Comparing HIV-related syringe-sharing behaviors among female IDU engaging versus not engaging in commercial sex

BackgroundTo compare the prevalence of syringe-sharing behaviors and other HIV-related characteristics among female injecting drug users (IDU) engaging and not engaging in sex work and to identify factors associated with such risk behaviors in the two groups.MethodsData were obtained from 1923 female respondents of behavioral surveillance studies conducted in Sichuan, China.ResultsThe prevalence of having at least one of the three syringe-sharing behaviors (borrowing, lending, or injecting from pre-filled syringes) was 45.3% in the female sex workers (FSW) group and 37.2% in the non-FSW group (adjusted OR = 1.28, p < 0.05). Compared with non-FSW, FSW were more likely to have injected drugs for 3 or more years, have non-regular sex partners, believe that condom use could prevent HIV, and have received free condoms/lubricants (OR = 1.34–5.08, p < 0.05); FSW were less likely to be older, better educated, and have attempted quitting drugs (OR = 0.31–0.68, p < 0.05). Being FSW, older, longer injecting drug use, higher drug injection frequency, and having regular sex partner were associated with injecting with others’ used syringes (multivariate OR = 1.26–1.92, p < 0.05) while the reverse was true for education level and voluntary HIV antibody testing (multivariate OR = 0.44–0.64, p < 0.05). Of all sampled FSW, 39.3% did not use a condom in the last episode of sex work.ConclusionsFemale IDU involving in sex work are at high risk of HIV transmission and the risk may even be higher than their non-FSW counterparts. The bridging effect poses a threat to the HIV epidemic in China and effective preventive services are warranted.