How likely are HIV-positive female sex workers in China to transmit HIV to others?

Background: Female sex workers (FSW) are highly marginalised and HIV-positive FSW are under a double stigma. No study has assessed the likelihood of secondary transmission via HIV-positive FSW in China. Methods: A total of 199 FSW who injected drugs were recruited by snowball sampling, and 158 non-injecting FSW were recruited from sex service establishments by convenience sampling in Dazhou, China. All participants were interviewed anonymously using a structured questionnaire. Results: If found to be HIV-positive, 11.7% of the participants would continue working as FSW, 24.6% would not care about transmitting HIV to others, 18.8% believed that they would eventually spread HIV to others and 9% would take revenge by spreading HIV to others. In multivariate models, factors associated with greater or equal 1 of the four aforementioned perceptions (42.0%) included drug use (odds ratio (OR) = 1.82-3.26, P < 0.01), perceived discrimination towards people living with HIV and AIDS in China (OR = 2.03, P < 0.05) and perceived inaccessibility to medical treatments if diagnosed as HIV-positive (OR = 2.30, P < 0.01); the reverse was true for use of HIV-related services (OR = 0.53, P < 0.05) and suicidal intentions if found to be HIV-positive (OR = 0.42, P < 0.05). Conclusions: Improvement of the social, care and medical environment of HIV-positive FSW is likely to reduce secondary transmission via HIV-positive FSW. Special attention should be given to FSW who inject drugs.