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Comparing Prevalence of Condom Use Among 15,379 Female Sex Workers Injecting or Not Injecting Drugs in China

Objectives: To compare the prevalence of condom use with clients and regular sex partners between female sex workers (FSWs) who were or were not injecting drug users (IDUs). Methods: Behavioral surveillance data (2002–2004) conducted in Sichuan, China were analyzed. Mapping exercises were done. About 250 to 400 FSWs were anonymously interviewed from selected establishments in 19 surveillance sites. Results: Of all 15,379 FSWs studied, 3.2% were IDUs. This group, when compared with the non-IDU group, was less likely to have used condoms with clients (last episode: 71.1% vs. 81.2%, OR = 0.6, P < 0.01; consistent use in the last month: 26.7% vs. 40.4%, OR = 0.5, P < 0.01) or to possess a condom (68.7% vs. 77.8%, OR = 0.6, P < 0.01). The between-group difference in last month’s consistent condom use with clients remained significant in the multivariate analyses, after adjusting for other significant factors [age, education level, age at first sex, having a regular sex partner, HIV-related knowledge and perceptions, HIV antibody testing (OR = 1.1–2.9, P < 0.05); STD symptoms, type of sex workers, longer duration of sex work, larger number of clients per week, and not having received HIV-related information (OR = 0.4–0.9)]. Comparable results were obtained for condom use with the last client. Such between-group differences were, however, not observed for condom use with regular sex partners (P > 0.05). Exposure to HIV-related services was associated with condom use with clients (OR = 1.3–2.8, P < 0.05). Conclusions: Higher sexual risk behaviors were found among FSWs who were also IDUs, when compared with those who were non-IUDs. A double-risk bridging population for HIV transmission thereby exists.