Joint effects of alcohol and stimulant use disorders on self-reported sexually transmitted infections in a prospective study of Cambodian female entertainment and sex workers

Abstract

Female entertainment and sex workers (FESW) have high rates of alcohol and amphetamine-type stimulant (ATS) use, increasing risk for HIV/sexually transmitted infections (STI), and other negative outcomes. A prospective cohort of 1,198 FESW in a HIV/ATS use prevention intervention in Cambodia was assessed for alcohol and stimulant use disorders (AUD and SUD) using the Alcohol and Substance Use Involvement (ASSIST) scale. STI history was measured by self-report at baseline and at quarterly follow-up visits. Participants were asked if they had been diagnosed with an STI by a medical provider in the past 3 months. Marginal structural models were used to estimate joint effects of AUD and SUD on recent STI. At baseline, one-in-four screened AUD positive and 7% screened positive for SUD. At 18-months, 26% reported ≥1 recent STI. Accounting for time-varying and other known confounders, the adjusted odds ratio (AOR) for recent STI associated with AUD alone and SUD alone were 2.8 (95% CI:1.5–5.1) and 3.5 (95% CI:1.1–11.3), respectively. The AOR for joint effects of AUD and SUD was 5.7 (95% CI:2.2–15.2). AUD and SUD are independently and jointly associated with greater odds of STI among Cambodian FESW. Further research is critical for understanding how AUD and SUD potentiate biological and behavioural pathways that influence STI acquisition and to inform HIV risk-reduction interventions in FESW.

Prevalence and Risks of Depression and Substance Use Among Adults Living with HIV in the Asia–Pacific Region

“…Recent tobacco use among adult men-who-have-sex-with-men (MSM) living with HIV in Taiwan was just under 50% [ 33 ]. Amphetamine use in our adult PLHIV cohort are consistent with those reported in populations at risk of HIV infection in the region, with rates of 7% reported among Cambodian female sex workers [ 34 ] and 30% among MSM in Vietnam [ 35 ]. Although the substantial proportions of sedative users in our cohort have not been widely documented elsewhere in the region, a study in Taiwan did find that PLHIV had an increased risk of sedative use compared to those without HIV, after adjusting for demographic data and psychiatric comorbidities [ 36 ].…”

Retrospective Cohort Study Examining the Correlates of Reported Lifetime Stimulant Use in Persons Diagnosed With Infectious Syphilis in Alberta, Canada, 2018 to 2019

“…16 Other studies show how concurrent alcohol and stimulant use disorders further elevate the risk of syphilis acquisition. 25 Racial disparities in terms of stimulant use were also present in our study. Although those identifying as First Nations and Métis comprise only 6.5% and 2.9% of Alberta's population, 26 they accounted for 41.2% and 10.3% of the total infectious syphilis cases during the study period.…”

“…10 Nearly 2 of every 3 sex workers with infectious syphilis reported stimulant usage in our study. Although stimulant usage is a known risk factor for STI acquisition among female sex workers, 25 the lifetime prevalence of stimulant use in this group has not previously been published, to our knowledge. Female sex workers often describe stimulant use to promote wakefulness and to cope with occupational hazards.…”

“…Female sex workers often describe stimulant use to promote wakefulness and to cope with occupational hazards 16 . Other studies show how concurrent alcohol and stimulant use disorders further elevate the risk of syphilis acquisition 25 …”