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Medina-Perucha L, Family H, Scott J, Chapman S, Dack C. Factors Associated with Sexual Risks and Risk of STIs, HIV and Other Blood-Borne Viruses Among Women Using Heroin and Other Drugs: A Systematic Literature Review. AIDS Behav 2019; 23:222-251. [PMID: 30073636 PMCID: PMC6342849 DOI: 10.1007/s10461-018-2238-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This systematic literature review identified factors associated with sexual risks related to sexually transmitted infections (STI), HIV and other blood-borne viruses (BBV) among women using heroin and other drugs. The search strategy included five databases (PubMed, EMBASE, PsycNET, Web of Science, Scopus), and PsycEXTRA for grey literature. Out of the 12,135 publications screened, 30 peer-reviewed articles were included. Most publications were cross-sectional (n = 25), quantitative (n = 23) and included 11,305 women. Factors identified were: (1) socio-demographics; (2) gender roles and violence against women; (3) substance use; (4) transactional sex; (5) partner characteristics, partner's drug use, and context of sex; (6) preferences, negotiation and availability of condoms; (7) HIV status and STIs; (8) number of sexual partners; (9) love and trust; (10) reproductive health and motherhood; and (11) risk awareness and perception of control. Overall, this review highlights important implications for future research and practice, and provides evidence for developing STI/BBV preventive strategies.
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Affiliation(s)
- L Medina-Perucha
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK.
- 5 West, 2.52, Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK.
| | - H Family
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
| | - J Scott
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
| | - S Chapman
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
| | - C Dack
- Department of Psychology, University of Bath, Bath, UK
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A randomized controlled trial to evaluate the relative efficacy of the addition of a psycho-social intervention to standard-of-care services in reducing attrition and improving attendance among first-time users of methadone maintenance treatment in China. AIDS Behav 2013; 17:2002-10. [PMID: 23413126 DOI: 10.1007/s10461-012-0393-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although methadone maintenance treatment (MMT) is an important means of HIV control, MMT clinics commonly have high attrition rates. The randomized controlled trial investigated the relative efficacy of adding a psycho-social intervention to the standard-of-care MMT in reducing attrition and non-attendance among first-time newly admitted MMT users in China (n = 288). Social workers implemented this three-phase intervention that was based on a behavioral maintenance theory. It also involved participants' family members and rectified some MMT-related misconceptions. As compared to the control group, the intervention group showed significantly lower likelihood of attrition (HR = 0.55, 95% confidence interval 0.39-0.80), lower estimated probability of attrition at Month 12 (0.35 vs. 0.55), and higher median number of days of attendance (Month 6: 147 vs. 91 days, p < 0.001; end-date: 225 vs. 142 days, p < 0.001). Further psycho-social services and translational research are warranted.
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Xu JJ, Smith MK, Chu J, Ding GW, Chang DF, Sharp GB, Qian HZ, Lu L, Bi AM, Wang N. Dynamics of the HIV epidemic in southern China: sexual and drug-using behaviours among female sex workers and male clients in Yunnan. Int J STD AIDS 2013; 23:670-5. [PMID: 23033525 DOI: 10.1258/ijsa.2009.009128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To examine the HIV/sexually transmitted infection (STI)-related risk behaviours among community-based female sex workers (FSWs) and their clients in Yunnan Province, China, we performed a cross-sectional study of 705 FSWs and 100 male clients. We found that HIV seroprevalence among FSWs was 13.0% and the most prevalent STI was herpes simplex virus type 2 (HSV-2) (71.1%), followed by Chlamydia trachomatis (18.1%) and syphilis (8.8%). The 20% of FSWs who reported injection drug use also reported needle-sharing behaviours in the last three months. Drug-using FSWs had substantially higher HIV and HSV-2 prevalence, serviced more clients and had a longer history of sex work than non-using FSWs. In total, 57.0% of male clients did not consistently use condoms with FSWs, 2.0% reported illicit drug use and 17.0% had STI symptoms in the last year. The dual risk behaviours of drug-using FSWs and clients place them at greater risk of HIV infection. Intervention programmes must adopt comprehensive methods.
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Affiliation(s)
- J J Xu
- Key Laboratory of Immunology, 1st Hospital of China Medical University, Shenyang, Liaoning Province
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Syphilis and Methamphetamine Use Among Female Sex Workers in Shandong Province, China. Sex Transm Dis 2011; 38:57-62. [DOI: 10.1097/olq.0b013e3181ebb475] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gu J, Lau JTF, Chen X, Liu C, Liu J, Chen H, Wang R, Lei Z, Li Z. Using the Theory of Planned Behavior to investigate condom use behaviors among female injecting drug users who are also sex workers in China. AIDS Care 2010; 21:967-75. [PMID: 20024752 DOI: 10.1080/09540120802657548] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Female injecting drug users who are sex workers (IDUFSWs) is a strategic "bridge population" for HIV transmission. Goals of the study were to investigate condom use behaviors during commercial sex among IDUFSWs using the Theory of Planned Behavior (TPB), and to investigate moderating effects that modify the strength of associations between the TPB-related variables and inconsistent condom use during commercial sex. A total of 281 non-institutionalized IDUFSWs were recruited using snowball sampling method. Anonymous face-to-face interviews were administered by trained doctors. The results showed that the prevalence of inconsistent condom use during commercial sex in the last six months was 64%. After adjusting for some significant background variables (e.g. main venue of sex work), all associations between the five TPB-related variables and the studied condom use variable were statistically significant (Odds Ratio (OR) = 0.43-0.68, p<0.001). In the hierarchical nested models, three background variables (age, venue of sex work, and ever used HIV-related interventions) entered in the first step (-2LL = 294.98, p<0.001) and the Social Norm Scale, the Perceived Behavioral Control Scale and the Behavioral Intention Scale were selected by the second step (OR = 0.67 - 0.72, p<0.01; -2LL = 160.99, p<0.001). Significant moderating effects between some TPB-related variables (Positive Condom use Attitude Scale and Behavioral Intention Scale) and duration of sex work and duration of drug use were also reported. The results highlighted the potential of using the TPB to better understand condom use behaviors in IDUFSWs in China. Theory-based research and intervention work should be developed in China in the future.
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Affiliation(s)
- Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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Lu L, Zhao D, Bao YP, Shi J. Methadone Maintenance Treatment of Heroin Abuse in China. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 34:127-31. [DOI: 10.1080/00952990701876989] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ebenstein AY, Jennings E. Bare Branches, Prostitution, and HIV in China: A~Demographic Analysis. GENDER POLICY AND HIV IN CHINA 2009. [DOI: 10.1007/978-1-4020-9900-7_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Gu J, Wang R, Chen H, Lau JT, Zhang L, Hu X, Lei Z, Li Z, Cai H, Wang T, Tsui H. Prevalence of needle sharing, commercial sex behaviors and associated factors in Chinese male and female injecting drug user populations. AIDS Care 2008; 21:31-41. [DOI: 10.1080/09540120802068787] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jing Gu
- a Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
| | - Renfan Wang
- b Dazhou Center for Disease Control and Prevention , Dazhou , Sichuan , China
| | - Hongyao Chen
- b Dazhou Center for Disease Control and Prevention , Dazhou , Sichuan , China
| | - Joseph T.F. Lau
- a Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
| | - Linglin Zhang
- c Sichuan Provincial Center for Disease Control and Prevention , China
| | - Xianyou Hu
- b Dazhou Center for Disease Control and Prevention , Dazhou , Sichuan , China
| | - Zhangquan Lei
- b Dazhou Center for Disease Control and Prevention , Dazhou , Sichuan , China
| | - Zhenglin Li
- b Dazhou Center for Disease Control and Prevention , Dazhou , Sichuan , China
| | - Hua Cai
- b Dazhou Center for Disease Control and Prevention , Dazhou , Sichuan , China
| | - Tao Wang
- b Dazhou Center for Disease Control and Prevention , Dazhou , Sichuan , China
| | - Hiyi Tsui
- a Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
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Client-Perpetuated Violence and Condom Failure Among Female Sex Workers in Southwestern China. Sex Transm Dis 2008; 35:141-6. [DOI: 10.1097/olq.0b013e31815407c3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
A comprehensive literature review was conducted to determine if there was a research gap between women's vulnerability to HIV and research addressing that vulnerability in China. Türmen's article Gender and HIV/AIDS served as a framework for examining the eight determinants placing women and adolescent girls at greater risk of HIV infection than men. Eighty-eight research reports were retrieved and categorized by general characteristics and the eight determinants. Women were found to be more vulnerable than men to HIV infection in China and worldwide. While researchers reported a considerable amount of research regarding women's HIV/AIDS-related issues in China, there is insufficient attention to some risk determinants. Investigators are encouraged to take advantage of political commitment and policy changes in China to conduct more research focusing on female vulnerability and to address the effects of violence, laws, stigma, and discrimination in female HIV prevention.
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Affiliation(s)
- Keke Lin
- University of Illinois at Chicago, Chicago, IL 60612-7350, USA
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Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China. AIDS 2007; 21 Suppl 8:S115-22. [PMID: 18172379 DOI: 10.1097/01.aids.0000304706.79541.ef] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a needle social marketing strategy to reduce needle sharing and hepatitis C Virus (HCV)/HIV transmission among injecting drug users (IDU) in China. DESIGN Two-armed, prospective, community-randomized prevention trial. SETTING Four counties/townships in Guangxi and Guangdong provinces; one randomized to intervention the other to control in each province. PARTICIPANTS Injecting drug users: 823 (443 intervention, 382 control) at baseline and 852 (415 intervention, 407 control) at the second cross-sectional survey 12 months later. INTERVENTION A needle social marketing programme, including promotion of safe injection norms and increased access to clean needles over a 12 month period. MAIN OUTCOME MEASURES Cross sectional surveys at baseline and follow-up compared changes in drug using behaviours and HIV and HCV rates in the intervention and control communities. RESULTS Needle sharing behaviours were similar in the two groups at baseline (68.4 vs. 67.8%), and dropped significantly to 35.3% in the intervention community and remained relatively stable in the control community (62.3%; P < 0.001). In a subset of cohort of new injectors, the incidence of HCV was significant lower in intervention than in control in both provinces (P < 0.001, P = 0.014) and overall (P < 0.001) but HIV was only significantly lower in intervention in Guangdong (P = 0.011). CONCLUSION Needle social marketing can reduce risky injecting behaviour and HIV/HCV transmission among injecting drug users in China and should be expanded.
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Abstract
OBJECTIVE To analyze the extent by which Chinese female sex workers (FSWs) serve as vectors of HIV/AIDS to an otherwise spared general population and to describe the implications of centering efforts solely on this high-risk group. GOAL By using the example of FSWs in China, we intend to demonstrate the role that structural factors can have on HIV transmission above and beyond individual high-risk behaviors. STUDY DESIGN Literature review of years 1980-2006. RESULTS Analysis of the literature suggests that major determinants of HIV transmission amongst FSWs in China include sociopolitical context, gender, work environment and finally, risky sexual behaviors. CONCLUSIONS Chinese FSWs live in a specific sociopolitical context that shapes their capacities to engage in safe-sex practices. Focusing on FSWs as vectors of HIV/AIDS epidemic in China neglects the larger context that endangers all members of society and blames an already vulnerable population.
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Affiliation(s)
- Catherine Pirkle
- Unité de Santé Internationale, Université de Montréal, Montreal, Quebec, Canada.
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Sullivan SG, Wu Z. Rapid scale up of harm reduction in China. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:118-28. [PMID: 17689354 DOI: 10.1016/j.drugpo.2006.11.014] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 11/10/2006] [Accepted: 11/15/2006] [Indexed: 10/23/2022]
Abstract
In the last 20 years, China has seen a resurgence in drug use, particularly heroin, and with it a growing epidemic of HIV/AIDS. Faced with this dual epidemic, the government has begun testing harm reduction strategies in recent years. These have included methadone maintenance treatment (MMT) programmes, needle-syringe programmes (NSP), outreach, and increasing access to HIV testing. MMT and NSP have moved from the pilot stage to scale-up, with 320 MMT clinics and 93 NSPs now open. Both will number more than 1000 by the end of 2008. There are some good examples of outreach programmes in some areas, however more needs to be done to facilitate greater involvement from non-government organizations. Similarly, HIV testing for drug users is widely available, but novel approaches to increasing its uptake need to be explored. Management of scale-up and reaching China's vast and dispersed drug-using population remain key challenges. The introduction of harm reduction has been a massive turn-around in thinking by the government, particularly law enforcement agencies, and achieving this has required considerable cooperation and understanding between the Ministries of Health, Public Security, and Justice, and the Food and Drug Administration. With their support, rapid scale-up to effectively reach a majority of drug users can be achieved in the coming years.
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Affiliation(s)
- Sheena G Sullivan
- National Center for AIDS, STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, China
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Qian HZ, Schumacher JE, Chen HT, Ruan YH. Injection drug use and HIV/AIDS in China: review of current situation, prevention and policy implications. Harm Reduct J 2006; 3:4. [PMID: 16451717 PMCID: PMC1402269 DOI: 10.1186/1477-7517-3-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Accepted: 02/01/2006] [Indexed: 11/10/2022] Open
Abstract
Illicit drug abuse and HIV/AIDS have increased rapidly in the past 10 to 20 years in China. This paper reviews drug abuse in China, the HIV/AIDS epidemic and its association with injection drug use (IDU), and Chinese policies on illicit drug abuse and prevention of HIV/AIDS based on published literature and unpublished official data. As a major drug trans-shipment country with source drugs from the "Golden Triangle" and "Gold Crescent" areas in Asia, China has also become an increasingly important drug consuming market. About half of China's 1.14 million documented drug users inject, and many share needles. IDU has contributed to 42% of cumulatively reported HIV/AIDS cases thus far. Drug trafficking is illegal in China and can lead to the death penalty. The public security departments adopt "zero tolerance" approach to drug use, which conflict with harm reduction policies of the public health departments. Past experience in China suggests that cracking down on drug smuggling and prohibiting drug use alone can not prevent or solve all illicit drug related problems in the era of globalization. In recent years, the central government has outlined a series of pragmatic policies to encourage harm reduction programs; meanwhile, some local governments have not fully mobilized to deal with drug abuse and HIV/AIDS problems seriously. Strengthening government leadership at both central and local levels; scaling up methadone substitution and needle exchange programs; making HIV voluntary counseling and testing available and affordable to both urban and rural drug users; and increasing utilization of outreach and nongovernmental organizations are offered as additional strategies to help cope with China's HIV and drug abuse problem.
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Affiliation(s)
- Han-Zhu Qian
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Joseph E Schumacher
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Huey T Chen
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Yu-Hua Ruan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Yang X, Latkin C, Celentano D, Luo H. Prevalence and correlates of HIV risk behaviors among drug users in China. AIDS Behav 2006; 10:71-81. [PMID: 16323036 DOI: 10.1007/s10461-005-9028-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined the prevalence and correlates of HIV risk behaviors among 1,153 current drug users in China. Chi-squared tests of differences were used to test if drug users differed from non-users; logistic regression was used to identify behavior-specific risk factors. Results indicate that 60% of drug users injected drugs and more than one third shared needles. Compared to non-users, drug users had higher rates of risky sexual behavior and HIV/STDs. Among drug users, ethnic minorities and migrants were most vulnerable to unprotected casual sex and needle sharing. Drug users who experienced social isolation were associated with lower odds of risk behaviors; those who had experiences of anti-social behaviors and commercial sex, poor HIV knowledge, and perceived greater vulnerability were more prone to unprotected casual sex and needle sharing. Additional correlates of unprotected casual sex included being single, depression, and taking drugs/alcohol during sex. Additional risk factors of needle sharing included education and initiated drug use at younger ages. It is imperative that HIV interventions in China target drug users and address behavior-specific risk factors.
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Affiliation(s)
- Xiushi Yang
- Department of Sociology and Criminal Justice, Old Dominion University, Norfolk, Virginia 23529, USA.
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Yang H, Li X, Stanton B, Liu H, Liu H, Wang N, Fang X, Lin D, Chen X. Heterosexual Transmission of HIV in China: A Systematic Review of Behavioral Studies in the Past Two Decades. Sex Transm Dis 2005; 32:270-80. [PMID: 15849527 PMCID: PMC1791011 DOI: 10.1097/01.olq.0000162360.11910.5a] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to address the role of heterosexual transmission of HIV in China. GOAL The goal of this study was to explore the prevalence of unsafe sex and the likelihood of HIV spread heterosexually from core populations to others. STUDY The authors conducted a review of behavioral studies. RESULTS Drug users were more likely to be involved in higher-risk sexual behaviors than were those who abstained from using drugs. Most female drug users (52-98%) reported having engaged in commercial sex. Most female sex workers (FSWs) and individuals with sexually transmitted diseases (STDs) had concurrent sexual partners. Many continued to have unprotected sex after noticing STD symptoms in themselves or their sexual partners. From 5% to 26% of rural-to-urban migrants had multiple sexual partners and 10% of males patronized FSWs during migration. CONCLUSIONS Factors such as high rates of FSW patronage, low rates of condom use during commercial sex, having sex with both commercial and noncommercial sexual partners, and high rates of STD infection may promote a heterosexual epidemic in China.
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Affiliation(s)
- Hongmei Yang
- Prevention Research Center the Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan 48201, USA.
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