Prevalence and associated factors of condom use during commercial sex by female sex workers who were or were not injecting drug users in China

Abstract

Objectives We compared the prevalence of inconsistent condom use during commercial sex between female sex workers (FSWs) who did or did not inject drugs (FSW-IDUs and FSW-NIDUs) and investigated factors associated with this inconsistent use within these two groups. Methods: Some 158 FSW-NIDUs recruited from sex work venues and 218 FSW-IDUs recruited via the snowball sampling method were interviewed anonymously. Results: Only 16.5% of the FSW-IDUs and 51.3% of the FSW-NIDUs had used condoms consistently during commercial sex in the last month (odds ratio (OR) = 0.19). Factors significantly associated with inconsistent condom use in both groups included: behavioural intention for condom use (adjusted odds ratio (AOR) = 0.05 and 0.13), condom unavailability (AOR = 4.77 and 5.33), a perceived need to engage in unprotected sex if the client paid more (AOR = 8.74 and 10.84) or insisted on demanding unprotected sex (AOR = 19.78 and 7.59), and submissive gender power (AOR = 11.65 and 2.58). One factor, perceived susceptibility (AOR = 2.64), was significant only among FSW-NIDUs, whereas perceived efficacy of condom use in preventing HIV transmission (AOR = 0.08), perceptions that peer FSWs would not use condoms with clients (AOR = 2.23), self-hatred (AOR = 2.25) and lack of social support (AOR = 2.93) were significant only among FSW-IDUs. Injecting with used syringes was also associated with inconsistent condom use among FSW-IDUs (AOR = 4.64). Conclusions: FSW-IDUs were more likely than FSW-NIDUs to possess the cognitive and psychosocial conditions associated with unprotected commercial sex. Interventions need to take these differences into account.