From 2010 to 2011, we conducted a cross-sectional survey of FSWs and their non-commercial male partners in Tijuana and Ciudad Juárez, Mexico. Eligible FSWs and their verified male partners were aged ≥18 years; FSWs reported lifetime use of heroin, cocaine, crack, or methamphetamine and recently exchanged sex (past month).
Participants completed baseline questionnaires and testing for HIV, chlamydia, gonorrhea, and syphilis. We determined the prevalence and correlates of individuals' HIV/STI positivity using bivariate probit regression. Among 212 couples (n = 424),
- prevalence of HIV was 2.6 %
- 9.9 % tested positive for any HIV/STIs, which was more prevalent among women than men (12.7 % vs. 7.1 %).
- FSWs with regular sex work clients were less likely to test positive for HIV/STIs than those without regular clients.
- Similarly, male partners of FSWs who had regular clients were 9 % less likely to have HIV/STIs.
- Higher sexual decision-making power was protective against HIV/STIs for women.
- Men who recently used methamphetamine or reported perpetrating any conflict within steady relationships were more likely to test positive for HIV/STIs.
Couple-based prevention interventions should recognize how intimate relationship factors and social contexts influence HIV/STI vulnerability
TABLE 1
Characteristics of 212 female sex workers and their 212 non-commercial male partners in two Mexico-USA border cities (N = 424)
| Variable | Women (n = 212) | Men (n = 212) | Overall (n = 424) |
|---|---|---|---|
| Sociodemographics | |||
| Lives in Tijuana (vs. Ciudad Juarez) | 104 (49 %) | 104 (49 %) | 208 (49 %) |
| Median age in years (interquartile range; IQR) | 33 (26–39) | 37 (31–43) | 34 (29–41)*** |
| Median educational attainment in years (IQR) | 6 (6–9) | 7 (6–9) | 7 (6–9)*** |
| Born in study site (vs. someplace else) | 105 (50 %) | 94 (44 %) | 199 (47 %) |
| Income <2,500 pesos per month (<$200 USD) | 81 (38 %) | 103 (49 %) | 184 (43 %)** |
| Ever been arrested (lifetime) | 116 (55 %) | 140 (66 %) | 256 (60 %)*** |
| Relationship factors | |||
| Median relationship duration in years (IQR) a | – | – | 3.0 (1.6–5.4) |
| Median % vaginal sex acts were unprotected in past month (IQR) a | – | – | 100 (82–100) |
| Median trust of partner on 10-point scale (IQR) | 9 (7–10) | 9 (8–10) | 9 (7–10)** |
| Median relationship satisfaction, 20-point scale (IQR) | 15 (13–15) | 15 (14, 15) | 15 (14, 15)* |
| Male financial dependence on FSW's income a | – | 62 (29 %) | – |
| Median relationship control, 48-point scale (IQR) b | 35 (31–36) | 27 (24–30) | 30 (26–36)*** |
| Median decision-making dominance, 24-point scale (IQR)b | 16 (16, 17) | 16 (16, 17) | 16 (16, 17) |
| Perpetrated/caused any conflict within steady relationship, past year c | 98 (46 %) | 108 (51 %) | 206 (49 %) |
| Victim of any conflict within steady relationship, past year c | 87 (41 %) | 115 (54 %) | 202 (48 %)** |
| Sexual behaviors | |||
| Sexually satisfied with steady partner (vs. not satisfied) | 185 (87 %) | 198 (93 %) | 383 (90 %)** |
| Self-identified as bisexual (vs. heterosexual) | 4 (2 %) | 10 (5 %) | 14 (3 %) |
| Male partner ever exchanged sex for money, drugs, other material goods (among men only, n = 212) | – | 73 (34 %) | – |
| Male partner had any outside sex partners, past 6 months (among men only, n = 212) | – | 65 (31 %) | – |
| Had any “steady” concurrent sex partners (including regular clients), past year | 54 (25 %) | 13 (6 %) | 67 (16 %)*** |
| FSW had any regular clients, past month (among FSWs only, n = 212) | 186 (88 %) | – | – |
| FSW often/always uses condoms with clients vs. rarely/never, past month (among FSWs only, n = 212) | 118 (56 %) | – | – |
| Drug abuse (past 6 months) | |||
| Used heroin | 136 (64 %) | 130 (61 %) | 266 (63 %) |
| Used methamphetamine | 69 (33 %) | 62 (29 %) | 131 (31 %) |
| Used cocaine use | 45 (21 %) | 40 (19 %) | 85 (20 %) |
| Used crack | 36 (17 %) | 23 (11 %) | 59 (14 %)** |
| Used inhalants | 20 (9 %) | 14 (7 %) | 34 (8 %) |
| Injected any drugs | 132 (62 %) | 123 (58 %) | 255 (60 %) |
| FSW used drugs before sex with male clients (among FSWs only, n = 212) | 63 (30 %) | – | – |
| “High” on drugs before/during sex with steady partner | – | – | 234 (55 %) |
| Drunk before/during sex with steady partner | – | – | 132 (31 %) |
| HIV and Sexually Transmitted Infections | |||
| HIV test result positive | 8 (3.8 %) | 3 (1.4 %) | 11 (2.6 %) |
| Chlamydia test result positive | 16 (7.5 %) | 9 (4.3 %) | 25 (5.9 %)* |
| Gonorrhea test result positive | 2 (0.9 %) | 3 (1.4 %) | 5 (1.2 %) |
| Syphilis test result positive | 3 (1.4 %) | 3 (1.4 %) | 6 (1.4 %) |
| STI/HIV-positive (any STI including HIV) | 27 (12.7 %) | 15 (7.1 %) | 42 (9.9 %) ** |
*p < 0.10, **p < 0.05, ***p < 0.01 (from logistic regression with clustered standard errors within couples)
aDyad average (uses information from both partners' responses within a given couple)
bSexual relationship power subscales
cConflict subscales (combined) for perpetrating or being the victim of psychological aggression, physical assault, injury, and sexual coercion within relationships
Full article at:
- 1Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
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