Epidemiology of HIV/STDs among female sex workers in Hanoi, Vietnam

HIV infection has recently been increasing rapidly among female sex workers (FSWs) in Hanoi, but little is known about them. We conducted a cross-sectional study among 400 working FSWs in Hanoi from June to September, 2002. The study's main objective was to examine the reason for the current outbreak of HIV among FSWs in Hanoi. The prevalence of HIV, syphilis, gonorrhea, and chlamydia among the study's participants were 12%, 17%, 3.8%, and 6.3%, respectively. The percentage of subjects using drugs was 38%, and 83% of these subjects injected drugs. Borrowing of used injecting equipment was found to be strongly associated with HIV infection (OR = 32; 95% CLs: 9.2--109). Other factors that were independently associated with HIV infection included young age, low level of education, longer residence in Hanoi, being a low-class FSW, having high income, poor knowledge of HIV, perceiving self as having low HIV infection risk, and consistent condom use with regular clients. Older age, longer residence in Hanoi, not currently living with a partner, being a low-class FSW, young age at first sexual experience, and not using drugs were found to correlate with STDs. Being low class, not using condoms, and sharing equipment were associated with reported signs of STDs. Condom use with irregular and regular clients shares common correlates. Being older, being a medium-class FSW, not or only sometimes feeling comfortable about asking clients to use condoms, and condom unavailability were found to be independently associated with inconsistent condom use. Subjects who had resided for longer periods in Hanoi, were not currently living with a partner, having more clients, having IDU love mates, and having drug-using clients were more likely to inject drugs. Interventions should focus on drug-using FSWs and clients of sex workers. Interventions should prevent drug use initiation among FSWs and reduce drug-related harm to drug-using FSWs. One-hundred percent condom use promotion among FSWs and clients and establishment of a quality and reliable voluntary counseling and testing system are necessary to limit the spread the virus. Vietnamese society and its government should demonstrate a positive attitude towards FSWs to promote behavior changes and reduce stigmatization.