Sex Work Regulation and Sexually Transmitted Infections in Tijuana, Mexico

While reducing the transmission of sexually transmitted infections is a common argument for regulating sex work, relatively little empirical evidence is available regarding the effectiveness of these policies. 

We investigate the effects of highly publicized sex work regulations introduced in 2005 in Tijuana, Mexico on the incidence of trichomoniasis. State-level, annual data for the 1995-2012 period are employed that include the incidence rates of trichomoniasis by age group and predictor variables. We find that the regulations led to a decrease in the incidence rate of trichomoniasis. Specifically, while our estimates are somewhat noisy, the all-ages incidence rate in the 2005-2012 period is roughly 37% lower than what is predicted by our synthetic control estimates and corresponds to approximately 800 fewer reported cases of trichomoniasis per year. 

We find that the decreases are especially pronounced for 15-24 and 25-44 age cohorts.

Purchase full article at:   http://goo.gl/CXN1CE

By:  Quast T1, Gonzalez F2.

• 1Health Policy and Management, College of Public Health, University of South Florida, Tampa, FL, USA.
• 2Economics and International Business, Sam Houston State University, Huntsville, TX, USA. 
• Health Econ. 2016 Mar 16. doi: 10.1002/hec.3339

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Cost-Effectiveness of Combined Sexual and Injection Risk Reduction Interventions among Female Sex Workers Who Inject Drugs in Two Very Distinct Mexican Border Cities

Background

We evaluated the cost-effectiveness of combined single session brief behavioral intervention, either didactic or interactive (Mujer Mas Segura, MMS) to promote safer-sex and safer-injection practices among female sex workers who inject drugs (FSW-IDUs) in Tijuana (TJ) and Ciudad-Juarez (CJ) Mexico. Data for this analysis was obtained from a factorial RCT in 2008–2010 coinciding with expansion of needle exchange programs (NEP) in TJ, but not in CJ.

Methods

A Markov model was developed to estimate the incremental cost per quality adjusted life year gained (QALY) over a lifetime time frame among a hypothetical cohort of 1,000 FSW-IDUs comparing a less intensive didactic vs. a more intensive interactive format of the MMS, separately for safer sex and safer injection combined behavioral interventions. The costs for antiretroviral therapy was not included in the model. We applied a societal perspective, a discount rate of 3% per year and currency adjusted to US$2014. A multivariate sensitivity analysis was performed. The combined and individual components of the MMS interactive behavioral intervention were compared with the didactic formats by calculating the incremental cost-effectiveness ratios (ICER), defined as incremental unit of cost per additional health benefit (e.g., HIV/STI cases averted, QALYs) compared to the next least costly strategy. Following guidelines from the World Health Organization, a combined strategy was considered highly cost-effective if the incremental cost per QALY gained fell below the gross domestic product per capita (GDP) in Mexico (equivalent to US$10,300).

Findings

For CJ, the mixed intervention approach of interactive safer sex/didactic safer injection had an incremental cost-effectiveness ratio (ICER) of US$4,360 ($310–$7,200) per QALY gained compared with a dually didactic strategy. Using the dually interactive strategy had an ICER of US$5,874 ($310–$7,200) compared with the mixed approach. For TJ, the combination of interactive safer sex/didactic safer injection had an ICER of US$5,921 ($104–$9,500) per QALY compared with dually didactic. Strategies using the interactive safe injection intervention were dominated due to lack of efficacy advantage. The multivariate sensitivity analysis showed a 95% certainty that in both CJ and TJ the ICER for the mixed approach (interactive safer sex didactic safer injection intervention) was less than the GDP per capita for Mexico. The dual interactive approach met this threshold consistently in CJ, but not in TJ.

Interpretation

In the absence of an expanded NEP in CJ, the combined-interactive formats of the MMS behavioral intervention is highly cost-effective. In contrast, in TJ where NEP expansion suggests that improved access to sterile syringes significantly reduced injection-related risks, the interactive safer-sex combined didactic safer-injection was highly cost-effective compared with the combined didactic versions of the safer-sex and safer-injection formats of the MMS, with no added benefit from the interactive safer-injection component.

Below:  Cost-effectiveness acceptability curve for the combined interactive safer sex-didactic safer injection intervention in Cd. Juarez

Below:  Cost-effectiveness acceptability curve for the combined interactive safer sex/Safer injection intervention for Ciudad Juarez

Below:  Cost-effectiveness acceptability curve for the combined interactive safer sex and didactic safer injection components of the Mujer Mas Segura intervention in Tijuana

Full article at:   http://goo.gl/RBQD6m

By:  

Jose L. Burgos, Steffanie A. Strathdee

University of California San Diego, Department of Medicine, Division of Global Public Health, La Jolla, California, United States of America

Jose L. Burgos

Universidad Autonoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, México

Thomas L. Patterson

University of California San Diego, Department of Psychiatry, La Jolla, California, United States of America

Joshua S. Graff-Zivin

University of California San Diego, School of Global Policy and Strategy, La Jolla, California, United States of America

James G. Kahn

University of California San Francisco, Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, Global Health Sciences, San Francisco, California, United States of America

M. Gudelia Rangel

Secretaria de Salud de México, Comision de Salud Fronteriza Mexico-Estados Unidos Sección México, Tijuana, Baja California, México

M. Remedios Lozada

Instituto de Servicios de Salud Pública del Estado de Baja California, Mexicali, Baja California, Mexico

Hugo Staines

Universidad Autonoma de Ciudad Juarez, Facultad de Medicina, Ciudad Juárez, Chihuahua, México

  

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Intravaginal Practices among HIV-Negative Female Sex Workers Along the US-Mexico Border & Their Implications for Emerging HIV Prevention Interventions

OBJECTIVE:

To describe intravaginal practices (IVPs) among female sex workers (FSWs) who inject drugs in two cities-Tijuana and Ciudad Juarez-on the border between the USA and Mexico.

METHODS:

Data for a secondary analysis were obtained from interviews conducted as part of a randomized controlled trial in FSWs who injected drugs between October 28, 2008, and May 31, 2010. Eligible individuals were aged at least 18 years and reported sharing injection equipment and having unprotected sex with clients in the previous month. Descriptive statistics were used to assess frequency and type of IVPs. Logistic regression was used to assess correlates of IVPs.

RESULTS:

Among 529 FSWs who completed both surveys, 229 (43.3%) had performed IVPs in the previous 6 months. Factors independently associated with IVPs were reporting any sexually transmitted infection in the previous 6 months, three or more pregnancies, and having clients who became violent when proposing condom use, which are all factors related to inconsistent condom use.

CONCLUSION:

Screening for IVPs could help to identify FSW at increased risk of HIV, and facilitate conversations about specific risk-reduction methods.

Purchase full article at: 

By:  Seidman D1, Rusch M2, Abramovitz D3, Stockman JK3, Martinez G4, Rangel G5, Vera A3, Ulibarri MD6, Strathdee SA7.

• 1Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
• 2Population Health and Epidemiology, Island Health, Victoria, BC, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada.
• 3Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA.
• 4Community Health and Development of Ciudad Juarez and the Mexican Federation of Private Associations, Ciudad Juarez, Mexico.
• 5El Colegio de la Frontera del Norte, Tijuana, Mexico.
• 6Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
• 7Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA. Electronic address: sstrathdee@ucsd.edu. 
• Int J Gynaecol Obstet. 2016 Jan 28. pii: S0020-7292(16)00037-0. doi: 10.1016/j.ijgo.2015.09.025.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities

We know little about predictors of injection drug cessation and relapse among female sex workers who inject drugs (FSW-PWID) at the US-Mexico border. 

Among HIV-negative FSW-PWID taking part in a behavioral intervention study in Tijuana and Ciudad Juárez, Cox regression was used to identify predictors of time to first cessation of injection, which was defined as reporting not having injected drugs for a period of 4 months or longer, and among that subset, we examined predictors of time to injection relapse. 

Among 440 women, 84 (19 %) reported ceasing injection during follow-up (median time to cessation = 9.3 months); of these, 30 (35 %) reported relapse to injection (median time to relapse = 3.5 months). The rate of injection cessation was lower for women reporting trading sex prior to age 18, ever being sexually abused, and a higher number of vaginal sex acts with casual clients. The rate of cessation was higher for women who spent more hours on the streets on a typical day and who lived in Tijuana vs. Ciudad Juárez. The rate of relapse was higher among women reporting regular drug use with clients and those scoring higher on a risk injection index. The rate of relapse was lower for FSW-PWID with higher than average incomes. 

These findings have important implications for the scale-up of methadone maintenance treatment programs (MMTPs) in Mexico and indicate a need for gender-specific programs that address sexual abuse experiences and economic vulnerabilities faced by FSW-PWID.

Purchase full article at:   http://goo.gl/EbvN4c

By:  West BS1, Abramovitz D2, Staines H3, Vera A2, Patterson TL4, Strathdee SA2; for Proyecto Mujer Mas Segura.

• 1Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA, 92093-0507, USA. bswest@ucsd.edu.
• 2Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA, 92093-0507, USA.
• 3Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
• 4Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Chihuahua, Mexico. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

A Qualitative Exploration of Perceived Gender Differences in Methamphetamine Use among Women Who Use Methamphetamine on the Mexico-U.S. Border

The purpose of this study is to extend the research on contextual factors that influence the initiation and continued use of methamphetamine (meth) by women on the U.S.-Mexico border. 

At present, a minimal body of literature exists that explores meth use on the Mexico-U.S. border. A purposeful sample of 20 women who were active meth users aged ≥18 years was recruited by trained outreach workers from a variety of meth-user networks in Ciudad Juárez, Mexico, the city bordering El Paso, Texas. 

Respondents participated in in-depth, semi-structured interviews including questions on users' perceived familial, social, and environmental influences of meth use. Gender-based themes emerged from the analysis: 

1. patterns of meth use; 
2. places where drugs were used; 
3. effects of relationship networks on meth use; 
4. differential access to drugs; 
5. trading sex for drugs; 
6. perceived class differences; and 
7. long-term drug use and its consequences. 

Respondents reported a preference for using meth as powder or pills as opposed to smoking or injecting the drug. They reported being introduced to meth by men they trust and relying on men for drug acquisition in spaces less accessible and more dangerous to women. 

They described how the drug changed their lifestyle and their behavior towards family members and friends, including instances of physical and psychological violence. Interventions for women on the Mexico-U.S. border should be developed based on users' social networks to target social processes to prevent initiation and to bring active meth users into treatment.

Purchase full article at:   http://goo.gl/0ZvM9Y

By:   Loza O¹, Ramos R², Ferreira-Pinto J¹, Hernandez MT³, Villalobos SA⁴.

¹a College of Health Sciences , University of Texas at El Paso (http://chs.utep.edu/) , El Paso , TX.

²b Alliance of Border Collaboratives (ABC) , El Paso , TX.

³c School of Public Health , University of California , Berkeley , CA.

⁴d Department of Emergency Medicine , Texas Tech Health Sciences of El Paso, Paul Foster School of Medicine , El Paso , TX.

J Ethn Subst Abuse. 2015 Dec 21:1-20. [Epub ahead of print]

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Measuring Current Drug Use in Female Sex Workers and Their Noncommercial Male Partners in Mexico: Concordance Between Data Collected from Surveys vs Semi-Structured Interviews

BACKGROUND:

Self-reports are commonly used to assess prevalence and frequency of drug use, but it is unclear whether qualitative methods like semi-structured interviews are as useful at obtaining such information as quantitative surveys.

OBJECTIVES:

This study compared drug use occurrence and frequency using data collected from quantitative surveys and qualitative interviews. We also examined whether combining data from both sources could result in significant increases in percentages of current users and whether the concordance between the two sets of data was associated with the type of drug use, age, gender and socioeconomic status.

METHODS:

Self- reports of recent marijuana, heroin, crack, cocaine, crystal/methamphetamine, inhalant, and tranquilizer use were collected using both methods from a cohort of Mexican female sex workers and their non-commercial male partners (n = 82).

RESULTS:

Participants were significantly less likely to report marijuana, cocaine and tranquilizer use and frequency of use during the qualitative interviews than during the quantitative surveys. Agreement on frequency of drug use was excellent for crystal/methamphetamine, heroin and inhalant use, and weak for cocaine, tranquilizers and marijuana use. Older participants exhibited significantly higher concordance than younger participants in reports of marijuana and methamphetamine use. Higher monthly income was significantly associated with higher concordance in crack use but lower concordance with marijuana use.

CONCLUSIONS:

Although use of such data can result in an underreporting of drug use, qualitative data can be quantified in certain circumstances to triangulate and confirm the results from quantitative analyses and provide a more comprehensive view of drug use.

Purchase full article at:   http://goo.gl/Oq4RlS

By:   Palinkas LA1, Bazzi AR2, Syvertsen JL3, Ulibarri MD4, Hernandez D5, Rangel MG6, Martinez G7, Strathdee SA8.

• 1 School of Social Work , University of Southern California , Los Angeles , California , USA.
• 2 Community Health Sciences , Boston University , Boston , Massachusetts , USA.
• 3 Anthropology, The Ohio State University , Columbus , Ohio , USA.
• 4 Psychiatry, University of California , San Diego, La Jolla , California , USA.
• 5 School of Medicine , University of California , Davis, Sacramento , California , USA.
• 6 El Colegio de la Frontera Norte , Tijuana , Mexico.
• 7 Federacion Mexicana de Asociaciones Privadas , Cuidad Juarez , Mexico.
• 8 Division of Global Public Health , University of California , San Diego, La Jolla , California , USA. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

A Qualitative Exploration of Perceived Gender Differences in Methamphetamine Use among Women Who Use Methamphetamine on the Mexico–U.S. border

The purpose of this study is to extend the research on contextual factors that influence the initiation and continued use of methamphetamine (meth) by women on the U.S.-Mexico border. 

At present, a minimal body of literature exists that explores meth use on the Mexico-U.S. border. A purposeful sample of 20 women who were active meth users aged ≥18 years was recruited by trained outreach workers from a variety of meth-user networks in Ciudad Juárez, Mexico, the city bordering El Paso, Texas. Respondents participated in in-depth, semi-structured interviews including questions on users’ perceived familial, social, and environmental influences of meth use. 

Gender-based themes emerged from the analysis: 

1. patterns of meth use; 
2. places where drugs were used; 
3. effects of relationship networks on meth use; 
4. differential access to drugs; 
5. trading sex for drugs; 
6. perceived class differences; and 
7. long-term drug use and its consequences. 

Respondents reported a preference for using meth as powder or pills as opposed to smoking or injecting the drug. They reported being introduced to meth by men they trust and relying on men for drug acquisition in spaces less accessible and more dangerous to women. 

They described how the drug changed their lifestyle and their behavior towards family members and friends, including instances of physical and psychological violence. Interventions for women on the Mexico-U.S. border should be developed based on users’ social networks to target social processes to prevent initiation and to bring active meth users into treatment.

Purchase full article at:   http://goo.gl/3HQjNt

By:   Oralia Loza^a*, Rebeca Ramos^b, João Ferreira-Pinto^a, Maria Teresa Hernandez^c & Susana A. Villalobos^d

• ^a College of Health Sciences, University of Texas at El Paso, El Paso, TX
• ^b Alliance of Border Collaboratives (ABC), El Paso, TX
• ^c School of Public Health, University of California, Berkeley, CA
• ^d Department of Emergency Medicine, Texas Tech Health Sciences of El Paso, Paul Foster School of Medicine, El Paso, TX

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

A Tale of Two Epidemics: Gender Differences In Socio-Demographic Characteristics & Sexual Behaviors among HIV Positive Individuals in Mexico City

BACKGROUND:

To date, the HIV epidemic in Mexico has been concentrated mainly among men who have sex with men, but heterosexual transmission, particularly to women, is increasingly important. This study examine gender differences in socio-demographic characteristics and risk behaviors of HIV positive individuals in Mexico City.

METHODS:

We analyzed data from a cross-sectional survey of 1,490 clinic patients (male:female ratio 8:1) with HIV inMexico City in 2010. We examined socio-demographic characteristics, risk behavior, and history of HIV infection.From multivariate non-linear probability (probit) models we calculated predicted probabilities by sex of several outcomes: marginalization, demographic and sexual risk behaviors.

RESULTS:

Significant differences were found between men and women. Multivariate models suggest that women had lower schooling levels; were less likely to have been employed in the past month and earn more than the minimal wage; more likely to have children, to have been sexually abused, to never have used condoms and to report having been infected by a stable partner. Additionally, women were less likely to report having a partner with a history of migration to the USA and to have engaged in transactional sex.

CONCLUSION:

Significant differences exist between men and women with HIV in Mexico City in terms of their socioeconomicand behavioral profiles, which translate into differences in terms of exposure to HIV infection. Women face social and economic vulnerability while men tend to have riskier sexual behavior. Gender issues must be approached in prevention and treatment efforts, using diverse methods to target those most vulnerable and at risk.

Table 2

History of HIV infection among study participants

	Women	Men	p-value*
	(N = 167)	(N = 1,323)
	Percentage [CI-95 %]
Presumed route of HIV infection
Blood transfusion	6.98 [3.55,12.9]	1.53 [0.95,2.42]	<0.001
Sharing syringes	1.55 [0.07,5.83]	0.51 [0.21,1.14]
Sex without condom	84.5 [77.2,89.8]	82.5 [80.2,84.6]
Condom failure	3.10 [0.95,7.97]	12.1 [10.3,14.1]
I was forced to have sex	3.10 [0.95,7.97]	3.06 [2.21,4.22]
I forced someone to have sex	0.78 [0.00,4.69]	0.34 [0.10,0.90]
Infected by a stable partner	69.6 [61.0,77.0]	44.0 [41.0,46.9]	<0.001
Migrant/military/prison background of the person who infected you
Military or police	18.7 [12.7,26.6]	3.77 [2.64,5.35]	<0.001
Prison experience	16.8 [11.0,24.9]	3.42 [2.29,5.07]	<0.001
Migrant to the USA	17.3 [11.3,25.5]	27.4 [24.1,31.1]	0.01
Migrant, military or prison background	41.5 [33.1,50.3]	24.4 [21.6,27.4]	0.01
Reason for getting HIV test
Unprotected sex	12.6 [8.13,18.9]	19.9 [17.7,22.2]	<0.001
Tested while hospitalized	14.6 [9.76,21.1]	13.9 [12.0,15.9]
Medical advice	12.6 [8.13,18.9]	18.2 [16.1,20.4]
Requested by employer	0.66 [0.00,4.03]	1.62 [1.04,2.51]
When donating blood	3.97 [1.65,8.59]	3.57 [2.66,4.77]
HIV positive partner	25.8 [19.5,33.4]	15.5 [13.6,17.6]
Shared injecting equipment	0.66 [0.00,4.03]	0.16 [0.00,0.63]
Routine test (frequent tester)	1.32 [0.06,5.01]	7.54 [6.19,9.16]
Other	19.9 [14.2,27.0]	19.7 [17.6,22.0]
In pregnancy	7.95 [4.48,13.5]	----

Footnote: *Tests for differences in means or proportions. We used bivariate t-test for continuous variables and Chi-square test for categorical variables to compare men and women

Table 3

Sexual violence and risk behaviour history before HIV diagnosis among study participants

	Women	Men	p-value*
	(N = 167)	(N = 1,323)
	Mean or percentage [CI-95 %]
Any time in life
Frequently, almost always or always	3.85 [1.19,9.79]	19.4 [16.5,22.6]	<0.001
Sex with men only	91.7 [85.3,95.6]	80.6 [78.1,82.9]	0.01
Sex with women only	4.13 [1.53,9.56]	9.46 [7.82,11.4]
Sex with men and women	4.13 [1.53,9.56]	9.93 [8.26,11.9]
Risk behavior at sexual encounters before diagnosis
Frequency of condom use
Never	73.8 [65.3,80.8]	49.8 [46.7,52.8]	<0.001
Sometimes	11.5 [6.84,18.5]	23.1 [20.6,25.8]
Frequently, almost always or always	14.8 [9.45,22.2]	27.1 [24.5,29.9]
Frequency of alcohol use
Never	70.7 [62.1,78.1]	55.2 [52.1,58.2]	<0.001
Sometimes	18.7 [12.7,26.6]	27.9 [25.3,30.8]
Frequently, almost always or always	10.6 [6.16,17.4]	16.9 [14.7,19.3]
Frequency of drug use
Never	86.7 [79.3,91.7]	79.8 [77.2,82.1]	0.20
Sometimes	7.50 [3.82,13.8]	10.8 [9.07,12.9]
Frequently, almost always or always	5.83 [2.65,11.8]	9.38 [7.73,11.3]
Frequency of both drug and alcohol use
Never	88.5 [81.5,93.2]	80.2 [77.7,82.6]	0.06
Sometimes	4.92 [2.05,10.5]	11.4 [9.54,13.4]
Frequently, almost always or always	6.56 [3.18,12.6]	8.41 [6.86,10.3]
Sexual abuse
Sexually abused at least once	17.9 [12.7,24.6]	12.6 [10.9,14.6]	0.09
Average (sd) number of times sexually abused	11.8 [4.66,18.9]	3.69 [2.72,4.67]	0.02
Age when first sexually abused	17.9 [13.6,22.2]	13.5 [11.9,15.2]	0.05
Number of sexual encounters in the last month a	9.30 [6.57,12.0]	9.18 [8.30,10.1]	0.94
Age of first sexual intercourse	16.9 [16.3,17.6]	15.5 [15.2,15.7]	<0.001

Footnote: *Tests for differences in means or proportions. We used bivariate t-test for continuous variables and Chi-square test for categorical variables to compare men and women

a78 % of women reported having frequent sex with regular partners (42.9 % among males), the rest reported frequent sex with an occasional or one-time partner (data not shown)

Full article at:  http://goo.gl/t4YzOU

By:   Bautista-Arredondo S1, Servan-Mori E2, Beynon F3, González A4, Volkow P5.

• 1National Institute of Public Health, Cuernavaca, Mexico. sbautista@insp.mx.
• 2National Institute of Public Health, Cuernavaca, Mexico. eservan@insp.mx.
• 3National Institute of Public Health, Cuernavaca, Mexico. fenellajb@gmail.com.
• 4Mexico City's AIDS Program, Mexico City, Mexico. andrea.gonzalez.condesa@gmail.com.
• 5National Institute of Oncology, Mexico City, Mexico. pvolkowf@incan.edu.mx. 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health