We sought to test the efficacy of a sexual risk intervention
for male clients of female sex workers (FSWs)
and examine whether efficacy was moderated by syndemic risk.
From 2010 to 2014, we conducted a 2-arm randomized
controlled trial (60-minute, theory-based, safer sex intervention versus a didactic
time-equivalent attention control) that included 400 male clients of FSWs on
the US-Mexico border
with follow-up at 4, 8, and 12 months. We measured 5 syndemic risk factors,
including substance use and depression. Primary outcomes were sexually
transmitted infections incidence and total unprotected sex with FSWs.
Although participants in both groups became safer, there was
no significant difference in behavior change between groups. However, baseline
syndemic risk moderated intervention efficacy. At baseline, there was a
positive association between syndemic risk and unprotected sex.
Then at 12 months, longitudinal analyses showed the association depended on
intervention participation (B = -0.71; 95% confidence interval [CI] = -1.22,
-0.20; P = .007). Among control participants there still existed this modest
association (B = 0.36; 95% CI = -0.49, 1.22; P = .09); among intervention
participants there was a significant negative association (B = -0.35; 95%
CI = -0.63, -0.06; P = .02).
A brief intervention might attenuate syndemic risks among
clients of FSWs. Other populations experiencing syndemic problems may also
benefit from such programs.
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By:
- 1Eileen V. Pitpitan, Steffanie A. Strathdee, Shirley J. Semple, and Claudia V. Chavarin are with the Division of Global Public Health, Department of Medicine, University of California San Diego. Carlos Magis-Rodriguez is with the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico. Thomas L. Patterson is with the Department of Psychiatry, University of California San Diego.
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