[C10772] Injecting drug use among street-based sex workers:
A high risk behaviour for HIV transmission

N.A. Tuan1, N.T. Hien 2,  P.K. Chi 1,  L.T. Giang 3,  B.D.
Thang 1,  H.T. Long 1,  T. Saidel 4,  R. Detels 5 1 National
Institute of Hygiene and Epidemiology, c/o FHI/IMPACT, 30
Nguyen Du, Suite 201, Hanoi, Vietnam; 2 Hanoi Medical
College, Hanoi, Vietnam; 3 AIDS Committee in Ho Chi Minh
City, Ho Chi Minh City, Vietnam; 4 Family Health
International/Asia Regional Office, Bangkok, Thailand; 5
University California of Los Angeles, California, United
States


Background: The prevalence of HIV has increased rapidly
among street-based sex workers (SSW) in Ho Chi Minh city
(HCMC). SSW interventions tend to target high-risk sexual
activity, although recent data indicate that many SSWs
inject drugs, and that this is also related to rising HIV
levels.

Methods: After a mapping exercise by peer educators for SSW,
400 were invited to visit one of 3 STD clinics in HCMC to be
interviewed and tested for HIV-1. Regression analysis was
conducted to examine the association between
socio-demographic profile, sexual and injecting risk
behaviors, condom use and HIV.

Results: The mean age of SSW was 31 and education levels
were low (16.7% illiterate), 12.8% reported injecting drugs,
with a mean starting age of 23.6 years. The mean number of
reported sexual partners last week was 8.9, (5.4 non-regular
partners, 3.2 regular partners). Consistent condom use was
approximately 40% with these partners. Prevalence of HIV was
16.3%. In bivariate analysis, HIV seropositivity was
associated with injecting by the SSW (OR=66; 95% CI:
28.7-152.4), injecting by the regular sex partners of SSW
(OR=3.8; 95% CI: 1.5-9.3) or by husband/lover (OR=4.2; 95%
CI:1.4-12.4), and with being younger than 26 (OR=6.8; 95%
CI: 3.8-12.2). In stepwise logistic regression, both
injecting drug use (OR=101.3; 95% CI: 33.5-305.9) and being
younger than 26 (OR=5.2; 95% CI: 2.1-13.0) were
independently and strongly associated with HIV
sero-positivity.

Discussion: SSWs who are also injecting drug users appear to
be at much greater risk of contracting and/or transmitting
HIV through risky behavior. Sexual partner turnover of SSW
is also relatively high, suggesting the potential for sexual
spread of HIV into the general population through bridging
groups. When developing and implementing interventions to
reduce harm and prevent /AIDS, interventions targeting SSWs
must take both risk from injecting and sexual risk into
consideration.

Presenting Author: Nguyen Anh Tuan,