Condom Access: Associations with Consistent Condom Use among Female Sex Workers in Two Northern Border Cities of Mexico

Abstract

To determine whether condom access is associated with consistent condom use among FSWs in Tijuana and Ciudad Juarez, between 2004 and 2006 we administered a questionnaire to 924 FSWs who reported unprotected sex with a client in the past two months. Of these women, 43% reported consistent ("often" or "always") condom use; 74% said condoms were available; and 38% reported having access to free condoms. In a logistic regression, factors positively associated with consistent condom use were condom availability (AdjOR = 2.00; 95% CI: 1.32-3.03), condom affordability (AdjOR = 1.72; 95% CI: 1.25-2.38) and self-efficacy (AdjOR = 2.16; 95% CI: 1.54-3.04). Factors inversely associated with consistent condom use included poor financial status (AdjOR = 0.65; 95% CI: 0.47-0.90), methamphetamine use (AdjOR = 0.58; 95% CI: 0.40-0.83), alcohol use (AdjOR = 0.68; 95% CI: 0.49-0.96), and recent injection drug use (AdjOR = 0.62; 95% CI: 0.39-0.97). While increased condom availability may improve condom use among FSWs in general, interventions to broaden condom use among lower-income and drug-using FSWs are critically needed. Keywordsfemale sex workers; condom use; prevention; HIV/AIDS; behavioral interventions; Mexico According to the United Nations Program on HIV/AIDS (UNAIDS), unprotected sex is the main vehicle of HIV transmission in Mexico and Latin America (Cohen, 2006;ONUSIDA, 2008). In 2008, the Mexican state of Chihuahua, where Ciudad Juarez is located, ranked fifth nationally with an HIV prevalence of 0.5%, while Baja California, where Tijuana is located, ranked 7th at 0.4%; both rates stand well above Mexico's national prevalence of 0.3% (CENSIDA, 2008 The sex work industry thrives in many cities of northern Mexico, with female sex workers (FSWs) frequently servicing clients from both the United States and Mexico. FSWs are considered a high risk group for acquiring and transmitting HIV (Jimenez, Lara, & Rosado, 2001;, and HIV prevalence among FSWs in the Mexico-U.S. border region is increasing. In 1997, only 0.6% of FSWs tested positive for HIV (del Rio & Sepúlveda, 2002); by 2008, 6.0% tested positive . Factors such as low socioeconomic status, migration, low education levels, drug use, and knowledge and perceptions about HIV and condom use all have been linked to risky sexual behaviors among FSWs (Basuki et al., 2002;Cohen, 2006;Dandona et al., 2005;Jimenez et al., 2001;Patterson et al., 2006b;Rhodes et al., 2007;Strathdee, Lozada, Semple, et al., 2008). However, condom access also plays a role, particularly in developing countries, because FSWs must have access to condoms in order to use them consistently (Morris, Morris, & Ferguson, 2009).Consistent condom use plays a vital role in preventing sexual transmission of HIV and has consequently become the primary focus of interventions targeting vulnerable groups such as FSWs (Cohen, 1999;Kayembe et al., 2008; ONUSIDA, 2001;Zhao, Wang, Fang, Li, & Stanton, 2008). In Mexico, the Secretariat of Health, through the national HIV/AIDS program, promotes condom use and ...

Prevalence and Correlates of HIV and Sexually Transmitted Infections among Female Sex Workers and Their Non-commercial Male Partners in Two Mexico-USA Border Cities

“…62 Methamphetamine abuse has been linked to risky sexual behaviors in a variety of settings, 63 and has been associated with HIV/STI positivity and inconsistent condom use among FSWs and male clients in our previous research. 26,28,45,64 Our findings imply that the association between methamphetamine abuse and HIV/STIs may also hold true for FSWs' non-commercial male partners. Effective drug treatment options, including programs that focus on stimulant abuse and co-occurring conflict within relationships, are needed in these cities in addition to more comprehensive programs that recognize and address the co-occurrence of stimulant abuse, violence, and sexual risk among socially marginalized couples.…”

“…26 Drug use, including injection drug use, which are increasingly common in this region due to "spillover" from trafficking routes, 27 further promote HIV/STI transmission by compromising FSWs' abilities to negotiate consistent condom use. 28 In these cities, FSWs' HIV positivity was associated with smoking, snorting, or inhaling methamphetamine and injecting cocaine, 26 and among FSWs who injected drugs, 72 % tested positive for at least one STI including HIV. 29 Our binational research team has estimated that more than one third of FSWs in the Mexico-USA border region have steady non-commercial partners, 30 and unprotected sex within these intimate relationships is twice as likely compared to commercial sex contexts.…”

Global epidemiology of HIV among female sex workers: influence of structural determinants

“…The authors of these studies examined how supportive venue-based policies 30, 32, 76, 77, 78, 79, 80, 81 or managerial practices (eg, client sign-in, safety mechanisms, or removal of violent clients) 48, 69, 76, 77, 80, 81, 82, 83, 84, 85 and physical features (eg, types or layout of venues) of sex work establishments are associated with increased condom use, often through synergistic effects with other social features of increased peer or sex worker support 32, 52, 53, 69, 72, 76, 79, 81, 83, 85, 86, 87, 88, 89, 90. Work environments for FSWs are shaped by economic features (eg, economic pressures, client financial incentives for non-condom use, refusal of payment, and bribes or fines by state agents [eg, police] to avoid arrest) resulting from macrostructural forces of poverty, laws, and access to resources and are associated with non-condom use27, 28, 29, 30, 40, 41, 48, 64, 70, 83, 84, 87, 91, 92, 93 and HIV infection among FSWs. 36, 65, 75, 94 Conversely, higher income and absence of economic dependence among FSWs mitigate HIV risks, including increased condom use 40, 48, 80, 86, 87 and lower HIV prevalence.…”

“…Where FSWs report adequate access to condoms, sexual health care (eg, STI testing and contraceptives) and HIV care (eg, HIV testing, ART, and sex worker-tailored clinics), increases are noted in condom use and reduced condom breakage, 39, 40, 32, 44, 47, 67, 79, 95, 96, 97, 98, 99 and lower HIV prevalence. 100, 101 Condom coverage must include condom access (eg, free or subsidised condoms at the workplace, the ability to carry condoms while working, and contact with peer condom distribution), availability and affordability, linked to reduced HIV acquisition and transmission among FSWs 25, 30, 39, 40, 44, 47, 68, 70, 79, 82, 84, 87, 93, 95, 97, 98, 99, 102, 103, 104, 105, 106, 107…”

Does Mass-Media Public Communication Campaign Normalize Discussion, Attitude and Behavior about Condom Use among Married Men in India?

“…In addition, a study among youth in urban Kenya suggests that both household and individual level measures of socioeconomic status are important correlates of condom use and that individual economic resources plays a crucial role in negotiations over the highest level of usage [41]. Similarly, in other studies of female sex workers and truckers, it shows that the poor financial status is inversely associated with consistent condom use [42,43].…”