Psychosociobehavioral characteristics associated with high condomless anal intercourse intention: a comparison of receptive,versatile, and insertive MSM in Taiwan

ABSTRACT

In Taiwan, men who have sex with men (MSM) continue to be disproportionately affected by HIV, and the main route of HIV transmission is condomless anal intercourse (CAI). This study examined the associations between psychosociobehavioral characteristics and CAI intention among MSM in Taiwan who had ever engaged in anal intercourse with men, and compared the differences across three sexual roles (receptive, versatile, and insertive) using online survey data (N?=?563). For all MSM, those that were in a relationship (AOR?=?2.55; 95% CI: 1.61–4.03), had three or more steady partners (AOR?=?2.58; 95% CI: 1.19–5.58), did not use a condom during last anal intercourse (AOR?=?6.81; 95% CI: 4.36–10.63), perceived high HIV risk (AOR?=?2.13; 95% CI: 1.26–3.60), and had high sexual sensation seeking (AOR?=?2.80; 95% CI: 1.82–4.30) were more likely to have high CAI intention. After stratification, the significant characteristics differed depending on sexual role, except for no condom use during last anal intercourse remaining significant in all models (AOR?=?5.09–20.30; 95% CI: 2.49–66.69, depending on sexual role). Tailoring the programs for MSM of different sexual roles may improve the effectiveness of future prevention efforts.     

Substance abuse treatment and hospitalization among a cohort of HIV-infected individuals with alcohol problems

BACKGROUND: We examined the association of substance abuse treatment services on hospitalization among participants in the HIV-Alcohol Longitudinal Cohort (HIV-ALC) study of HIV-infected individuals with a history of alcohol problems. METHODS: A standardized questionnaire that inquired about demographics, substance use, use of substance abuse treatment services, and hospitalization was administered to 349 HIV-ALC participants. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility, 12 visits to a substance abuse counselor or mental health professional, or participation in any methadone maintenance program. RESULTS: Almost one third of this cohort were hospitalized in the past 6 months. Substance abuse treatment was not significantly associated with hospitalization [adjusted odds ratio (AOR) 1.0; 95% confidence interval (CI) 0.7-1.5), whereas homelessness (AOR 2.3; 95% CI 1.5-3.6), injection drug use (AOR 1.7; 95% CI 1.0-2.7), severity of alcohol dependence (AOR 1.02; 95% CI 1.00-1.05), CD4 cell count (AOR 0.999; 95% CI 0.998-1.00), and HIV RNA (AOR 1.1; 95% CI 1.0-1.2) were independently associated with increased odds of hospitalization over time. CONCLUSIONS: Engagement in substance abuse treatment was not associated with a decrease in hospital use by HIV-infected individuals with a history of alcohol problems. The period of substance abuse treatment may present an opportunity to address health care utilization patterns of HIV-infected individuals.     

Unsafe sexual behaviour associated with hazardous alcohol use among street-involved youth

While risky sexual behaviours related to illicit drug use among street youth have been explored, the impacts of alcohol use have received less attention. This longitudinal study examined hazardous alcohol use among a population of street-involved youth, with particular attention to sexual and drug-related risk behaviours. Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada. The outcome of interest was hazardous alcohol use defined by the US National Institute on Alcohol Abuse and Alcoholism. We used generalized estimating equations (GEEs) analyses to identify factors associated with hazardous alcohol use. Between 2005 and 2014, 1149 drug-using youth were recruited and 629 (55%) reported hazardous alcohol use in the previous 6 months during study follow-up. In multivariable GEE analyses, unprotected sex (adjusted odds ratio [AOR]?=?1.28, 95% confidence interval [95% CI]?=?1.12–1.46) and homelessness (AOR?=?1.35, 95% CI?=?1.19–1.54) were independently associated with hazardous alcohol use (all p?p?相似文献   

Loneliness and substance use: the influence of gender among HIV+ Black/African American adults 50+

Estimates suggest 30% of adults report the highest levels of loneliness. Though men are more likely than women to use illicit substances and engage in heavy drinking, the prevalence of substance use in women is growing and their escalation toward dependence occurs more rapidly. Loneliness and substance use have greater relevance within the HIV+ population, with higher rates of substance misuse than the general population. However, the association between loneliness and substance use within HIV+ individuals remains understudied. The purpose of the present study was to test the hypothesis that there would be an association between loneliness and substance moderated by gender in HIV+ older adults. A cross-sectional study was conducted between October 2013 and January 2014. Study participants included 96 HIV-positive Black/African American men and women recruited through the University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) in Jacksonville, Florida. Participants completed an interviewer-administered assessment examining mental and behavioral health. Pearson correlations examined associations between loneliness and substance use. Binary logistic regression analyses stratified by gender examined the association between loneliness and substance use while controlling for covariates. Among women, loneliness was associated with illicit drug use, AOR?=?3.37, 95% CI: 1.23–9.21, p?=?.018 and heavy drinking, AOR?=?2.47, 95% CI: 1.07–5.71, p?=?.033. No significant associations were found between loneliness and illicit drug use, and heavy drinking in men. Substance use among women in this population may be linked to loneliness. Interventions should be gender specific. Further research into this association is necessary as it will likely have important clinical implications for this population.     

Correlates of same-sex behavior disclosure to health care providers among Black MSM in the United States: implications for HIV prevention

Disclosure of same-sex behavior to health care providers (HCPs) by men who have sex with men (MSM) has been argued to be an important aspect of HIV prevention. However, Black MSM are less likely to disclose compared to white MSM. This analysis of data collected in the United States from 2006–2009 identified individual and social network characteristics of Black MSM (n?=?226) that are associated with disclosure that may be leveraged to increase disclosure. Over two-thirds (68.1%) of the sample had ever disclosed to HCPs. Part-time employment (AOR?=?0.32, 95% CI?=?0.11–0.95), bisexual identity (AOR?=?0.29, 95% CI?=?0.12–0.70), and meeting criteria for alcohol use disorders (AOR?=?0.32, 95% CI?=?0.14–0.75) were negatively associated with disclosure. Disclosers were more likely to self-report being HIV-positive (AOR?=?4.47, 95% CI?=?1.54–12.98), having more frequent network socialization (AOR?=?2.15, 95% CI?=?1.24–3.73), and having a social network where all members knew the participant had sex with men (AOR?=?4.94, 95% CI?=?2.06–11.86). These associations were not moderated by self-reported HIV status. Future interventions to help MSM identify social network members to safely disclose their same-sex behavior may also help disclosure of same-sex behavior to HCPs among Black MSM.     

HIV Risk and Protective Factors in the Context of Alcohol and Substance Use During Pride

This investigation sought to identify HIV-risk and -protective factors among men-who-have-sex-with-men (MSM) who engaged in anal sex following alcohol or substance use during an international Pride Festival. MSM attending World Pride were surveyed regarding (1) alcohol, substance use, and sex during the past 24 h; and (2) HIV-risk and -protective factors. Valid data were provided by 1123 MSM. Anal sex was reported by 195 MSM, among whom the majority (n?=?105) consumed alcohol or substances prior to sex. Among MSM aware of their HIV status who consumed alcohol or substances prior to sex (n?=?99), those who engaged in serodiscordant condomless anal sex (n?=?22) were more likely to be HIV+ (AOR?=?10.14, 95% CI 1.48–69.35); report multiple sex partners (AOR?=?9.05, 95% CI 1.70–48.12); and possess lower condom efficacy (AOR?=?0.47, 95% CI 0.23–0.93) and social support (AOR?=?0.08, 95% CI 0.01–0.46). Bolstering condom negotiation skills and social support could potentially reduce HIV acquisition/transmission-risk behavior, even when under the influence of alcohol or substances.     

Behavior change communication and mobile populations: the evaluation of a cross-border HIV/AIDS communication strategy amongst migrants from Swaziland

This study investigates the effect of being exposed to the Soul City Southern Africa Regional OneLove campaign, a behavior change communication program, on sexual behavior and condom use among a mobile population in Swaziland. Data for this study come from a nationally representative sample of 845 individuals who reported traveling to neighboring countries for at least two weeks at any time in the previous two years. Respondents were asked about exposure to the campaign through television, radio, booklets, posters, and advertisements both in Swaziland and in the other countries where they had traveled in the previous two years. Odds ratios were used to estimate the relationships between the HIV/AIDS outcomes of interest and program exposure for the full sample as well as separately for males and females. The program had no effect on reducing known risky behaviors such as having multiple sexual partners. However, men exposed in Swaziland only (AOR?=?3.4, CI 1.2–9.4) and in Swaziland and another country (AOR?=?2.8, CI 1.0–7.7) were more likely to report using a condom at last sex. In the full sample, those exposed in Swaziland were more likely to report using a condom at last sex (AOR?=?2.6, CI 1.3–5.3) and a condom at last sex with a regular partner (AOR?=?2.3, CI 1.1–4.8). Men who reported multiple sexual partnerships and who were exposed in Swaziland and another country were nine times as likely to report condom at last sex than men with no exposure. Respondents exposed in Swaziland and another country were more likely to have been tested for HIV; this was true for the total population (AOR?=?2.9, CI 1.1–7.9) and for men separately (AOR?=?3.3, CI 1.1–10.1). These findings provide support for more regional HIV prevention programs in Southern Africa as a way to increase positive behaviors among mobile populations.     

High Uptake of HIV Testing in a Cohort of Male Injection Drug Users in Delhi, India: Prevalence and Correlates of HIV Infection

We report baseline findings from a longitudinal cohort study to examine HIV incidence, high-risk injection and sexual behaviors of 3,792 male injection drug users (IDUs) in Delhi. The majority (95.4 %) accepted HIV testing; HIV prevalence was 21.9 %. In multivariate analysis, belonging to states adjacent to Delhi (AOR: 1.23; 95 % CI: 1.07–1.52), earning INR 500–1,500 (AOR: 2.38; 95 % CI: 1.43–3.96); duration of drug use 2–5 years (AOR: 2.02; 95 % CI: 1.09–3.73), 6–10 years (AOR: 2.81; 95 % CI: 1.55–5.11), ≥11 years (AOR: 3.35; 95 % CI: 1.84–6.11); prior HIV testing (AOR: 1.60; 95 % CI: 1.35–1.91), self-reported risky-injection behavior (AOR: 1.60; 95 % CI: 1.33–1.92), and utilization of harm-reduction services (AOR: 1.32; 95 % CI: 1.11–1.58) were positively associated with HIV infection. Alcohol use ≤2 times/week (AOR: 0.67; 95 % CI: 0.55–0.82) or ≥3 times/week (AOR: 0.74; 95 % CI: 0.54–1.01), unit increase in age (AOR: 0.99; 95 % CI: 0.98–1.00), ≥7 years of schooling (AOR: 0.82; 95 % CI: 0.66–1.02) and unsafe sex with any female partner (AOR: 0.69; 95 % CI: 0.55–0.86) were negatively associated with HIV infection. HIV prevalence remains high among male IDUs in Delhi. HIV prevention programs should include comprehensive package of services for IDUs.     

Factors associated with sex work among at-risk female youth in Cambodia: a cross-sectional study

In Cambodia, despite great achievements in reducing the prevalence of HIV in the general population, reducing new HIV infections among young at-risk women remains a challenge. This study was designed to examine the prevalence of risky behaviors of sexually active female youth in Cambodia and to explore risk factors associated with engagement in transactional sex. We surveyed sexually active female youth aged 10–24 enrolled at risk “hotspots” in eight provinces in Cambodia. We collected data on demographic factors, sexual behavior, and factors hypothesized to be associated with transactional sex. Multivariable logistic regression was used to identify associations between demographic and sexual behavior and transactional sex. Of the 280 respondents, the mean age was 21.2, and 48.1% had been paid for sex in the past year. After adjustment, at-risk females who were never have been married (adjusted odds ratio (AOR) 3.40, 95% confidence interval (CI)?=?1.65–6.97), have completed less than 6 years of school (AOR 3.26, 95% CI?=?1.60–6.66), have 1 or more parents who had died (AOR 4.34, 95% CI?=?2.00–9.38), be a heavy alcohol drinker (AOR 3.58, 95% CI?=?1.78–7.18), have used a condom with their boyfriend during last sexual encounter (AOR 3.50, 95% CI?=?1.68–7.32), and have ever had an HIV test (AOR 3.51, 95% CI?=?1.68–7.32) were more likely to engage in sex work. Our findings suggest that prevention strategies for female youth at risk of engagement in sex work should include upstream structural interventions that aim to encourage girls' education and empowerment. In addition, tailored sex education and behavior change messaging about the risks of heavy drinking, condom use with romantic partners, and the importance of frequent HIV testing for at-risk youth and sex workers should be designed and delivered to youth currently engaging in sex work.     

Mental health disorders and substance use among people living with HIV in Nepal: their influence on non-adherence to anti-retroviral therapy

People living with HIV often experience mental health disorders and engage in substance use. Evidence, however, is limited about the influence of mental health disorders and substance use on non-adherence to ART. We conducted a cross-sectional study among 682 HIV-positive people on ART in Nepal. We measured their depressive symptoms, anxiety, stress levels, substance use, and non-adherence to ART. We developed logistic regression models to examine the association of mental health disorders and substance use with non-adherence to ART. Experiencing depressive symptoms was positively associated with ART non-adherence among HIV-positive people (men: AOR?=?2.77, p?=?.001; women: AOR?=?3.69, p?=?.001). Additionally, both men and women were more likely to have non-adherence to ART when they had anxiety (men: AOR =?2.19, p?=?.022; women AOR?=?2.83, p?=?.001) and higher stress scores (men: AOR?=?1.11, p?=?.001; women: AOR?=?1.08, p?=?.001). While substance use was associated with non-adherence only in HIV-positive men (AOR?=?3.12, p?<?.001). Depressive symptoms, anxiety, and high level of stress had negative roles on adherence in HIV-positive men and women. While substance use had a negative role on ART adherence among men only. Results highlight that the HIV-positive people should be screened and provided treatment and psychosocial support while providing ART services to improve their medication adherence.     

Associations of types of substances with condomless sex in vulnerable people living with HIV/AIDS

For people living with HIV who are not readily retained in medical care, substance use can contribute to risky sexual behavior that may lead to HIV transmission. This cross-sectional study examined the relationship between stimulants versus opioids and condomless sex in a sample of 223 vulnerable people living with HIV/AIDS. We examined the associations of stimulant and opioid use in the past 30 days with condomless sex while controlling for sample characteristics. More than two thirds (69%) reported having condomless sex in the past six months. Results showed a positive association between condomless sex and any illicit substance use (AOR: 2.82; 95% CI: 1.29–6.17; P?=?0.009) or stimulant use (AOR: 2.54; 95% CI: 1.04–6.24; P?=?0.041) in the past 30 days. These findings suggest the importance of promoting behavioral interventions that increase consistent condom use and reduce stimulant use among people who have difficulties with HIV care retention.     

Characteristics of older adults living with HIV accessing home and community care services in British Columbia,Canada

ABSTRACT

Over half of people living with HIV (PLHIV) engaged in care in British Columbia (BC) are age ≥50. The public home and community care (HCC) system offers formal support that PLHIV may turn to as they age, but little is known about access specific to PLHIV. Using data from the STOP HIV/AIDS cohort, which includes linked treatment and demographic records for PLHIV accessing care in BC, we compared older PLHIV (defined as those age ≥50) who did and did not access HCC services. We estimated adjusted odds ratios (aORs) for factors associated with HCC service utilization using logistic regression. This study included 5,603 PLHIV age ≥50, 837 (14.94%) of whom accessed any HCC service between 2005 and 2015. Services most commonly used were community nursing (8.98%, n?=?503) and rehabilitation (7.73%, n?=?433). Those who received HCC were more likely to be female (aOR?=?1.56, 95% CI?=?1.24, 1.98), have a history of injection drug use (aOR?=?1.88, 95% CI?=?1.57, 2.25), have a higher Charlson comorbidity score (aOR?=?1.11, 95% CI:1.07, 1.15) and to have visited a general practitioner in the past year (aOR?=?2.17, 95% CI?=?1.77, 2.67). Approximately 15% of older PLHIV have accessed HCC, but the extent of potential unmet need for these services requires further research.     

Classification of alcohol use disorders among nightclub patrons: associations between high-risk groups,sociodemographic factors and illicit drug use

Background: Nightclubs are favorable environments for alcohol abuse and the use of other drugs among patrons. Objective: To identify patterns of alcohol use in a high-risk population and their relationship with sociodemographic factors and illicit drug use. Methods: A portal survey technique was used to recruit patrons in 31 nightclubs in the city of São Paulo, Brazil. A two stage sampling method allowed the selection of nightclubs and patrons within a nightclub. A total of 1057 patrons answered to a three stages-survey (nightclub entrance and exit face-to-face interviews and a day-after online questionnaire). Entrance survey offered information on sociodemographic data and history of drug use. The day-after survey used the Alcohol Use Disorders Identifications Test (AUDIT) that identified patterns of alcohol abuse disorders. Data were modeled using an ordered logit regression analysis, considering sample weights. Results: Almost half of the nightclub patrons presented any alcohol use disorder (AUDIT score ≥8). Being male (OR?=?1.68; 95% CI?=?1.09–2.60) and single (OR?=?1.71; 95% CI?=?1.05–2.76) increased the chances for more severe alcohol use disorders. Having a graduate degree (OR?=?0.57; 95% CI?=?0.38–0.87) and age ≥35 years (OR?=?0.48; 95% CI?=?0.27–0.85) decreased the chances of patrons’ alcohol use disorders. The prevalence rates of past-year marijuana, cocaine and inhalants use increased with the increased level of alcohol use disorders. Conclusions: Patrons of nightclubs show higher prevalence rates for any alcohol use disorders than the general population. Patrons could benefit from governmental brief intervention or referral to treatment for alcohol used disorders disclosed in nightclubs.     

Stigma and suicide among gay and bisexual men living with HIV

HIV positive gay and bisexual men (GBM) continue to struggle with the pervasiveness of HIV stigma, but little is known about the health effects of stigma. In this article, suicidal ideation and attempts are measured among GBM living with HIV, evaluating the extent to which these experiences are associated with stigma and suicide. Drawing from an online national survey of Canadian GBM completed by 7995 respondents, a sub-set of data provided by respondents self-reporting HIV-positive status was used for the current study. The associations between suicidal ideation (SI) and attempts (SA) and four measures of HIV stigma were measured: social exclusion, sexual rejection, verbal abuse and physical abuse. A total of 673 HIV-positive men completed the survey (8% of total sample). Among this group, 22% (n?=?150) reported SI and 5% (n?=?33) SA in the last 12 months. After adjusting for sociodemographic factors, SI and SA were associated with each of the four measures of HIV stigma: being excluded socially for being HIV positive (SI adjusted odds ratio, AOR 2.0 95% CI 1.4–3.1; SA AOR 3.8 95% CI 1.9–7.9), rejected as a sexual partner (SI AOR 1.6 95% CI 1.1–2.4; SA AOR 2.6 95% CI 1.1–6.0), verbally abused (SI AOR 2.9 95% CI 1.9–4.5; SA AOR 2.4 95% CI 1.1–5.1), and physically abused (SI AOR 4.5 95% CI 1.8–11.7; SA AOR 6.4 95% CI 2.0–20.1). Furthermore, experiencing multiple forms of stigma was associated with significantly increased risk of SI and SA. The authors conclude that HIV positive GBM experience significant levels of stigma that are associated with heightened risk for suicide. The findings affirm the need for targeted interventions to prevent suicide amid public health efforts to de-stigmatize HIV and mental illness.     

Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

Background

Food insecurity, or the uncertain availability of nutritionally adequate, safe foods, has been associated with poor HIV outcomes. There are few data on the extent to which food insecurity impacts patterns of health-care utilization among HIV-infected individuals.

Objective

We examined whether food insecurity was associated with hospitalizations, Emergency Department (ED) visits, and non-ED outpatient visits.

Methods

HIV-infected, homeless and marginally housed individuals participating in the San Francisco Research on Access to Care in the Homeless (REACH) cohort underwent quarterly structured interviews and blood draws. We measured food insecurity with the validated Household Food Insecurity Access Scale, and categorized participants as food secure, mild/moderately food insecure, and severely food insecure. Primary outcomes were: (1) any hospitalizations, (2) any ED visits, and (3) any non-ED outpatient visits. Generalized estimating equations were used to estimate model parameters, adjusting for socio-demographic (age, sex, ethnicity, education, income, housing status, health insurance) and clinical variables (CD4 nadir, time on antiretroviral therapy, depression, and illicit drug use).

Results

Beginning in November 2007, 347 persons were followed for a median of 2 years. Fifty-six percent of participants were food insecure at enrollment. Compared with food-secure persons, those with severe food insecurity had increased odds of hospitalizations [adjusted odds ratio (AOR)?=?2.16, 95 % confidence interval (CI)?=?1.50–3.09] and ED visits (AOR?=?1.71, 95 % CI?=?1.06–2.30). While the odds of an outpatient visit were 41 % higher for severely food insecure individuals, the effect was not statistically significant (AOR?=?1.41, 95 % CI?=?0.99–2.01). Mild/moderate food insecurity was also associated with increased hospitalizations (AOR?=?1.56, 95 % CI?=?1.06–2.30), ED visits (AOR?=?1.57, 95 % CI?=?1.22–2.03), and outpatient visits (AOR?=?1.68, 95 % CI?=?1.20–2.17).

Conclusions

Food insecurity is associated with increased health services utilization among homeless and marginally housed HIV-infected individuals in San Francisco. Increased ED visits and hospitalizations are not related to fewer ambulatory care visits among food-insecure individuals. Addressing food insecurity should be a critical component of HIV treatment programs and may reduce reliance on acute care utilization.     

The intersection of intimate partner violence and HIV risk among women engaging in transactional sex in Ugandan fishing villages

Intimate partner violence (IPV) may increase risk for HIV/AIDS among women engaging in transactional sex in Ugandan fishing communities. In this cross-sectional study, 115 women reporting engaging in transactional sex in Lake Victoria fishing communities completed a computerized interview. We tested associations between IPV and other HIV risk factors, with unprotected sex and HIV status, and tested moderators of the IPV-HIV risk relationship. Women reporting recent sexual IPV reported 3.36 times more unprotected sex acts (AdjExp[B]?=?3.36, 95% CI?=?1.29–8.69, p?=?0.07). The effect of sexual IPV on sexual risk was significantly greater among alcohol and fish sellers compared to sex workers (interaction: Exp[B]?=?12.29, 95% CI?=?5.06–29.85, p?p?=?0.02). Integrated IPV and HIV interventions are needed in this context, especially among alcohol and fish sellers engaging in transactional sex.     

A Population-Based Study on Substance Abuse Treatment for Adults with Disabilities: Access,Utilization, and Treatment Outcomes

Aims: To examine potential disparities in access to substance abuse treatment services for Medicaid-eligible adults with disabilities, and compare utilization rates and outcomes in outpatient programs. Design: Population-based multi-year cross-sectional study. Setting: State-wide examination of substance-abuse treatment, particularly outpatient. Participants: Medicaid enrollees aged 18–64. Measures: Treatment access and utilization; outcome measures of retention, completion, readmission, and abstinence derived from state treatment and Medicaid databases. Findings: Access and utilization rates for adults with disabilities were about half others' rates; treatment outcomes were generally equivalent across groups. Conclusions: Adults with disabilities are underutilizing substance abuse treatment, suggesting barriers to accessing treatment.     

Factors associated with establishment-based female sex workers accessing health care services in Shanghai

Female sex workers are a priority population for HIV prevention and health promotion in China. This paper examines the patterns of and factors associated with the utilisation of HIV-related and general health services by establishment-based sex workers in Hongkou District, Shanghai. Participants were recruited through a three-stage sampling strategy and invited to self-complete a brief survey in 2012. The median age of the 400 participants included in the analyses was 33 years (range = 18–52 years old), with over three-quarters being married at the time of the survey. Participants were mostly internal migrants, more than half had lived in Shanghai for six months or longer and nearly two-thirds were working in an establishment with a total of less than five female sex workers. Routine physical examination and HIV testing were the most commonly accessed health services in the previous 12 months. Altogether, 347 women (86.8%) had actively sought, including 157 women had obtained, free health services mainly from local Community Health Service Centres (CHSCs) in the previous 12 months. The active seeking of free, largely CHSC-provided health services was associated with a longer duration of residence in Shanghai (adjusted odds ratio [AOR] = 2.55, 95% CI = 1.32–4.93; p < 0.01) and having tested for HIV in the previous 12 months (AOR = 3.68, 95% CI = 1.84–7.38; p < 0.001). Conversely, a higher annual income (AOR = 0.41, 95% CI = 0.21–0.80; p < 0.01), working in a larger establishment (AOR = 0.40, 95% CI = 0.20–0.79; p < 0.01) and knowing that HIV can be transmitted through blood transfusion with unscreened blood (AOR = 0.21, 95% CI = 0.05–0.91; p < 0.05) were associated with not actively seeking such services. Free, community-based health services are highly demanded by establishment-based female sex workers in Shanghai. Scaling-up of free and integrated health services provided by community-based health service providers in metropolitan areas in China and beyond holds promise for promoting health and well-being of female sex workers.