Drug‐related behaviors independently associated with syphilis infection among female sex workers in two Mexico–US border cities

Abstract

AIMS To identify correlates of active syphilis infection among female sex workers (FSWs) in Tijuana and Ciudad Juarez. DESIGN Cross-sectional analyses of baseline interview data. Correlates of active syphilis (antibody titers >1:8) were identified by logistic regression. SETTING Tijuana and Ciudad Juarez, two Mexican cities on the U.S. border that are situated on major drug trafficking routes and where prostitution is quasi-legal. PARTICIPANTS 914 FSWs aged ≥18 years without known HIV infection who had recent unprotected sex with clients. MEASUREMENTS Baseline interviews and testing for syphilis antibody using Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) tests. FINDINGS Median age and duration in sex work were 32 and 4 years, respectively. Overall, 18.0% had ever injected drugs, 14.2% often or always used illegal drugs before or during sex in the past month, 37.7% had clients who injected drugs in the last 6 months, and 68.6% reported having clients from the U.S. Prevalence of HIV and active syphilis were 5.9% and 10.3%, respectively. Factors independently associated with active syphilis included injecting drugs (AOR: 2.39; 95% CI: 1.40, 4.80), using illegal drugs before or during sex (AOR: 2.06; 95% CI: 1.16, 3.65), and having any U.S. clients (AOR: 2.85; 95% CI: 1.43, 5.70). CONCLUSIONS Among female sex workers in Tijuana and Ciudad Juarez, drug-using behaviors were more closely associated with active syphilis than were sexual behaviors, suggesting the possibility of parenteral transmission of T. pallidum. Syphilis eradication programs should consider distributing sterile syringes to drug injectors and assisting FSWs with safer-sex negotiation in the context of drug use.

Analysis of duration of risk behaviour for key populations: a literature review

“…This period varied from 3.5 to 8.8 years according to the dataset, with a mean of 6 years and a median of 5.6 years, which would lead to a duration of risk behaviour between 11.2 and 12 years. [73][74][75][76][77][78][79] Three papers were found in North America, showing the duration of sex work up to the interview in median years. The median ranged from 5 to 6.4 years with a mean of 5.5 years and a median of 5.1 years.…”

HIV risk among female sex workers with different patterns of drug use behaviors in Southwest China: a cross-sectional study

“…Many researchers have suggested that women who were engaging in both commercial sex and drug use are more susceptible to infection of HIV and other sexually transmitted diseases (STD) because of the potentially synchronized effects of sexual risks and drug use behaviors (Lau et al, 2007; Loza et al, 2010; Medhi et al, 2012; Strathdee et al, 2001). For instance, the prevalence of HIV, syphilis and HCV among female sex workers (FSW) who were also drug users was as high as 2.0%, 18.6% and 32.4% respectively in a study conducted in China (Kwong-Lai Poon, Pui-Hing Wong, Sutdhibhasilp, Trung-Thu Ho, & Wong, 2012), which was much higher than that among general population of FSW(0.3%, 2.6%, and 0.8% in 2012, respectively) (Wang et al, 2014; Zhou et al, 2013).…”

Drug-Using Female Sex Workers and HIV Risk: A Systematic Review of the Global Literature

“…10, No. 5; played a more important role than sexual behavior in syphilis transmission among drug-using FSWs (Loza et al, 2010). Recreational drug use, both injection and non-injection, has been considered to be the greatest risk factor for HIV acquisition among FSWs in China Xu et al, 2008).…”

“…Researchers have increasingly paid attention to DU-FSWs because of the potentially enhanced effects of sexual risks and drug use behaviors (Baral et al, 2013;Malta et al, 2008;Tang et al, 2014;Loza et al, 2010;Lau et al, 2007;Strathdee et al, 2001). The overlap between illicit drug use and sex work has been identified as an important factor responsible for HIV prevalence among FSWs (Medhi et al, 2012), which would indicate double risk for DU-FSWs.…”