Associations of depression, substance use, self-efficacy and future control with sexual risk behavior among female sexual workers in China

Background: Depression may play an important role in engagement in sexual risk behaviors. Limited research has been done to assess the association between depression, substance use, self-efficacy for protective behaviors, and future over the control among female sexual workers (FSW) in China. Methods: A self-administered cross-sectional survey was conducted among 700 FSW in two cities of Guangxi, China. A composite scale of sexual risk behavior was created based on whether a FSW had sex with clients who were drunken or using drugs, whether she had a sexual intercourse after alcohol use, whether she had a sexual intercourse without using a condom after alcohol use, whether she inconsistently used a condom with stable sexual partners, whether she inconsistently used a condom with casual sexual partners, whether she used a condom before starting the sexual intercourse. Results: The mean age of the sample was 26 years old. Thirty seven percent of FSW had CES-D scores ≥16. Multivariate regression analysis show that depressive symptoms and substance use were positively associated with engagement in sexual risk behaviors while self-efficacy and future control were negatively associated with risk behavior. Conclusions: FSW with high levels of depressive symptoms were more likely to report sexual risk behavior. Further analysis is needed on the mediate effect of substance use, self-efficacy, and future control on the relationship of depression and sexual risk behavior. To reduce sexual risk behavior, STI/HIV prevention needs to strengthen education on reducing substance use and increasing self-efficacy and perceived future over the control among FSW.