. From 2008 to 2010, 628 FSW-injection drug users underwent interviewer-administered surveys and HIV/STI testing. Approximately one in five participants (20%) reported having a parent involved in sex work and majority referred it was their mother (88%). Close to one-third of participants (31%) reported first injecting drugs <18 years of age, and 33% reported they began working regularly as a prostitute <18 years of age. First drinking alcohol <18 years old (AOR = 1.87, 95%CI: 1.13-3.08), lifetime cocaine use (AOR = 1.76, 95%CI: 1.09-2.84), ever being forced or coerced into non-consensual sex as a minor (<18 years of age; AOR = 1.54, 95%CI: 1.01-2.35), and injecting drugs with used syringes in the prior month (AOR = 1.63, 95%CI: 1.07-2.49) were the factors associated with having had a parent involved in sex work. These findings begin to lay the groundwork for understanding the potential vulnerabilities faced by the children of sex workers. Understanding these potential needs is necessary for creating relevant, evidence-based interventions focused on supporting these women.
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Affiliation(s)
- Argentina E Servin
- a Department of Medicine, Division of Global Public Health , University of California , San Diego , CA , USA
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Medhi GK, Mahanta J, Hazarika I, Armstrong G, Adhikary R, Mainkar M, Paranjape RS. Syphilis infection among female sex workers in Nagaland, Northeast India: analysing their vulnerability to the infection. Int J STD AIDS 2013; 24:193-7. [PMID: 23514833 DOI: 10.1177/0956462412472427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper describes the sex work characteristics and factors associated with syphilis among female sex workers (FSWs) in Dimapur district of high HIV prevalence Indian state, Nagaland. The study recruited 426 FSWs in 2006 using respondent-driven sampling. The prevalence of syphilis was 21.1% and HIV prevalence was 11.7%. Approximately half were under 25 years of age. Clients were solicited mainly in public places (32.7%), while hotels/lodges/rented rooms were the most common places of entertainment (57.2%). Condom use during the last sex was 36.5% with occasional and 27% with regular clients. Being married, being widowed/divorced/separated, being illiterate or having a history of drug use increased the likelihood of syphilis infection. Entertaining clients in bars/booze joints decreased the probability of syphilis. FSWs who moved between soliciting in public places or bars/booze joints and then entertaining in hotels/lodges/rented rooms had a higher vulnerability to syphilis. In summary, we found that the vulnerability to syphilis among mostly young FSWs in Dimapur varied according to their sex work characteristics, marital and educational status and drug use habits. They may be more vulnerable to HIV and sexually transmitted infections (HIV/STIs) due to the low rate of condom use. The findings have direct implications for HIV/STI prevention programmes in Northeast India.
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Affiliation(s)
- G K Medhi
- Regional Medical Research Centre, NE Region, Indian Council of Medical Research, Dibrugarh, Assam, India
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25
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Fazito E, Cuchi P, Mahy M, Brown T. Analysis of duration of risk behaviour for key populations: a literature review. Sex Transm Infect 2013; 88 Suppl 2:i24-32. [PMID: 23172343 PMCID: PMC3512397 DOI: 10.1136/sextrans-2012-050647] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The objective of this paper is to review literature in order to calculate regional estimates of the average duration of time individuals maintain a specific high-risk behaviour. Methods The review targeted the key populations of female sex workers (FSW), male clients of female sex workers (MCFSW), people who inject drugs (injecting drug users (IDU)) and high-risk men who have sex with men (MSM). To be included in the review the study had to provide information on (1) the time a person spent at risk until death or cessation of the risk behaviour, (2) the percentage of the sample who initiated the risk behaviour in less than a year or (3) the mean or median duration of the behaviour from a representative sample. Results 49 papers were found for the FSW population describing the period of time FSW stay in sex work to be between 2.9 years (Asia) and 12 years (Latin America). Eight papers were found for MCFSW showing the duration of the risk behaviour in this category varying from 4.6 years in Africa to 32 years in Asia. 86 papers were reviewed for the population of IDU showing that the average time a person injects illegal drugs varies from 5.6 years (Africa) to 21 years (South America). No information was found for duration of high-risk behaviour among MSM; instead, the definitions found in the literature for high- and low-risk behaviour among MSM were described. Conclusions There is high variability of estimates of duration of high-risk behaviours at regional level. More research is needed to inform models and prevention programmes on the average duration of time individuals maintain a specific high-risk behaviour.
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Affiliation(s)
- Erika Fazito
- University of Brasília, 26 Chemin Colladon, 1209 Genève, Suisse, Brasília, Brazil.
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26
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Chen Y, Li X, Zhou Y, Wen X, Wu D. Perceived peer engagement in HIV-related sexual risk behaviors and self-reported risk-taking among female sex workers in Guangxi, China. AIDS Care 2013; 25:1114-21. [PMID: 23316998 DOI: 10.1080/09540121.2012.750709] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Searching for modifiable perceptions that are associated with sexual risk behaviors among female sex workers (FSWs) are considered a priority in HIV/sexually transmitted disease preventions. Perception of peers' involvement in risk behaviors, a key correlate of individual risk behaviors, has barely been studied among FSWs. A self-administered questionnaire was completed by 1022 FSWs in Guangxi, China, a country with rapid growth in both HIV epidemic and commercial sex. Multiple imputation using chained equation (MICE) was applied to handle missing values (1-10%) in the data-set. Regression analysis that focused on relationship between perceived peers' risk involvement and FSWs' risk-taking was performed on full data-sets generated by MICE. FSWs who perceived more peer alcohol use was significantly more likely to have sex under the influence of alcohol. Those who perceived more unprotected sex among peers had a higher likelihood to use condom inconsistently with both stable and casual partners. Perceiving more peers engaging in sex after using alcohol was positively associated with having sex with clients who were intoxicated and/or high on drugs, and with having sex under the influence of alcohol. Perceived peer promiscuity, defined as having sex with any types of clients at any price offered, was positively associated with inconsistent condom use with casual partners, but negatively associated with having sex under the influence of alcohol. These data suggest that the potential for intervention programs to address behavioral change among FSWs through modifying perceptions of peer involvement in sexual risk behaviors. Longitudinal studies are needed to confirm these findings and qualitative researches will be essential for the clarification of mechanisms behind associations found in the current study and for the actual design of effective norm-based interventions among FSWs.
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Affiliation(s)
- Yiyun Chen
- a Carman and Ann Adams Department of Pediatrics, Prevention Research Center , Wayne State University School of Medicine , Detroit , MI , USA
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27
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Border crossing to inject drugs in Mexico among injection drug users in San Diego, California. J Immigr Minor Health 2012; 14:281-6. [PMID: 21442300 PMCID: PMC3163238 DOI: 10.1007/s10903-011-9462-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
We examined correlates of ever injecting drugs in Mexico among residents of San Diego, California. From 2007 to 2010, injecting drug users (IDUs) in San Diego underwent an interviewer-administered survey. Logistic regression identified correlates of injection drug use in Mexico. Of 302 IDUs, 38% were Hispanic, 72% male and median age was 37; 27% ever injected in Mexico; 43% reported distributive syringe sharing there. Factors independently associated with ever injecting drugs in Mexico included being younger at first injection, injecting heroin, distributive syringe sharing at least half of the time, and transporting drugs over the last 6 months. One-quarter of IDUs reported ever injecting drugs in Mexico, among whom syringe sharing was common, suggesting possible mixing between IDUs in the Mexico-US border region. Prospective studies should monitor trends in cross-border drug use in light of recent Mexican drug policy reforms partially decriminalizing drug possession.
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Systematic differences in risk behaviors and syphilis prevalence across types of female sex workers: a preliminary study in Liuzhou, China. Sex Transm Dis 2012; 39:195-200. [PMID: 22337106 DOI: 10.1097/olq.0b013e31823d2e2a] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Female sex workers (FSWs) have become one of the key populations for HIV/STI control in China. Categorization of FSWs can help prioritize HIV/STI intervention efforts. We examined 2 possible categorizations of FSWs and the relationship with syphilis infection risk in Liuzhou City, China. METHODS From October 2009 to February 2010, a total of 583 FSWs recruited by respondent-driven sampling in a cross-sectional survey were tested for syphilis and interviewed to collect sociodemographic and behavioral information. Respondents were categorized based on transaction price for vaginal sex and type of sex work location. The relationship between the 2 categorizations and syphilis infection risk was assessed using univariate and multivariate logistic regression analysis. RESULTS The prevalence rates of lifetime and active syphilis infection were 8.6% and 4.1%, respectively. Lifetime and active syphilis prevalence was higher among FSWs in the lowest price category (52.7% and 25.4%, respectively) and those working in streets (69.7% and 39.8%, respectively) or through telephone (46.3% and 17.0%, respectively). Multivariate analysis showed that lifetime syphilis prevalence was significantly higher among street- (adjusted odds ratio [AOR]: 38.7, 95% confidence intervals [CI]: 10.7-139.9) and telephone-based FSWs (AOR: 10.8, 95% CI: 3.3-35.1), and that active syphilis prevalence was significantly higher among street-based FSWs (AOR: 15.2, 95% CI: 3.7-62.1) after adjusting for demographic and behavioral factors. CONCLUSIONS Categorization based on sex work location was more closely related to the risk of syphilis infection than the price classification. Street- and telephone-based FSWs had significantly higher risk of syphilis infection. Focused interventions among these particular high-risk FSWs subgroups are warranted.
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29
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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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Sherman SG, Lilleston P, Reuben J. More than a dance: the production of sexual health risk in the exotic dance clubs in Baltimore, USA. Soc Sci Med 2011; 73:475-81. [PMID: 21724311 DOI: 10.1016/j.socscimed.2011.05.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/19/2011] [Accepted: 05/22/2011] [Indexed: 11/30/2022]
Abstract
Women who exchange sex for money, drugs, or goods are disproportionately infected with HIV and have high rates of illicit drug use. A growing body of research has underscored the primacy of environmental factors in shaping individual behaviors. HIV/STI rates among sex workers are influenced by environmental factors such as the physical (e.g., brothel) and economic (e.g., increased pay for unsafe sex) context in which sex work occurs. Exotic dance clubs (EDCs) could be a risk environment that is epidemiologically significant to the transmission of HIV/STIs among vulnerable women, but it is a context that has received scant research attention. This study examines the nature of the physical, social, and economic risk environments in promoting drug and sexual risk behaviors. Structured observations and semi-structured qualitative interviews (N = 40) were conducted with club dancers, doormen, managers, and bartenders from May through August, 2009. Data were analyzed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data analysis. Dancers began working in exotic dance clubs primarily because of financial need and lack of employment opportunities, and to a lesser extent, the need to support illicit drug habits. The interviews illuminated the extent to which the EDCs' physical (e.g., secluded areas for lap dances), economic (e.g., high earnings from dancers selling sex), and social (e.g., prevailing social norms condoning sex work) environments facilitated dancers' engaging in sex work. Drug use and alcohol use were reported as coping mechanisms in response to these stressful working conditions and often escalated sexual risk behaviors. The study illuminated characteristics of the environment that should be targeted for interventions.
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Affiliation(s)
- Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA.
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31
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Strathdee SA, Lozada R, Martinez G, Vera A, Rusch M, Nguyen L, Pollini RA, Uribe-Salas F, Beletsky L, Patterson TL. Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region. PLoS One 2011; 6:e19048. [PMID: 21541349 PMCID: PMC3081836 DOI: 10.1371/journal.pone.0019048] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/19/2011] [Indexed: 11/19/2022] Open
Abstract
Background FSWs who inject drugs (FSW-IDUs) can acquire HIV through high risk sexual and injection behaviors. We studied correlates of HIV infection among FSW-IDUs in northern Mexico, where sex work is quasi-legal and syringes can be legally obtained without a prescription. Methods FSW-IDUs>18 years old who reported injecting drugs and recent unprotected sex with clients in Tijuana and Ciudad Juarez underwent surveys and HIV/STI testing. Logistic regression identified correlates of HIV infection. Results Of 620 FSW-IDUs, prevalence of HIV, gonorrhea, Chlamydia, trichomonas, syphilis titers ≥1∶8, or any of these infections was 5.3%, 4%, 13%, 35%, 10% and 72%, respectively. Compared to other FSW-IDUs, HIV-positive women were more likely to: have syphilis titers ≥1∶8 (36% vs. 9%, p<0.001), often/always inject drugs with clients (55% vs. 32%, p = 0.01), and experience confiscation of syringes by police (49% vs. 28%, p = 0.02). Factors independently associated with HIV infection were syphilis titers ≥1∶8, often/always injecting with clients and police confiscation of syringes. Women who obtained syringes from NEPs (needle exchange programs) within the last month had lower odds of HIV infection associated with active syphilis, but among non-NEP attenders, the odds of HIV infection associated with active syphilis was significantly elevated. Conclusions Factors operating in both the micro-social environment (i.e., injecting drugs with clients) and policy environment (i.e., having syringes confiscated by police, attending NEPs) predominated as factors associated with risk of HIV infection, rather than individual-level risk behaviors. Interventions should target unjustified policing practices, clients' risk behaviors and HIV/STI prevention through NEPs.
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Affiliation(s)
- Steffanie A Strathdee
- Department of Medicine, School of Medicine, University of California San Diego, La Jolla, California, United States of America.
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32
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Wagner KD, Pollini RA, Patterson TL, Lozada R, Ojeda VD, Brouwer KC, Vera A, Volkmann TA, Strathdee SA. Cross-border drug injection relationships among injection drug users in Tijuana, Mexico. Drug Alcohol Depend 2011; 113:236-41. [PMID: 20889270 PMCID: PMC3025041 DOI: 10.1016/j.drugalcdep.2010.08.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 08/19/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND International borders are unique social and environmental contexts characterized by high levels of mobility. Among drug users, mobility increases risk for human immunodeficiency virus (HIV) in part through its effects on the social environment. However, the social dynamics of drug users living in border regions are understudied. METHODS 1056 injection drug users (IDUs) residing in Tijuana, Mexico were recruited using respondent-driven sampling (RDS) from 2006 to 2007, and underwent surveys and testing for HIV, syphilis, and tuberculosis (TB). Using logistic regression on baseline data, we identified correlates of having ever injected drugs with someone from the US. RESULTS Almost half (48%) reported ever injecting drugs with someone from the US. In RDS-adjusted logistic regression, factors independently associated with having ever injected with someone from the US included: having greater than middle school education (Adjusted Odds Ratio [AOR] 2.91; 95% confidence interval [C.I.] 1.52, 5.91), speaking English (AOR 3.24, 95% C.I. 1.96, 5.36), age (AOR 1.10 per year; 95% C.I. 1.07, 1.14), age at initiation of injection drug use (AOR 0.90 per year; 95% C.I. 0.86, 0.94), homelessness (AOR 2.61; 95% C.I. 1.27, 5.39), and having ever been incarcerated (AOR 11.82; 95% C.I., 5.22, 26.77). No associations with HIV, syphilis, TB, drug use, or injection risk behavior were detected. CONCLUSION Findings suggest that IDU networks in Mexico and the US may transcend international borders, with implications for cross-border transmission of infectious disease. Binational programs and policies need to consider the structure and geographic distribution of drug using networks.
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Affiliation(s)
- Karla D. Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Robin A. Pollini
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Thomas L. Patterson
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0680; La Jolla, California, 92093-0680, USA
| | - Remedios Lozada
- Pro-COMUSIDA, Niños héroes 697, Oficina 1 y 6, Zona Norte, Tijuana 22000-Baja California; Mexico
| | - Victoria D. Ojeda
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Kimberly C. Brouwer
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Tyson A. Volkmann
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Steffanie A. Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
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