Mujer Mas Segura(Safer Women): a combination prevention intervention to reduce sexual and injection risks among female sex workers who inject drugs

Abstract

BackgroundFemale sex workers who inject drugs (FSW-IDUs) are at risk of acquiring HIV, sexually transmitted infections (STI) and blood-borne infections through unprotected sex and sharing injection equipment. We conducted a 2×2 factorial randomized controlled trial to evaluate combination interventions to simultaneously reduce sexual and injection risks among FSW-IDUs in Tijuana and Ciudad Juarez, Mexico.Methods/designFSW-IDUs ≥18 years reporting sharing injection equipment and unprotected sex with clients within the last month were randomized to one of four conditions based on an a priori randomization schedule, blinding interviewer/counselors to assignment. Due to the extreme vulnerability of this population, we did not include a control group that would deny some women access to preventive information. All women received similar information regardless of group allocation; the difference was in the way the information was delivered and the extent to which women had an interactive role. Each condition was a single 60-minute session, including either an interactive or didactic version of an injection risk intervention and sexual risk intervention. Women underwent interviewer-administered surveys and testing for HIV, syphilis, gonorrhea, Chlamydia, and Trichomonas at baseline and quarterly for 12 months. Combined HIV/STI incidence will be the primary outcome. Secondary outcomes are proportionate reductions in sharing of injection equipment and unprotected sex with clients.DiscussionOf 1,132 women, 548 (48.4%) were excluded (88.9% were ineligible; 11.1% refused to participate or did not return); 584 eligible women enrolled (284 in Tijuana; 300 in Ciudad Juarez). All 584 participants completed the baseline interview, provided biological samples and were randomized to one of the four groups. During follow-up, 17 participants (2.9%) were lost to follow-up, of whom 10 (58.8%) had died, leaving 567 participants for analysis. This study appears to be the first intervention to attempt to simultaneously reduce injection and sexual risk behaviors among FSW-IDUs. The factorial design will permit analysis to determine whether the combination of the two interactive interventions and/or its respective components are effective in reducing injection and/or sexual risks, which will have direct, tangible policy implications for Mexico and potentially other resource-poor countries.Trial registrationNCT00840658

Predictors of injection cessation and relapse among female sex workers who inject drugs in two Mexican-U.S. border cities

“…32,44,45 For FSW at the US-Mexico border, a large majority have dependent children and financial responsibilities for them has frequently been cited as a key reason for entering sex work. 36,48 Previous studies by our group suggest, however, that FSW-PWID are less likely to report living with their children than other FSWs, 19, 49 perhaps because they have been apprehended by child welfare agencies. The provision of child care and support for child custody may then be an important motivator for women to enter and stay in MMTPs or other harm reduction programs.…”

“…sex in the context of drug use and safer injection behaviors. 19,20 The study compared four brief, single-session conditions combining either an interactive social cognitive theory-based intervention using motivational interviewing techniques or a didactic version of a sexual risk intervention to promote safer sex in the context of drug use, and an injection risk intervention to reduce sharing of needles/injection paraphernalia. 20 From October 2008 to 2009, outreach workers recruited 584 FSW-PWID from venues frequented by FSW and PWID (e.g., motels, brothels, shooting galleries, bars, street corners).…”

Vulnerabilities faced by the children of sex workers in two Mexico–US border cities: a retrospective study on sexual violence, substance use and HIV risk

“…Juarez (N=628); details of sampling and recruitment have been published elsewhere (Strathdee et al, 2011; Vera et al, 2012). Eligibility criteria included being at least 18 years old, HIV negative (based on concurrent testing) and in the past month have a) exchanged sex for money, goods or drugs; b) injected drugs; c) had unprotected vaginal or anal sex; and d) shared needles/syringes or other injection paraphernalia.…”

Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial

“…171 One manuscript published in Chinese was excluded. 172 In total, 42 manuscripts from 32 trials were eligible, 22,[68][69][70][71][72][73][74][75][76][77][81][82][83][84][85] 41 originating from the electronic database searches, and one from hand-searching recent reviews and review of reviews 178 was added as a result of this process. Twenty-four trials were included in the meta-analysis.…”