Correlates of sharing of needles and syringes among people who inject drugs in Dhaka city, Bangladesh

Introduction: This paper examines the correlates of needle and syringe sharing among People Who Inject Drugs in Dhaka city, Bangladesh, which is currently experiencing a steep increase in HIV prevalence despite the ongoing presence of Needle Exchange Programs. Methodology: This was a retrospective chart review with cross-sectional design that extracted data from 783 male People Who Inject Drugs enrolled into five Opioid Substitution Treatment clinics in Dhaka city between April 2010 and January 2016. Data were retrieved from the program’s electronic database. Needle and syringe sharing constituted the borrowing or lending of needles and syringes from others within the past month preceding data collection. Results: Buprenorphine was the preferred injection drug and 44.6% shared needles and syringes within the past month. Multivariate analysis indicated that People Who Inject Drugs who were homeless (OR = 8.1, 95% CI = 1.4-44.9, p < 0.05), living with friends (OR = 6.8, 95% CI = 2.5-18.2, p < 0.001), injecting 2-3 times/day (OR = 4.8, 95% CI = 1.2-19.7, p < 0.05), injecting more than three times/day (OR = 4.8, 95% CI = 1.1-20.0, p < 0.05), not using condom with non-commercial female sex partners (OR = 3.3, 95% CI = 1.8-6.0, p < 0.05), bought sex from female sex workers (OR = 2.9, 95% CI = 1.0-8.3, p < 0.05), and did non-suicidal self-injury (OR = 1.8, 95% CI = 1.0-3.0, p < 0.05) were more likely to share needles and syringes. Conclusions: This study demonstrates that operating a standalone harm reduction approach that just provides sterile needles and syringes may not adequately curb needle and syringe sharing among People Who Inject Drugs.

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Correlates of Inconsistent Refusal of Unprotected Sex among Armenian Female Sex Workers

AIDS Research and Treatment ◽

10.1155/2014/314145 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Karine Markosyan ◽

Delia L. Lang ◽

Ralph J. DiClemente

Keyword(s):

Sex Workers ◽

Behavioral Interventions ◽

Female Sex Workers ◽

Cross Sectional Study ◽

Unprotected Sex ◽

Behavioral Characteristics ◽

Cross Sectional ◽

Sexually Transmitted ◽

The Past ◽

Female Sex

This cross-sectional study assessed the prevalence and correlates of inconsistent refusal of unprotected sex among female sex workers (FSWs) in Armenia. One hundred and eighteen street-based FSWs between the ages of 20 and 52 completed a questionnaire assessing FSWs’ demographic, psychosocial, and behavioral characteristics. A total of 52.5% (n=62) of FSWs reported inconsistent refusal of unprotected sex with clients in the past 3 months. Logistic regression analysis controlling for participants’ age and education revealed that perceiving more barriers toward condom use (AOR = 1.1;P<0.01), reporting more types of abuse (AOR = 2.1;P<0.01), and setting lower fees for service (AOR = 0.9;P=0.02) significantly predicted inconsistent refusal of unprotected sex. HIV-risk-reduction behavioral interventions tailored to FSWs working in Yerevan Armenia should address the factors identified in this study toward the goal of enhancing refusal of unprotected sex and ultimately preventing acquisition of sexually transmitted infections (STIs) including HIV.

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Uptake and correlates of chlamydia and gonorrhea testing among female sex workers in Southern China: a cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-11526-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pei Zhen Zhao ◽

Ya Jie Wang ◽

Huan Huan Cheng ◽

Ye Zhang ◽

Wei Ming Tang ◽

...

Keyword(s):

Sexual Behaviors ◽

Sex Workers ◽

Female Sex Workers ◽

Southern China ◽

Multivariable Analysis ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

The Past ◽

Female Sex

Abstract Background Female sex workers (FSW) are highly susceptible to chlamydia and gonorrhea infection. However, there is limited literature examining their testing uptake to date. This study aimed to assess the uptake and determinants of chlamydia and gonorrhea testing among FSW in Southern China. Methods A cross-sectional study with convenience sampling was performed in five cities in Southern China. Data on socio-demographic characteristics, sexual behaviors, chlamydia and gonorrhea testing, and the utilization of health care services from participants were collected through face-to-face interviews. Univariate and multivariable logistic regressions were used to determine factors associated with chlamydia and gonorrhea testing, respectively. Results Overall, 1207 FSWs were recruited, with the mean age of 30.7 ± 6.8 years and an average number of clients of 7.0 (4.0–10.0) per week. 65.4% participants constantly used condoms with clients during the past month. Only 7.5 and 10.4% had been tested for chlamydia and gonorrhea in the last year, respectively. Multivariable analysis indicated that FSW who worked at low tiers (adjusted Odds Ratio (aOR) = 2.36, 95%CI:1.23–10.14), had more clients in the last month (aOR = 1.03, 95%CI:1.01–1.05), used condoms consistently (aOR = 1.79, 95%CI:1.12–2.86), had STD symptoms (aOR = 4.09,95%CI:2.62–6.40), had been tested for HIV (aOR = 5.16, 95%CI:3.21–8.30) or syphilis (aOR = 6.90, 95%CI:4.21–11.22) in the last year were more likely to have chlamydia testing. In addition, FSW who had more clients in the past month (aOR = 1.02,95%CI:1.00–1.04), had STD symptoms (aOR = 3.33, 95%CI:2.03–5.46), had been tested for HIV (aOR = 3.94, 95%CI:2.34–6.65) and syphilis (aOR = 3.27, 95%CI:1.96–5.46) in the last year were more likely to have gonorrhea testing. Conclusions The testing rates of chlamydia and gonorrhea are low among Chinese FSW. Integrating chlamydia and gonorrhea testing into HIV testing promotion programs may help bridge the gap among FSW.

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Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV

Sexual Health ◽

10.1071/sh10047 ◽

2011 ◽

Vol 8 (2) ◽

pp. 251 ◽

Cited By ~ 18

Author(s):

Nienke J. Veldhuijzen ◽

Chantal Ingabire ◽

Stanley Luchters ◽

Wilkister Bosire ◽

Sarah Braunstein ◽

...

Keyword(s):

Hiv Prevention ◽

Sex Workers ◽

Female Sex Workers ◽

Anal Intercourse ◽

Sub Saharan Africa ◽

Risk Behaviours ◽

Cross Sectional ◽

The Past ◽

Female Sex ◽

Heterosexual Anal Intercourse

Introduction Epidemiological and HIV prevention studies in sub-Saharan Africa have almost exclusively focussed on vaginal transmission of HIV, the primary mode of transmission in the region. Little is known about the prevalence of heterosexual anal intercourse (AI), its correlates and its role in the spread of HIV. Prevention messaging seldom, if ever, includes AI. Methods: Sexual and other risk behaviours (including frequency of AI) were assessed in two cross-sectional surveys of female sex workers (FSW) in Kigali, Rwanda (n = 800) and Mombasa, Kenya (n = 820). In addition, a subset of FSW surveyed in Kigali attended seven focus group discussions and four in-depth interviews. Results: AI was reported by 5.5% and 4.3% of FSW in the cross-sectional surveys, in Kigali and Mombasa, respectively. FSW practising AI reported multiple risk factors for HIV transmission: inconsistent condom use (odds ratio (OR) Kigali 5.9 (95% CI 1.4–24.7); OR Mombasa 2.1 (1.1–4.2)); more than five sexual partners in the past week (OR Kigali 4.3 (1.5–12.4); OR Mombasa 2.2 (1.1–4.3)); alcohol use before sex (OR Kigali 2.8 (1.4–5.8)); more than 5 years of female sex work (OR Mombasa 2.4 (1.2–4.9)); and history of genital symptoms in the past year (OR Mombasa 3.6 (1.7–7.9)). AI was, however, not associated with HIV prevalence (OR Kigali 0.9 (0.5–1.9); OR Mombasa 0.5 (0.2–1.2)). Negative connotations and stigma associated with AI were expressed during qualitative interviews. Conclusions: AI was associated with several indicators of sexual risk behaviour. Prevalence of AI was probably underreported due to social desirability bias. Stigma associated with AI poses methodological challenges in obtaining valid data.

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High levels of used syringe use and unsafe sex among people who inject drugs in Kumasi, Ghana: an urgent call for a comprehensive harm reduction approach

Harm Reduction Journal ◽

10.1186/s12954-021-00510-7 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Lisa J. Messersmith ◽

Rose Adjei ◽

Jennifer Beard ◽

Angela R. Bazzi ◽

Joel J. Earlywine ◽

...

Keyword(s):

Drug Use ◽

Harm Reduction ◽

Population Size ◽

Sex Workers ◽

People Who Inject Drugs ◽

Syringe Sharing ◽

Unsafe Sex ◽

Lack Of Information ◽

Sex With Men ◽

Major Drug

Abstract Background Drug use is a growing concern in Ghana. People who inject drugs (PWID) are highly vulnerable to HIV and other infectious diseases. Ghana’s National Strategic Plan for HIV/AIDS 2016–2020 identifies PWID as a key population, but efforts to address the needs of PWID have lagged behind those targeting sex workers and men who have sex with men. Lack of information about PWID is a critical barrier to implementing effective HIV prevention and treatment. We aimed to learn more about the vulnerability of the PWID population in order to inform much-needed harm reduction interventions. Methods From April to July 2018, we conducted a mixed methods study in Kumasi, Ghana, to identify all major drug using locations, count the numbers of PWID to obtain rough population size estimations, and administer anonymous surveys to 221 PWID regarding drug use and sexual behavior. We also tested for HIV, HCV, and HBV from syringes used by survey participants. Results Key informants identified five major drug using locations and estimated the total PWID population size to be between 600 and 2000. Enumerators counted between 35 and 61 individuals present at each of the five bases. Sharing syringes and reusing discarded syringes are common practices. Over half of survey participants (59%) reported past-month syringe sharing (34% used a used syringe and 52% gave away a used syringe). Individuals with higher injection frequency (≥ 21 times weekly) and who injected with four or more people had higher odds of syringe sharing. Of the survey participants reporting sex in the last month (23%), most reported having one partner, but only 12% used condoms. Nearly all women (11/13) reported exchanging sex for drugs and 6/13 reported exchanging sex for money in the last six months. Fifteen percent of participants (all men) reported paying for sex using drugs or money. Of the used syringes, prevalence estimates were 3% (HIV), 2% (HCV), and 9% (HBV). Conclusions Our findings confirm the urgent need to implement harm reduction interventions targeting PWID and to build a strong and enabling legal and policy environment in Ghana to support these efforts.

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Sexual IPV and non-partner rape of female sex workers: findings of a cross-sectional community-centric national study in South Africa

SSM - Mental Health ◽

10.1016/j.ssmmh.2021.100012 ◽

2021 ◽

pp. 100012

Author(s):

Rachel Jewkes ◽

Kennedy Otwombe ◽

Kristin Dunkle ◽

Minja Milovanovic ◽

Khuthadzo Hlongwane ◽

...

Keyword(s):

South Africa ◽

Sex Workers ◽

Female Sex Workers ◽

National Study ◽

Cross Sectional ◽

Female Sex

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Risk and vulnerability of key populations to HIV infection in Iran; knowledge, attitude and practises of female sex workers, prison inmates and people who inject drugs

Sexual Health ◽

10.1071/sh14165 ◽

2014 ◽

Vol 11 (6) ◽

pp. 568 ◽

Cited By ~ 11

Author(s):

Razieh Khajehkazemi ◽

AliAkbar Haghdoost ◽

Soodabeh Navadeh ◽

Hamidreza Setayesh ◽

Leily Sajadi ◽

...

Keyword(s):

Sex Workers ◽

Female Sex Workers ◽

People Who Inject Drugs ◽

Sexual Transmission ◽

Study Data ◽

Prison Inmates ◽

Female Sex ◽

Comprehensive Knowledge ◽

Sexual Transmission Of Hiv ◽

Hiv Aids

Background In this study data of three national surveys conducted among female sex workers (FSW), prison inmates and people who inject drugs (PWID) were presented and compared in relation to knowledge, attitude, and practises. Methods: The surveys were conducted in 2009 and 2010 and included 2546 PWID, 872 FSW and 5530 prison inmates. Knowledge, attitude and practises towards HIV were measured through similar questions for each category. Results: Over 90% of all participants had ever heard of HIV/AIDS, although only approximately half of them perceived themselves at risk of contracting HIV. More than 80% were able to correctly identify the ways of preventing the sexual transmission of HIV; while more than two-thirds did not use condom in their last sexual contact. Approximately 20% of prisoners and FSW had a history of injecting drugs. Among all participants who have injected drugs, prisoners had the highest unsafe injecting behaviour at the last injection (61%), followed by FSW (11%) and PWID (3%). Conclusions: Despite major efforts to control the HIV epidemic in Iran, the level of risk and vulnerability among prisoners, FSW and PWID is still high. The level of comprehensive knowledge about HIV/AIDS is relatively good; however, their risk perception of contracting HIV is low and high-risk behaviours are prevalent. Therefore, HIV prevention programs should be redesigned in a more comprehensive way to identify the best venues to reach the largest number of people at a higher risk of contracting HIV and decrease their risk overlaps and vulnerability factors.

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Association between treatment for gonorrhoea and chlamydia and lower condom use in a cross-sectional study of female sex workers in southern India

BMJ Open ◽

10.1136/bmjopen-2015-009774 ◽

2016 ◽

Vol 6 (5) ◽

pp. e009774

Author(s):

Marianne Legendre-Dugal ◽

Janet Bradley ◽

Subramanian Potty Rajaram ◽

Catherine M Lowndes ◽

Banadakoppa M Ramesh ◽

...

Keyword(s):

Condom Use ◽

Sex Workers ◽

Female Sex Workers ◽

Cross Sectional Study ◽

Southern India ◽

Sectional Study ◽

Cross Sectional ◽

Female Sex

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Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis

Sexually Transmitted Infections ◽

10.1136/sextrans-2016-052549 ◽

2016 ◽

Vol 92 (8) ◽

pp. 593-598 ◽

Cited By ~ 9

Author(s):

Angela M Parcesepe ◽

Kelly L L'Engle ◽

Sandra L Martin ◽

Sherri Green ◽

Chirayath Suchindran ◽

...

Keyword(s):

Condom Use ◽

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Cross Sectional ◽

Female Sex ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region

10.1101/2021.08.05.21261671 ◽

2021 ◽

Author(s):

Steffanie Ann Strathdee ◽

Daniela Abramovitz ◽

Alicia Harvey-Vera ◽

Carlos Vera ◽

Gudelia Rangel ◽

...

Keyword(s):

Sex Work ◽

Sex Workers ◽

San Diego ◽

People Who Inject Drugs ◽

Risk Mitigation ◽

Border Region ◽

Protective Behavior ◽

Protective Measures ◽

The Past ◽

Hispanic People

Background: People who inject drugs may be at elevated SARS-CoV-2 risk due to their living conditions and/or exposures when seeking or using drugs. No study to date has reported upon risk factors for SARS-CoV-2 infection among people who inject drugs or sex workers. Methods and Findings: Between October, 2020 and June, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month underwent interviews and testing for SARS-CoV-2 RNA and antibodies. Binomial regressions identified correlates of SARS-CoV-2 seropositivity. Of 386 participants, SARS-CoV-2 seroprevalence was 36.3% (95% CI: 31.5%-41.1%); 92.1% had detectable IgM antibodies. Only 37.5% had previously been tested. Seroprevalence did not differ by country of residence. None tested RNA-positive. Most (89.5%) reported engaging in ≥1 protective behavior [e.g., facemasks (73.5%), social distancing (46.5%), or increasing handwashing/sanitizers (22.8%)]. In a multivariate model controlling for sex, older age, and Hispanic/Latinx/Mexican ethnicity were independently associated with SARS-CoV-2 seropositivity, as was engaging in sex work (AdjRR: 1.63; 95% CI: 1.18-2.27) and having been incarcerated in the past six months (AdjRR: 1.49; 95% CI: 0.97-2.27). Presence of comorbidities and substance using behaviors were not associated with SARS-CoV-2 seropositivity. Conclusions: This is the first study to show that sex work and incarceration were independently associated with SARS-CoV-2 infection. Despite engaging in protective measures, over one-third had evidence of infection, reinforcing the need for a coordinated binational response. Risk mitigation and vaccination is especially needed among older and Hispanic people who inject drugs and those with less agency to protect themselves, such as those who are sex workers or incarcerated.

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Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe

BMJ Open ◽

10.1136/bmjopen-2017-018751 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018751 ◽

Cited By ~ 3

Author(s):

Rebecca Rhead ◽

Jocelyn Elmes ◽

Eloghene Otobo ◽

Kundai Nhongo ◽

Albert Takaruza ◽

...

Keyword(s):

Sex Workers ◽

Female Sex Workers ◽

Household Survey ◽

Hiv Treatment ◽

Sample Survey ◽

Physical And Mental Health ◽

Hiv Knowledge ◽

Cross Sectional ◽

Female Sex ◽

Treatment Services

ObjectiveGlobally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake.MethodsData from a household survey conducted in 2009–2011 and a parallel snowball sample survey of FSWs were matched using probability methods to reduce under-reporting of FSWs. HIV treatment cascades were constructed and compared for FSWs (n=174) and NSWs (n=2555). Determinants of service uptake were identified a priori in a theoretical framework and tested using logistic regression.ResultsHIV prevalence was higher in FSWs than in NSWs (52.6% vs 19.8%; age-adjusted OR (AOR) 4.0; 95% CI 2.9 to 5.5). In HIV-positive women, FSWs were more likely to have been diagnosed (58.2% vs 42.6%; AOR 1.62; 1.02–2.59) and HIV-diagnosed FSWs were more likely to initiate ART (84.9% vs 64.0%; AOR 2.33; 1.03–5.28). No difference was found for antiretroviral treatment (ART) adherence (91.1% vs 90.5%; P=0.9). FSWs’ greater uptake of HIV treatment services became non-significant after adjusting for intermediate factors including HIV knowledge and risk perception, travel time to services, physical and mental health, and recent pregnancy.ConclusionFSWs are more likely to take up testing and treatment services and were closer to achieving optimal outcomes along the cascade compared with NSWs. However, ART coverage was low in all women at the time of the survey. FSWs’ need for, knowledge of and proximity to HIV testing and treatment facilities appear to increase uptake.

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