1. COINFECTION OF HIV, HBV, HCV IN FEMALE SEX WORKERS IN HA NOI, 2013 RESULTS OF IBBS Ass. Prof. NGUYEN ANH TUAN, MPH, PhD NATIONAL INSTITUTE OF HYGIENE AND EPIEPIDEMIOLOGY MINISTRY OF HEALTH

2. Introduction Integrated Biological-Behaviors Surveys (IBBS) were implemented to strengthen serological surveillance and give behavior data in order to provide strategic information to Ministry of Health for more effective strategy on HIV/AIDS intervention prevention IBBS were implemented 3 rounds (2005-2006, 2009-2010 and 2013- 2014) in 3 high-risk behaviors of PWID, FSW and MSM Main objectives of IBBS: –Give estimated HIV prevalence (present and trend over time) for PWID, FSW and MSM –Have risk behaviors in sexual intercourse, drug use, and receive of HIV/AIDS intervention prevention services

3. Participant Female Sex Worker (FSW) is woman over or equal 18 years old, have sex to receive money at least one time in the past month, meet client in the street (S-FSW) or in hot spot such as karaoke, massage parlor, … (K-FSW) Methods Cross-sectional study used time location sampling (TLS) Sample size Sample size of study participants was calculated in IBBS round III: 599 FSWs (299 S-FSW, 300 K-FSW) Period: 6-10/2013 Study design

4. Statistical analysis Software STATA 12 was used to estimate point value, 95% confidence interval Weighted for sampling selection and adjusted probability of participant selection

5. Testing HIV testing Used III strategy of Ministry of Health to confirm one HIV positive case Screened by Genscreen Ultra HIV Ag/Ab (Biorad, US), Determine HIV- 1/2 (Alere, Japan) and Murex HIV Ag/Ab Combination (DiaSorin, UK) were used HIV testing was tested in HIV laboratory of PAC in Hanoi HBV and HCV testing Architech HBsAg qualitative II was used to detect HBsAg. One HBV positive case was defined if specimen was reacted with HBsAg and the value ≥ 1 S/CO Architech Anti-HCV was used to detect antibody HCV. One HCV positive case was confirmed if specimen was reacted with Anti-HCV and the value ≥ 1 S/CO HBV and HCV testing were done in National Reference HIV Laboratory at NIHE. HBV, HCV results were confirmed in Molecular laboratory in CDC Atlanta, USA

6. Social-demographic characteristics Characteristic S-FSWK-FSW Age (n) 299300 Mean 32.7 29.03 Age groups (n) 299300 <20 1.0 2.67 20 - <25 10.4 23.0 25 - <30 20.427.0 >=30 68.247.3 Married (n) 299300 Proportion 77.356.7 Years selling sex (n) 293290 Mean 7.36.0 Monthly income – million VND(n) 299290 Mean 7.911.0 Monthly income from selling sex – million VND(n) 299300 Mean 7.5 9.2 Place meet client (n) 299300 On street or public place 90.00.9 Entertainment0.041.2 Massage parlor 0.3 28.2 Brothel 0.3 0.0 Motel 0.7 14.7 Hotel 0.30.8 Telephone 8.414.0 Internet0.00.3

7. Ever injecting drug

8. Client average S-FSW K-FSW

9. Consistent condom use with different clients S-FSW K-FSW

10. Receiving condom (free and buy)

11. Prevalence of HIV, HBV, HCV and coinfections Prevalence Proportion % (95%CI) S-FSWK-FSW HIV10,4 (7,4-14,4)13,9 (10,5-18,2) HBV11,0 (7,9-15,1)13,6 (10,2-18,0) HIV +19,4 (8,5-38,1)25,7 (14,9-40,8) HIV-10,1 (7,0-14,4)11,7 (8,3-16,3) HCV14,7 (11,1-19,2)13,7 (10,4-18,0) HIV+67,7 (48,6-82,3)47,6 (33,4-62,2) HIV-8,6 (5,8-12,7)8,3 (5,5-12,3) HIV+/HBV+2,0 (0,9-4,4)3,4 (2,0-6,3) HIV+/HCV+7,0 (4,6-10,6)6,6 (4,4-9,9) HIV+/HBV+/HCV+0,7 (0,2-2,7)0,8 (0,3-2,6)

12. Factors associated to HIV prevalence CharacteristicOR95%CIAOR95%CI > 30 years old4,372,35-8,113,361,51-7,45 > Secodary school1,620,68-3,88 Ever married2,551,39-4,671,270,62-2,59 1,781,06-2,990,870,47-1,58 0,650,37-1,14 Consistent condom use with one-time client/past month1,310,60-2,84 Consistent condom use with casual client/past month1,050,55-2,01 Consistent condom use with boy friend/husband/last year 0,760,28-2,06 Ever buy condom0,540,30-0,950,800,39-1,63 Ever received free condom0,710,40-1,28 Ever used drug2,151,14-4,04 Ever used heroin2,591,36-4,93 Ever injected drug3,331,56-7,100,630,24-1,61 Having one-time client injecting drug in past month1,090,37-3,23 Having casual client injecting drug in past month1,830,83-4,02 Having boy friend/husband injecting drug in past month0,910,31-2,64 Ever had sex after using drug2,931,17-7,31 HBV+2,261,25-4,072,601,26-5,36 HCV+12,937,55-22,1214,237,30-27,72

13. Conclusions Average number of clients per week is about from 6.3-6.9 persons Proportion of consistent condom use with one-time client and casual client was about 85.0% Proportion of ever injecting drug in S-FSW and K-FSW were 6.4% and 5.2%, respectively Proportion of HIV+/HBV+ co-infection in S-FSW (2.0%) was lower than this in K-FSW (3.4%) Proportion of HIV+/HCV+ co-infection (7.0% in S-FSW and 6.6% in K- FSW) were higher the proportion of HIV+/HBV+ co-infection Proportion of HIV+/HBV+/HCV+ co-infection was low and not different in two FSW populations (0.7% in S-FSW and 0.8% in K-FSW) Factors of > 30 years old (OR=3.36; 95%CI: 1.51-7.45), HBV infection (OR=2.60; 95%CI: 1.26-5.36) and HCV infection (OR=14.23; 95%CI: 7.30-27.72) were associated to HIV infection in both FSW populations