Efficacy of a Brief Behavioral Intervention to Promote Condom Use Among Female Sex Workers in Tijuana and Ciudad Juarez, Mexico

Abstract

Objective To examine efficacy of a brief behavioral intervention to promote condom use among female sex workers (FSWs) in two Mexico-U.S. border cities. Methods 924 FSWs aged ≥18 years without known HIV infection living in Tijuana and Ciudad Juarez having recent unprotected sex with clients were randomized to a 30 minute behavioral intervention integrating motivational interviewing and principles of behavior change, or a didactic control condition. At baseline and six months, women underwent interviews and testing for HIV, syphilis, gonorrhea and chlamydia. Results Comparing intervention versus control groups, we observed a 40% decline in cumulative STI incidence (p=0.049). Incidence density for the intervention vs. control was 13.8 vs 24.92 per 100 person years (py) for STIs combined (p=0.034), and 0 vs. 2.01 per 100 py for HIV (p<0.001), with concomitant increases in total numbers and percentages of protected sex acts and decreases in total numbers of unprotected sex acts with clients (p<0.05). Conclusions This brief behavioral intervention shows promise in reducing HIV/STI risk behaviors among FSWs in two Mexican-U.S border cities, and may be transferable to other resource-constrained settings.

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

“…1 In both cities, sex work is quasi-legal, with an estimated 9000 female sex workers (FSW) in Tijuana and 4000 FSW in Ciudad Juárez, 2 which attracts large numbers of clients from the USA and elsewhere. Since the communities where sex work is tolerated overlap those with heavy drug use, a significant proportion of FSW inject drugs; in Tijuana and Ciudad Juárez, about 18 % of FSW report ever injecting drugs.…”

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

“…1 Although behavioral interventions have improved FSWs' condom use with male clients, [2][3][4][5][6] research from diverse settings suggests that 25-95 % of FSWs have non-commercial male partners with whom they are two to five times more likely to have unprotected sex compared with clients. [7][8][9][10][11][12][13][14][15][16][17] As in other intimate relationship contexts, unprotected sex is a normative part of FSWs' relationships despite FSWs' knowledge of their intimate male partners' sexual and drug-related risk behaviors for HIV/STIs.…”

“…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. 31 Although a behavioral intervention for FSWs in Tijuana and Ciudad Juarez successfully increased condom use with FSWs' male clients and reduced cumulative STI incidence by 40 % in the intervention group, 3 it did not target condom use within FSWs' non-commercial relationships. 32 Additional analyses revealed that, among FSWs with non-commercial partners, the majority (74 %) reported having unprotected vaginal sex with their partners even though half believed that their partners had outside sexual partners.…”

The Effect of Geography on HIV and Sexually Transmitted Infections in Tijuana’s Red Light District

“…However, nearly half are believed to work without permits. 2,3 Some studies have examined the role of space in shaping epidemics of HIV and sexually transmitted infections (STIs) among FSWs; 4,5 however, these findings do not generalize to settings where sex work is geographically concentrated within a formalized red light district. In a previous Tijuana study, a small number of bars accounted for a high proportion of HIV/STI prevalence among FSWs but excluded the large number of FSWs soliciting from public spaces, such as street corners.…”