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. 

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