Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Jeffrey A. Wickersham

Second Advisor

Kaveh Khoshnood


Objective: To describe the female and transgender sex worker population in Kuala Lumpur, Malaysia, understand their patterns of substance use, and examine the correlates of active amphetamine-type substance (ATS) use.

Methods: We administered a cross-sectional survey and performed biological testing on 492 sex workers to assess lifetime and active substance use history and frequency, criminal justice involvement, alcohol and substance abuse disorders, sexual risk behaviors, experience of childhood and adulthood physical and sexual abuse, depression, and prevalence of HIV, syphilis, chlamydia, and gonorrhea. We performed descriptive statistics to describe demographics and lifetime and active drug use patterns and employed bivariate and multivariate logistic regression to examine correlates of active ATS use.

Results: Of 492 participants 299 (60.8%) were female and 193 (39.2%) were transgender. Prevalence of substance abuse disorders (29.7%) were high. ATS (32.3%) was the substance with highest reported use in the 30 days prior; smoking was the main route of administration. Of the sample, 11.7% was HIV-infected and 11.9% tested positive for syphilis. The majority of

participants were unaware of their infections. History of childhood and adulthood physical and sexual abuse, depression (57.1%), and previous incarceration was also high (57.5%). Location, history of incarceration, history of self-harm, polysubstance use, and testing positive for syphilis were significantly associated with active ATS use even after controlling for all other variables.

Conclusion: Our findings suggest there is a high need for evidence-based interventions for HIV prevention tailored specifically towards female and transgender women who dually engage in drug use and sex work.

Open Access

This Article is Open Access